Massage & Bodywork

NOVEMBER | DECEMBER 2019

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3 4 5 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 . 97 The Modified McMurray is a pain provocation test that helps determine if either the lateral or medial meniscus is at risk. The Apley Compression Test is positive if the client reports discomfort when the tibia is internally and externally rotated under moderate compression. The Joint Line Pain Provocation Test is positive if the client reports tenderness as the thumbs compress both lateral and medial menisci while the knee is slowly flexed. dramatically—especially with the addition of a thorough clinical background history. Modified McMurray The Modified McMurray is a pain provocation test that helps determine if either the lateral or medial meniscus is at risk. Notice in Image 3 how the hip and knee are flexed at 90–90 with my left thumb compressing the lateral meniscus and my index finger compressing the medial meniscus at the tibiofemoral joint line. As my hands slowly take the tibia from a position of abduction and external rotation to adduction and internal rotation (valgus knee position), if the client reports discomfort or clicking along the lateral meniscal border, I make note that the McMurray is positive on that side. Conversely, if the pain occurs as I bring the knee into abduction and external rotation (varus knee position) Watch "McMurray Test" and the client reports discomfort or clicking laterally, the test is positive for possible medial meniscus damage. Apley Compression Test Shown in Image 4, the Apley Compression Test is performed with the client prone. A positive test result is the production of deep pain or joint line tenderness when the client's tibia is internally and externally rotated under moderate compression. If the client complains of discomfort during internal tibial rotation, the test is positive for medial meniscus damage and vice versa. Joint Line Pain Provocation Test In the Joint Line Pain Provocation Test (Image 5), the prone client's knee and hip are flexed to 90–90 with the client's left ankle resting on my right shoulder. To test both menisci at the same time, my thumbs compress the tibiofemoral joint line bilaterally while the client's knee is slowly flexed. If the client reports tenderness on the lateral side during knee flexion and thumb compression, the test is positive for that side and vice versa. During your intake evaluation, take time to look above and below the affected knee and examine the client's system as a whole. As physical therapist and orthopedic- certified specialist Gray Cook says, "Treat the pattern, not the pain." Ultimately, a thorough assessment will help pinpoint the appropriate treatment protocol. I've found that manual therapy, along with a well- designed and executed corrective exercise program, can improve movement pattern dysfunctions and enhance the body's natural healing processes. Erik Dalton, PhD, is the executive director of the Freedom from Pain Institute. Educated in massage, osteopathy, and Rolfing, he has maintained a practice in Oklahoma City, Oklahoma, for more than three decades. For more information, visit www.erikdalton.com.

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