Issue link: https://www.massageandbodyworkdigital.com/i/494122
MYOFASCIAL TECHNIQUES • Have your client lock her knees again. Ask, "Where is the weight in your feet? Is it more toward your toes? Your heels? Or somewhere in between?" Knee hyperextension typically shifts weight either more forward or more back. • Then, suggest she unlock her knees. Ask, "Where is the weight now?" Usually it becomes more centered front to back. Movement Reeducation Exercise B: Kneecap Lifting • Teach the client to lift her kneecap by tightening her quadriceps. If the knee is hyperextended, she typically won't be able to lift the patella when standing, because the quadriceps will be already contracted. If this is the case, have the client soften her knee, and practice lifting the kneecap and releasing it. • Draw her attention to the proprioceptive sensations of this kind of movement, and of the details of standing in a way that makes it possible to lift and lower the kneecaps. Clients can do this throughout the day to retrain the tone in their quadriceps. Encourage clients to practice these techniques whenever they find themselves standing and waiting somewhere. Since the main purpose of these exercises is reeducation, rather than strengthening or stretching, even a little bit of practice can yield results. 4. Strength and Stability Training Now that we've addressed chronically short, tight areas with both myofascial work and movement reeducation, encourage clients to strengthen and stabilize any overstretched, weak areas. Knee- lockers generally need to improve their use of gluteal and transversus abdominis muscles. Additionally, strengthening thigh and leg muscles The four heads of the quadriceps femoris muscle converge as a tendon (green) on the superior patella. Use the Quadriceps: Knee Flexion Technique to work any areas of this tendon that feel hard or undifferentiated. Image courtesy Primal Pictures, used by permission. 6 often provides needed support to hypermobile knees. Whole- body exercises like single-leg bridge pose, planks, and stability exercises are ideal. Don't hesitate to refer clients to a qualified physical therapist or sports and conditioning trainer to help them strengthen appropriately, especially if there are any complications or special considerations relevant to exercise, such as additional musculoskeletal concerns or medical issues. SUMMARY Although hyperextended knee patterns often change slowly, addressing them in the ways described here will typically improve issues throughout the body. At first, clients may be surprised to find that standing with neutral knees actually takes a bit more effort than their old approach—certainly, it takes more awareness. But as we engage the whole person through a variety of sensory and motor activities in every step of this approach, clients can often find a softer, more supported posture that feels natural to them, and when they do, they'll appreciate the increase in available energy and comfort that comes from being able to rest into a balanced knee position. Notes 1. Katsuhiro Kawahara et al., "Effect of Genu Recurvatum on the Anterior Cruciate Ligament-Deficient Knee During Gait," Knee Surgery, Sports Traumatology, Arthroscopy 20, no. 8 (August 2012): 1,479–87. 2. Janice K. Loudon et al., "The Relationship Between Static Posture and ACL Injury in Female Athletes," Journal of Orthopaedic and Sports Physical Therapy 24, no. 2 (1996): 91–7. 3. Christopher Bellicini and Joseph G. Khoury, "Correction of Genu Recurvatum Secondary to Osgood-Schlatter Disease: A Case Report," The Iowa Orthopaedic Journal 26 (2006): 130–3. 4. M. Acasuso Díaz, E. Collantes Estévez, and P. Sánchez Guijo, "Joint Hyperlaxity and Musculoligamentous Lesions: Study of a Population of Homogeneous Age, Sex and Physical Exertion," Rheumatology 32, no. 2 (1993): 120–22; Lars-Goran Larsson, J. Baum, and G. S. Mudholkar, "Hypermobility: Features and Differential Incidence Between the Sexes," Arthritis & Rheumatism 30, no. 12 (1987): 1,426–30. Bethany Ward is a member of the Advanced-Trainings.com faculty, which offers distance learning and in-person seminars throughout the United States and abroad. She is also a Certified Advanced Rolfer, a faculty member at the Rolf Institute of Structural Integration, and past president of the Ida P. Rolf Research Foundation. Contact her via bethany@advanced-trainings.com or www.rolfusa.com. Til Luchau is a member of the Advanced-Trainings.com faculty. He is a Certified Advanced Rolfer and originator of the Advanced Myofascial Techniques approach. Contact him via info@advanced-trainings.com and Advanced-Trainings.com's Facebook page. His book Advanced Myofascial Techniques, Volume 1 has just been released, with Volume 2 slated for publication by the end of 2015. F r e e S O A P n o t e s w i t h M a s s a g e B o o k f o r A B M P m e m b e r s : a b m p . u s / M a s s a g e b o o k 109