Issue link: https://www.massageandbodyworkdigital.com/i/494122
knee tension, hip placement, or weight shift in the feet. Have your client hyperextend and soften her knees a few times to compare the difference and appreciate its effects throughout her body. Take care that your client doesn't overcorrect and stand with bent (flexed) knees. Over-flexed knee patterns also place unnecessary strain on the body. Our goal is to help the client learn to find balance in standing by aligning the bones and recruiting only the appropriate postural muscles. Once your client has had a glimpse of this, it's time to take her new awareness to the table, where you will address the fascial patterns related to knee hyperextension. 2. Quadriceps: Knee Flexion Technique This technique is an excellent approach for releasing any fascial inelasticity and shortness in front of the leg that can contribute to knee locking. To perform this technique, have the client lie supine and slightly diagonally on the table, so the working leg hangs off the edge and bends at the knee (Image 5) without abducting the hip. Once in position, support her leg with your bottom hand under the femur. With the client's leg extended (straight), use a soft, open fist or sensing forearm to sink into the outer fascial layers just above the knee (Image 4). Angle your pressure superiorly, with the intention of freeing the fascia lata (the outer wrapping of the thigh) above the kneecap. As the tissue begins to soften, ask your client to slowly bend (flex) her knee, which encourages the tissue to lengthen. Keep sensing with your bottom hand and cue the client to move at a smooth, deliberate speed. Repeat a couple times at this layer, moving your position to address the tightest areas. On your next pass, gently sink deeper into the quadriceps femoris tendon (Image 6). In knee hyperextension, rectus femoris and vastus intermedius fascia are often shortened and undifferentiated. You can customize this technique to work 108 m a s s a g e & b o d y w o r k m a y / j u n e 2 0 1 5 wherever there is denser, inelastic tissue around the superior aspect of the knee. In people with a tendency toward anterior pelvic tilt, we commonly see internal rotation of the femurs. This may result in hard, tight tissue at the superior medial aspect of the patella. If needed, repeat the technique, focusing on vastus medius fascia at the knee. Although visually assessed hyperextended knees will most commonly show the tissue tension patterns described here, always retest the tissue itself by palpating it before working, and pay attention to your observations as you proceed. You might find denser or shorter tissue where you least expect it—this is the nature of compensatory myofascial patterns. Keep your awareness on the whole body, not just what you'd expect based on visual assessment. In addition to shortness in quadriceps, check for hypertonicity in the iliopsoas and gastrocnemius. Addressing any dorsiflexion restrictions in the ankles can help make repositioning the tibia easier as well (see "Working with Ankle Mobility," Massage & Bodywork, March/April 2011, page 110). 3. Homework As clients experience more ease in areas that are habitually tight, introduce movement reeducation homework, so they can practice on their own. Movement Reeducation Exercise A: Weight Shift Before your client leaves the session, return to the awareness exercise you began with, comparing locked and unlocked knees. Use the Quadriceps: Knee Flexion Technique to lengthen chronically short tissue that can maintain knee hyperextension. Starting with the client's leg in extension ( Image 4), use a soft, open fist to hook into tight areas in the superficial and then deeper fascial layers of the quadriceps complex. Cue the client to slowly flex the knee, allowing the myofascia to eccentrically lengthen. Images courtesy ActionPotential. 4 5