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108 m a s s a g e & b o d y w o r k s e p t e m b e r / o c t o b e r 2 0 1 4 MYOSKELE TAL ALIGNMENT TECHNIQUES Dierks's research team confirmed that the application of specific hip strengthening exercises improved joint and muscle biomechanics and effectively reduced pain. As the legs were trained to move through a greater range of motion, the (pain) guarding mechanism was reduced, allowing greater coordination and control. According to Michael Fredericson, MD, orthopedic professor and team physician for the Stanford University track program, patellofemoral pain often originates in the hips. "Runners who have patellofemoral pain and IT-band problems are often weak in the hip abductors," Fredericson says. "Systematic strengthening of the hips can help alleviate and prevent pain." 3 Image 5 shows a simple corrective exercise to help activate weak hip abductors. GLOBAL ASSESSMENT IS KEY Whether the knee is a dumb joint, unable to determine its destiny, is debatable. However, we can say with certainty that it is a vital part of the kinetic chain and must be globally assessed to ensure a positive outcome. Take time to look above and below the pain site, examining the system as a whole. As author and physical therapist Gray Cook often says, "Treat the pattern, not the parts." Manual therapy, alongside a well- designed and executed corrective exercise program, will help keep your clients in the game. Ultimately, this treatment combo will improve movement pattern dysfunction and permit optimal functioning of the body's natural healing processes. Notes 1. Tracy Dierks et al., "Hip Strength and Hip Kinematics During Prolonged Running in Runners with Patellofemoral Joint Pain," Medical Science in Sports and Exercise 37, no. 5 (2005): 157–8; M. L. Ireland et al., "Hip Strength in Females with and without Patellofemoral Pain," Journal of Orthopaedic & Sports Physical Therapy 33, no. 11 (2003): 671–6; M. R. Prins and P. van der Wurff, "Females with Patellofemoral Pain Syndrome Have Weak Hip Muscles: A Systematic Review," Australian Journal of Physiotherapy 55, no. 1 (2009): 9–15; Frances Long-Rossi and Gretchen B. Salsich, "Pain and Hip Lateral Rotator Muscle Strength Contribute to Functional Status in Females with Patellofemoral Pain," Physiotherapy Research International 15, no. 1 (2010): 57–64. 2. Dierks et al., "Hip Strength and Hip Kinematics During Prolonged Running in Runners with Patellofemoral Joint Pain." 3. Michael Fredericson and Tammara Moore, "Muscular Balance, Core Stability and Injury Prevention for Middle- and Long-Distance Runners," Physical Medicine and Rehabilitation Clinics of North America 16, no. 3 (2005): 669–89. Erik Dalton is the executive director of the Freedom from Pain Institute. Educated in massage, osteopathy, and Rolfing, Dalton has maintained a practice in Oklahoma City, Oklahoma, for more than three decades. For more information, visit www.erikdalton.com. Grasp and lift the client's ankle and externally rotate the tibia. Ask the client to pronate the ankle against your resistance. As the client relaxes, mobilize the ankle joints into supination. ©erikdalton.com. Log Roll. Therapist's hands bring client's thigh fascia to first internal rotation barrier. Client externally rotates against therapist's resistance to a count of 5 and relaxes. Therapist brings femur to new internal rotation barrier. ©erikdalton.com. Therapist flexes and externally rotates client's tibia. Client gently extends the knee against therapist's resistance to a count of 5 and relaxes. Therapist brings tibia to new external rotation barrier. ©erikdalton.com. Client stands on weak abductor side (preferably on an unstable surface) to activate gluteus medius. ©erikdalton.com. 2 3 4 5