JW LowerExtremity

Integrated Manual Therapy & Orthopedic Massage For Complicated Lower Extremity Conditions
Assessment Protocols
Treatment Protocols
Treatment Protocols
Corrective Exercises
Artwork and slides taken from the book Clinical Massage Therapy: A Structural Approach to Pain Management Published by Pearson Education
By Author & International Lecturer James Waslaski LMT, CPT
Integrated Manual Therapy & Orthopedic Massage For Complicated Lower Extremity Conditions
Todays manual therapist needs to have multiple skills in order to address a wide variety of complicated musculoskeletal pain conditions. Specialization in just one modality is becoming a thing of the past because of limited patient outcomes. This unique total system consists of orthopedic assessment, clinical reasoning, multidisciplinary and multimodality therapies, and precise corrective stretching and strengthening exercises. Participants will learn to integrate the skills of leading practitioners from the fields of massage therapy, physical therapy, athletic training, personal training, osteopathic and chiropractic to restore balance, posture, function and pain free living. Recent clinical studies will forever change the way manual therapists look at musculoskeletal pain, muscle-tendon strain pain, and adhesive capsular pain. This seminar will teach manual therapists to address clinical conditions of the lower extremity such as hyperpronation, excessive supination, Achilles tendinosis, plantar fascial pain, tarsal tunnel syndrome, posterior tibial stress syndrome, anterior lateral compartment syndrome, fixated ankle joints, joint arthritis, mortons neuroma, bunions, hammer toes, flat feet, and ankle sprains and strains. Corrective stretching and strengthening techniques will be also taught to keep the muscles balanced, and joints aligned for pain free living. Twelve Steps: 1. Client History 2. Assess Active Range of Motion 3. Assess Passive Range of Motion 4. Assess Resisted Range of Motion 5. Area Preparation 6. Myofascial Release/ Compression Broadening 7. Cross Fiber Gliding/Trigger Point Therapy 8. Multidirectional Friction 9. Pain Free Movement 10. Eccentric Scar Tissue Alignment 11. Stretching 12. Strengthening James Waslaski is an Author & International Lecturer who teaches approximately 40 seminars per year around the globe. Hes served as AMTA Sports massage Chair and FSMTA Professional Relations Chair. Hes developed 8 Orthopedic Massage and Sports Injury DVDs, and authored manuals on Advanced Orthopedic Massage and Client Self Care. His new book, Clinical Massage Therapy: A Structural Approach to Pain Management was published by Pearson Education in 2011. James presents at state, national and international massage, chiropractic, and osteopathic conventions including keynote addresses at the FSMTA, World of Wellness, New England Regional Conference, the World Massage Festival, and Australian National Massage Conventions. His audience includes massage and physical therapists as well as athletic trainers, chiropractors, osteopaths, nurses and physicians. He is a certified personal trainer with NASM. James received the 1999 FSMTA International Achievement Award and was inducted into the 2008 Massage Therapy Hall of Fame. www.orthomassage.net
8/3/2013
CLINICAL MASSAGE THERAPY

