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ESSENTIAL SKILLS For a video demonstration of proper squat and lunge techniques, visit www.benbenjamin.com/Squats and www.benbenjamin.com/Lunges. this weakening is a slow process, a person can overstretch for years before getting this injury. When stretching properly, the pull should be felt in the muscle, not the tendon. Climbing or hiking down steep hills or mountains, especially where the terrain is gravelly or slippery, can cause the front thigh to contract suddenly to prevent a fall and thus become injured. The mechanics of injury are this: as you start to slip or begin to fall, the quadriceps contract so severely that it causes either a massive tear throughout the muscle, or a tear in the tendon. In cases where the tear is severe, walking becomes painfully diffi cult and running becomes impossible. In milder cases, walking feels all right, but lifting the leg straight up in front or doing a single leg lift from a lying-down position is quite painful. INJURY VERIFICATION TESTS Resisted Extension Supine With the client lying supine, stand at the side of the knee. Slip your headward hand under the knee closest to you, placing it on the other thigh just above the knee. Place your footward hand on top of the ankle and grasp it fi rmly. Now, ask the client to try to straighten the leg as you resist with equal force. Resisted Extension Supine Test. Resisted Extension Off Table (Sitting) Have the client sit at the edge of the table with the knee at a 90-degree angle. Kneel in front of their knee and place your hands around the anterior ankle. Now, ask the client to try to straighten the leg as you resist with equal force. Use this position as a second test if the fi rst one causes no pain or if the person is very strong and overpowers you. Resisted Extension Sitting Test. TREATMENT CHOICES Friction Therapy For injuries to the tendon at the top of the thigh, friction therapy is effective. Because this area is commonly very sensitive, and the tendon is deep, the hip and knee must sometimes be bent at a 90-degree angle in order to access the area. First, let me describe how to treat the tenoperiosteal junction, which is the most commonly injured section of the tendon where it attaches to the bone. With the knee bent and the foot on the table, place the tip of your index fi nger on the ASIS. Now, move your fi nger inferior about one inch until you are over the AIIS. Ask your client to lift her foot an inch or so off the table so that the muscle will contract. This will help you trace the tendon up to the attachment site. With your fi nger pressing against the bone, perform the friction motion medially and laterally, applying pressure in one direction only. This treatment can be performed either with the hip fl exed 108 massage & bodywork january/february 2012