Issue link: https://www.massageandbodyworkdigital.com/i/494122
F r e e S O A P n o t e s w i t h M a s s a g e B o o k f o r A B M P m e m b e r s : a b m p . u s / M a s s a g e b o o k 107 likely feel tissue tension in this area. If you try to gently push the knee more posteriorly, you will sense immediate resistance. Keep in mind that locked knees don't occur in isolation. They undermine support of structures above, and increase load on areas below. As mentioned, in a neutral leg position, the head of the trochanter, the head of the fibula, and the lateral malleolus are vertically aligned. In a locked knee posture, we often see a tendency toward anterior pelvic tilt, internally rotated femurs, knee hyperextension, and sometimes, limited ankle dorsiflexion. Working with chronically hyperextended knees is a multidimensional task, since it means addressing short and tight structures, overstretched structures, and habitual postural patterns. We find we are most effective when we use a four-pronged approach: 1. Client awareness 2. Myofascial techniques 3. Homework 4. Strength and stability training 1. Client Awareness Clients can't change what they don't understand. Once you observe knee hyperextension, have your client observe her stance side- view in a mirror. Draw her attention to the reduced curve of one or both knees. To help her feel the difference between a locked and neutral knee, ask her to intentionally lock out her knees and notice the tension on the back of the knee. Then ask her to just barely unlock her knees. Other effective cues might be, "Back off just enough to reduce the tightness in the back of your knees," or, "Let your knees breathe." Ask your client to describe the difference between the locked and balanced positions. Clients often describe changes in Compared to the more neutral knee (right), the locked knee (left) appears to bow or bend backward. Image redrawn from somastruct.com. In the neutral leg on the right, the lateral malleolus, fibular head, and head of the trochanter are vertically stacked and self-supporting. The leg on the left shows how knee hyperextension requires soft-tissue changes and undermines whole-body support. Image redrawn from somastruct.com. 2 3 Watch Til Luchau's technique videos and read his past Myofascial Techniques articles in Massage & Bodywork's digital edition. The link is available at www.massageandbodywork.com, www.abmp.com, and on Advanced-Trainings.com's Facebook page. "Working with Clients' Locked Knees"