Massage & Bodywork

May/June 2012

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MEDIALLY AND LATERALLY SHIFTED KNEES I tend not to favor Latinate names for what can be explained in plain English, so using genu varus and genu valgus generally strikes me as a cheap and not very helpful way of separating me from the client and the client from his experience. The phenomenon of medially and laterally shifted knees—which actually can involve several underlying patterns of relationship—is easily understood: when you bring your feet slowly together, either the ankles touch first and there is space between the knees (Image 3A), or the knees touch first while there is still space between the ankles (Image 3B). If they both contact more or less simultaneously, the knee position is neutral. Mild discrepancies in either direction are not clinically 3 significant (but why not correct them while they still are mild?), while larger differences put significant strain on the cartilage of one condyle or another, as well as the knee ligaments. This also creates muscle imbalance. Because these patterns vary in femoral rotation, knee twist, and weight bearing on the foot, I leave you to work out the muscular details for each case. Fascially speaking, the general approach is simple: where you see a bow, look for the bowstring and ease it (Image 3C). For knock-knees, no matter how much strain or pain is on the inner knee, the fascia is short and tight on the outer side of the leg (i.e., the Lateral Line). For bowlegs, the bowstring is along the inside of the leg. Therefore, look to fascial lengthening along the DFL—all the way from the ankle to the ischiopubic ramus and even the pelvic floor. Laying your client on her side and easing the fascia all along the inside of the leg—and doing this for a few minutes over several sessions is usually necessary—eases that tight bowstring and gives room for the bones to move medially. THE ADDUCTOR COMPARTMENT Together, the adductors form a triangular prism shape on the inside of the thigh. In my opinion, the adductors are everyone's friend: they can be involved in both hip flexion and extension, and (this is more controversial) medial and lateral rotation, as well as adduction. For certain, they are major hip stabilizers in most actions. Among many other muscle- specific issues, it is worth observing whether the fascial compartment as a whole has moved either forward or back. Observe your client from the front and from behind, with this question in mind: can I see more of the adductor compartment from the front or the back? More prominence in the back often goes with medially rotated femurs and/or an anterior tilt of the pelvis (Image 4A). When the adductors are C A Obvious in the legs (but still not widely practiced because of our muscular orientation over the fascial point-of-view), the long bowstrings of myofascia, when overly short, push the bones one way or the other. B 100 massage & bodywork may/june 2012

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