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Ta k e 5 a n d t r y A B M P F i v e - M i n u t e M u s c l e s a t w w w. a b m p . c o m / f i v e - m i n u t e - m u s c l e s . 95 to compressive or tensile stress during active knee flexion. In active knee flexion we are looking at: • Knee (joint region) • Flexion (specific motion being tested) • Active movement (type of motion) The evaluation results are shown in Table 2. Now we have an idea of the various biomechanical stresses on several specific tissues during active knee flexion. This information will help us consider whether any of those tissues might be contributing to our client's current complaint. Having some knowledge of potential causes of knee pain in various motions will help us consider whether any of these patterns seem likely for our client. Additional Regions of Pain and Possible Causes We can take this evaluation one step further by using another visual reference that shows several possible causes of pain in a particular region, with a particular motion, when it is performed either actively, passively, or resisted. Sticking with our previous example of active knee flexion, here's what that might look like, as illustrated in Table 3. Application of Evaluation Using Table 3 as an example, let's say that our client complained of anterior knee pain. In that case, we would be most interested in the possible causes of pain found in the first column under "Anterior Knee." In this first column, we can see there are two primary factors that are likely to cause anterior knee pain during active flexion. First, the distal quadriceps retinacula and patellar tendon are being pulled— especially near the end range—and there are compression forces on the underside of the patella that may also be a primary factor. Now that we have this information, we can cross-reference it with findings from other aspects of the assessment process and increase our accuracy in identifying tissues involved in the client's complaint. ASSESSMENT BIOMECHANICS: EFFICIENCY, UNDERSTANDING, AND CONFIDENCE Applying a system of assessment biomechanics can streamline your assessment process and make your evaluation much more efficient. It also produces a much better understanding of particular tissues involved in your client's condition, so you can choose the most effective treatment strategies. There is also an important underlying factor of this type of detailed assessment, which is often underappreciated. Performing a detailed physical examination can boost your client's confidence in your skills—an increased confidence that greatly contributes to your treatment success! Note 1. This article is an excerpt from the upcoming 2nd edition of Orthopedic Assessment in Massage Therapy, which is due out in early 2020. Whitney Lowe is the developer and instructor of one of the profession's most popular orthopedic massage training programs. His text and programs have been used by professionals and schools for almost 30 years. Learn more at 3 Flexion AROM Anterior Knee Posterior Knee Medial Knee Lateral Knee Anterior Thigh Posterior Thigh Possible Cause of Pain • Distal quadriceps, retinacula, or tendon injury being pulled. Pain increases toward end range • Compression of patella against femoral condyles (at end range) when there is damage to underside of patella (chondromalacia patellae) • Presence of fluid, such as Baker's cyst • Muscle dysfunction or injury in distal hamstrings or proximal gastrocnemius • Ligament injury to primary posterior stabilizing ligaments (due to compression) • Medial collateral ligament injury • Distal adductor muscle attachments irritated during movement • Lateral collateral ligament injury • Iliotibial band rubbing over femoral lateral epicondyle • Quadriceps muscle strain—muscles are pulled at end range of flexion • Myofascial trigger points in quadriceps muscles (mostly at end range) • Muscles that produce active knee flexion being overloaded Additional Regions of Pain and Possible Causes CLINICAL E XPLORATIONS

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