Massage & Bodywork

July | August 2014

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Flexion Extension I t p a y s t o b e A B M P C e r t i f i e d : w w w. a b m p . c o m / g o / c e r t i f i e d c e n t r a l 105 MENISCI MOTION The knee is a double condyloid joint with two distinct sides padded by large, fibrocartilage disks called menisci. The main function of the menisci are to seat and stabilize the femoral condyles to prevent them from sliding or rolling off the horizontal tibial plateau during joint motion. Each meniscus is anchored to the tibia by two ligaments, one at each of its open ends or "horns," which allows a small amount of motion. The slight mobility of the menisci allows them to stay under the femoral condyles as the condyles rotate along a migrating axis. Each meniscus moves independently. The lateral meniscus can glide forward and backward twice as far as the medial meniscus, about 12 millimeters. The disks also pivot like cogwheels, counter- rotating in an outward and backward direction during knee flexion and reversing the pathway during extension (Image 3). The crushing forces of the condyles deform the menisci, pressing them across the tibia like a pestle pressing a dried apricot across a mortar. If the menisci follow an ideal pathway of motion, they will remain under the condyles throughout range of motion. If a meniscus fails to shift position quickly enough, it can be ruptured or crushed under the pressure of the femoral condyle. A torn meniscus can no longer follow a normal movement range and loses its ability to absorb compressive load. When working with clients with knee injuries or symptoms, always start by determining if passive knee motion is contraindicated. You can assess patellar and meniscus tracking patterns by palpating these structures as your client moves the knee. Menisci motion is subtle and difficult to detect, but with practice, it can be perceived during palpation. Keep in mind that damaged cartilage is susceptible to reinjury, so when passively moving your client's knees, make sure to move each joint slowly, with attention to tracking patterns. Next Issue: The Foot & Ankle Exploring Technique Tracking Motion in the Menisci To explore meniscal movement in your own knee: 1. Palpate both menisci on one knee, along the joint line on the sides of your knee, anterior to the collateral ligaments (A). Note any soreness, which may indicate a poorly tracking disk. 2. Firmly press your fingers into both menisci of one knee and hold them while slowly flexing and extending your knee (B). Repeat several times until you can feel the motion pattern of each meniscus. The motion will be minimal and difficult to perceive. 3. To encourage the normal movement of the menisci, press them slightly forward as you extend your knee; press them slightly backward as you flex your knee. Make sure to press both menisci at the same time, as if you were turning two cogwheels together. 4. After you track one knee, get up and walk around. Notice whether it feels any different from the other knee, then repeat these steps on the other knee. B Mary Ann Foster is the author of Therapeutic Kinesiology: Musculoskeletal Systems, Palpation, and Body Mechanics (Pearson Publishing, 2013). She can be contacted at 3 Pathways of menisci motion. Extension Flexion A Flexion Extension

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