Issue link: https://www.massageandbodyworkdigital.com/i/68173
your way up slowly until you are on the injured portion of the tendon. Now, place your index and middle finger on the injured structure, move across the tendon at a 90-degree angle with moderate pressure, and then move back to your original position with no force. After you have frictioned in this manner for five minutes, take a break, followed by another five minutes of friction. This treatment should cause mild discomfort, but no pain. It is normal for the client to be sore for 24–48 hours following the treatment, but if the discomfort lasts longer than that, you have used too much pressure. Go lighter the next time. Location and friction of the adductor tendon body and muscle belly. Perform the palpation testing described earlier to locate the painful area(s). There will often be one primary area of pain and one or two secondary areas. Using the pads of your fingers, move through the muscle belly structure at a 90-degree angle, using moderate pressure. Apply pressure repeatedly in one direction for five or six minutes, take a short rest, and then repeat. Location and friction of the pectineus at the pubis. After obtaining permission from the client to work in this sensitive area, use the tips of your middle three fingers to apply friction along the broader bony attachment to the lateral edge of the pubic bone. Apply pressure in one direction for only five or six minutes, then rest and repeat. MaSSage TheraPy Massage the entire thigh, anterior and posterior, accenting the adductors on the medial aspect. Be sure to include some transverse massage on the adductors as well. Also, work the entire kinetic chain, including the lower leg and the buttock. exercISe PrOgraM The exercise program for the adductors has five steps and should be done daily for six to eight weeks, or until the client is pain-free for two weeks. Give your client the following instructions: 1. Warm up the leg for two to three minutes, either walking or swinging the leg from side to side. 2. Lie on your back, bend your knee, and place your hand on the inner surface of the knee. Allow the leg to open out to the side and stretch gently for 20–30 seconds. You should feel only a slight pull; use no extra force beyond the weight of the leg. Rest the leg for a moment and repeat four more times. 3. Lie on your side with the injured leg on the bottom and bend the top leg, placing that foot on the floor in front of the other knee. Lift your bottom leg off the floor about 8–10 inches, and then lower it so that it is an inch above the ground. Repeat this 10 times. Now lower the leg to the ground for a brief rest. Repeat this action for three sets of 10 repetitions. The goal is to feel fatigue at some point in the last set of 10 repetitions. If you do not feel any fatigue, add a 1-pound ankle weight. Continue with the same amount of weight for a week or so. When the exercise no longer creates fatigue, increase the weight by half a pound or a pound and proceed for another week. Continue increasing the weight until you can do the exercise with the same amount of weight on your injured leg as on your uninjured leg (a minimum of 8 pounds). If you feel fatigue in the first or second set of 10 before you add any weight, modify the exercise by bending your knee to a 90-degree angle. It is much easier to raise the thigh without the weight of the lower leg. As you get stronger, straighten the leg a little bit more each week. 4. Repeat the stretch from Step 2. 5. Place an ice pack or heating pad on the injured area for five minutes. Be sure to educate the client about the importance of regular exercise, including a warm-up procedure, stretching, and strengthening of not only the adductor muscles (which have likely atrophied), but also the hamstrings, abductors, and quadriceps muscles. All three types of exercise are important for maintaining the health of the thigh, and should be done at least three times a week. SAFETY IN STRENGTH For athletes who perform any sport or other activity that involves running, having very strong adductors is an absolute necessity. The average person should be strong enough to do whatever he or she wants to do in life, plus a bit of extra strength. Flexibility is also extremely beneficial. Regular stretching that achieves maximum flexibility in the thigh gives protection against future injuries to the thigh and to the low back as well, making it an excellent investment in the continuing health of the lower body. education and sports medicine. He is founder of the Muscular Therapy Institute. Benjamin has been in private practice for more than 45 years and has taught communication skills as a trainer and coach for more than 25 years. He teaches extensively across the country on topics including SAVI communications, ethics, and orthopedic massage, and is the author of Listen to Your Pain, Are You Tense? and Exercise Without Injury, and coauthor of The Ethics of Touch. He can be contacted at 4bz@mtti.com. Editor's note: Massage & Bodywork is dedicated to educating readers within the scope of practice for massage therapy. Essential Skills is based on author Ben E. Benjamin's years of experience and education. The column is meant to add to readers' knowledge, not to dictate their treatment protocols. connect with your colleagues on massageprofessionals.com 95 Ben E. Benjamin, PhD, holds a doctorate in