Massage & Bodywork

July | August 2014

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100 m a s s a g e & b o d y w o r k j u l y / a u g u s t 2 0 1 4 An orthopedic surgeon referred Patrick for massage treatment for a very painful and debilitating knee injury, in hopes of avoiding an invasive surgery. Patrick's injury would usually fall outside the scope of massage treatment but demonstrates how massage can be used for advanced injuries in a cooperative health-care relationship with a physician. In addition, this case illuminates the role of clinical reasoning. technique CLINICAL APPS Patrick's Quadriceps Tear By Whitney Lowe Patellar retinaculum Musculotendinous junction between the distal quadriceps and patellar retinaculum. Copyright Primal Pictures Ltd., 1 The problem began several weeks earlier when Patrick slipped on his apartment stairs. He used his right leg to catch himself, placing a sudden, intense load of his whole body weight on one lower extremity. He felt a sudden and excruciating pain around his right knee as he fell to the ground. Knowing he had injured it badly, he immediately iced the area. The next day there was signifi cant bruising in his distal anterior thigh, a great deal of pain and swelling around his knee, and very limited motion. He went to the doctor and was diagnosed with a distal quadriceps tear. Further investigation showed the exact site of the tear was the musculotendinous junction between the distal quadriceps and the patellar retinaculum (Image 1). Patrick was advised to rest the leg for several days until the acute infl ammatory stage had subsided, then to begin gentle movement and stretching. He continued to have considerable range-of-motion restriction and serious pain. Three to four weeks postinjury, a signifi cant mass of scar tissue had developed in his distal thigh around the site of the tear. Patrick's orthopedist was concerned that if this scar tissue was not reduced, regaining range of motion in the knee would be extremely diffi cult. At this point, Patrick was referred to massage treatment to see if it was possible to avoid surgery. In Patrick's history, he shared that he had been a competitive bodybuilder who had previously used anabolic steroids. One of the known side effects of anabolic steroid use is gradual weakening of connective tissue. Thus, it is likely that steroid use weakened his quadriceps muscles and retinacular tissues so that when they were overwhelmed by this accident, the tissues tore.

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