A Structural Approach to Pain Management
Chapter Outline
Twelve-Step Approach to Lower Leg, Ankle, and Foot Conditions Achilles Tendinosis Gastrocnemius Protocol to Address Achilles Tendon Pain Soleus Protocol Posteromedial Shin Splints
CHAPTER
Lower Leg, Ankle, and Foot Conditions
Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski
Chapter Outline
Flat Feet and Fallen Arches and Hyperpronation Plantar Fasciitis Anterior Compartment Syndrome (ACS) Anterolateral Shin Splints Inversion Ankle Sprain and Strain Stress Fracture
Learning Objectives
Choose the appropriate massage modality or treatment protocol for each specific clinical condition of the lower leg; Based on restoring normal range of motion throughout the body, and normal muscle resting lengths
Learning Objectives
The focus is to work on the contracted muscle groups typically short and gastrocnemius, soleus, and tiblialis posteriorbefore working on the weak, inhibited antagoniststibialis anterior, extensor digitorum longus, extensor hallucis longus, and peroneals
Learning Objectives
This will ensure
Structural integrationbalance of the opposing muscle groups That the therapist eliminates the underlying soft-tissue cause of the lower leg conditions before addressing the clinical symptoms
Restore pain-free ankle joint normal range of motion Create ankle stability
8/3/2013
Learning Objectives
Differentiate between soft-tissue problems caused by
Myofascial restrictions Muscletendon tension Trigger point tension Strained muscle fibers Sprained ligaments Nerve compression Bony fixations
Learning Objectives
Teach the client self-care stretching and strengthening exercises (if needed) to perform at home to maintain musculoskeletal balance and pain-free movement following therapy
Figure 4-1
Lower Leg Muscles
Figure 4-2
Ankle Plantar Flexion, 3050 Degrees.
Figure 4-3
Ankle Dorsiflexion, 2030 Degrees.
Figure 4-5 Ankle Eversion at Subtalar Joint 1520 Degrees.
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Figure 4-5 Ankle Eversion at Subtalar Joint 1520 Degrees.
Figure 4-16A
Muscle Resistance Test, Soleus.
Figure 4-6
Myofascial Spreading, Gastrocnemius.
Figure 4-7
Compression, Gastrocnemius.
Figure 4-8 Cross-Fiber Gliding Strokes and Trigger Point Work, Gastrocnemius.
Figure 4-9A
Arthrokinetics, Compression.
8/3/2013
Figure 4-9B
Arthrokinetics, Decompression.
Figure 4-10
Gastrocnemius Stretch.
Figure 4-13
Myofascial Release of Soleus.
Figure 4-14
Ankle Distraction and Traction.
Figure 4-15
Soleus Stretch.
Figure 4-16A
Muscle Resistance Test, Soleus.
8/3/2013
Figure 4-16B
Multidirectional Friction, Soleus.
Figure 4-17
Eccentric Muscle Contraction, Soleus.
Figure 4-18B
Myofascial Release, Right Achilles Tendon.
Figure 4-19
Tibialias Posterior Review.
Figure 4-21
Myofascial Release, Tibialis Posterior.
Precautionary Note
There is an accupressure point approximately four fingers above the medial malleolus and a reflexology point between the malleolus and calcaneus. Avoid direct pressure on these areas on pregnant women.
8/3/2013
Figure 4-22
Posterior Tibialis Stretch.
Figure 4-25 Compression and Myofascial Spreading, Foot Muscles.
Figure 4-26 Massage Intereoseus Membrane Using Long Bones of Foot.
Figure 4-29
Bunion.
Figure 4-28A
Arthrokinetics, Gentle Compression.
Figure 4-28B
Arthrokinetics, Traction.
8/3/2013
Figure 4-23 Plantar Fascial Pain is not usually red, swollen and inflamed.
Figure 4-27 Stretch Muscles and Plantar Fascia of the Foot by Extending the Toes.
Figure 4-24 Muscle Resistance Test for Plantar Fascial Strain.
Figure 4-32 Multidirectional Friction, Plantar Fascia Strain.
Figure 4-33 Eccentric Muscle Contraction, Plantar Fascia Strain.
Precautionary Note
When you take a clients ankle out of inversion and plantar flexion, this may lower the arch and change the foot strike. For clients who wear hard orthotics in their shoes, this can create increased pressure on the plantar fascia. Make sure they are aware of this and consult their podiatrist.
8/3/2013
Figure 4-35 Muscle Resistance Test on Anterior Compartment Muscles.
Figure 4-34
Anterior Compartment Muscles.
Figure 4-36
Retinaculum Release.
Figure 4-38
Compression Broadening.
Figure 4-39
Release Intermuscular Septums.
Figure 4-42A
Ankle Decompression.
8/3/2013
Figure 4-42B
Traction Hip, Knee, and Ankle.
Figure 4-44
Ankle Ligaments.
Figure 4-53
Lateral Leg Muscles.
Figure 4-45
Muscle Resistance Test, Ankle Strain.
Figure 4-46
Myofascial Release, Lateral Lower Leg.
Figure 4-47 Compression Broadening, Lateral Lower Leg.
8/3/2013
Figure 4-49
Muscle Resistance Test, Ankle Strain.
Figure 4-50
Multidirectional Friction.
Figure 4-51
Eccentric Muscle Contraction.
Figure 4-44
Ankle Ligaments.
Figure 4-52
Eccentric Ligament Technique.
Stretching (Client Self-Care)

Goal: for the client to perform stretches suggested by you to create normal muscle resting lengths in shortened or contracted muscle groups, and restore normal range of motion to the joint.
10
8/3/2013
Figure 4-54
Gastrocnemius Stretch.
Figure 4-55
Soleus Stretch.
Figure 4-56 Stretch posterior tibialis to correct supination. Stretch Peroneals to correct hyper-pronation!
Strengthening (Client Self-Care)

Goal: to strengthen weak, inhibited muscle groups around a joint creating muscle balance throughout the structural integration.
Precautionary Note
To prevent reinjury after treating a strain, have the client refrain from beginning a strengthening program for 7 to 10 days, or until he or she is painfree. To facilitate healing, have the client stretch the tight antagonist muscles, taking the tension off the injured muscles until pain-free strengthening can begin.
Figure 4-57
Strengthen Peroneals to stabilize lateral ankle.
11
8/3/2013
Figure 4-58 Strengthen Posterior Tibialis to correct hyper-pronation problems..
Figure 4-59 Strengthen Tibialis Anterior for anterior compartment syndrome clients.
12

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Integrated Manual Therapy & Orthopedic Massage For Complicated Lower Extremity Conditions

By Author & International Lecturer James Waslaski LMT, CPT

CLINICAL MASSAGE THERAPY

Lower Leg, Ankle, and Foot Conditions

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Lower Leg Muscles

Ankle Plantar Flexion, 3050 Degrees.

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Ankle Dorsiflexion, 2030 Degrees.

Figure 4-5 Ankle Eversion at Subtalar Joint 1520 Degrees.

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Figure 4-5 Ankle Eversion at Subtalar Joint 1520 Degrees.

Muscle Resistance Test, Soleus.

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Myofascial Spreading, Gastrocnemius.

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Myofascial Release of Soleus.

Ankle Distraction and Traction.

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Muscle Resistance Test, Soleus.

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Multidirectional Friction, Soleus.

Eccentric Muscle Contraction, Soleus.

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Myofascial Release, Right Achilles Tendon.

Tibialias Posterior Review.

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Myofascial Release, Tibialis Posterior.

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Posterior Tibialis Stretch.

Figure 4-25 Compression and Myofascial Spreading, Foot Muscles.

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Figure 4-26 Massage Intereoseus Membrane Using Long Bones of Foot.

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Arthrokinetics, Gentle Compression.

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Figure 4-24 Muscle Resistance Test for Plantar Fascial Strain.

Figure 4-32 Multidirectional Friction, Plantar Fascia Strain.

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski