Massage & Bodywork

March/April 2013

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@work Anterior Cruciate Ligament Sprain The anterior cruciate ligament (ACL) is one of the most frequently injured ligaments of the knee. A closer look at the biomechanical function of the ACL illustrates why injury here occurs so frequently in the military and with other physically active individuals. The ACL attaches to the posterior aspect of the femur and the anterior surface of the tibial plateau (Image 3). Its primary biomechanical function is to prevent forward translation of the tibia in relation to the femur. It is also involved in preventing excessive rotational movements between the tibia and femur. When an individual lands from a jump or attempts to decelerate the body, such as when going down a hill, the quadriceps muscles, which attach on the anterior tibia, contract strongly to decelerate forward motion. When they contract to decelerate motion, they pull the tibia in an anterior direction. Their direction of pull is the direction of force the ACL is attempting to resist. A strong and forceful contraction of the quadriceps in decelerating forward motion can be enough to overstretch or tear the ACL. The greater the velocity or distance traveled prior to deceleration, the greater is the quadriceps contraction. When you add the excessive weight many soldiers carry, the forces the ACL must resist are great, which leads to many ACL injuries. Massage can play an important role in ACL rehabilitation. While the ACL is deep within the knee joint and not accessible to palpation, one of the key factors that stresses the ACL is quadriceps pulling, and massage can be very helpful in reducing excess hypertonicity and tensile loads in the quadriceps muscle group during ACL rehabilitation. Hamstring strengthening is also important during rehabilitation as the hamstrings provide additional stability for the ACL while it is in a weakened state. The hamstring muscles have an angle of pull that aids the ACL in producing knee stability. For those Who give so much Clearly, there are far more soldier injuries than these three lower-extremity conditions. And in many of those other conditions, such as low-back complaints, massage could prove very useful for injury prevention and rehabilitation. While there are some facilities that include massage as a treatment modality for soldiers, for the most part it is left out. One of the arguments against massage is that soldiers might find that it feels good, and therefore would want to use it more. No doubt! Feeling good can be one of the best things there is for improved function. But massage is more than a feelgood therapy. It produces (sometimes extensive) tissue changes and is proven to be so effective that professional sports teams use it regularly. If a modality is accepted and provided to our professional athletes, isn't it only fair that those who are voluntarily contributing to our country are also given these benefits? 3 ACL Cross-section of the knee showing the anterior cruciate ligament. 3D anatomy images. Copyright of Primal Pictures Ltd. www.primalpictures.com. Note 1. US Army, "Injuries: The Modern Military Epidemic," accessed February 2013, www.army.mil/article/25626/ Injuries_the_modern_military_epidemic. 2. US Medicine, "Human Performance Optimization Used to Prevent Common Injuries in Troops," accessed February 2013, www.usmedicine.com/articles/ human-performance-optimization-used-to-preventcommon-injuries-in-troops.html#.UN44fW9TySp. 3. Army Times, "Report: Combat Soldiers Carry Too Much Weight," accessed February 2013, www.armytimes.com/news/2011/02/ap-reportsoldiers-carry-too-much-weight-021411. 4. K.G. Hauret et al., "Musculoskeletal Injuries Description of an Under-Recognized Injury Problem Among Military Personnel," American Journal of Preventive Medicine 38, no. S1 (2010): S61–70. 5. J. Fairclough et al., "The Functional Anatomy of the Iliotibial Band During Flexion and Extension of the Knee: Implications for Understanding Iliotibial Band Syndrome," Journal of Anatomy 208, no. 3 (2006): 309–316. Whitney Lowe is the author of Orthopedic Assessment in Massage Therapy (Daviau-Scott, 2006) and Orthopedic Massage: Theory and Technique (Mosby, 2009). He teaches advanced clinical massage in seminars, online courses, books, and DVDs. Contact him at www.omeri.com. www.abmp.com. See what benefits await you. 109

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