My massage therapy client has been working very hard to lose weight. She is going to the gym four times a week, training under the watch of two very good kiniesiology trainers, and eating a diabetic diet. She has lost more than 70 pounds in the past year.
That is a little fast to lose weight, but she has been a trooper. This past holiday season she stayed on track, upping her workouts to make up for time spent traveling and enjoying a few extra carbs. I had not seen her for nearly more than 6 weeks when she limped into my office.
“It’s my knee,” she said. “My good knee!”
Sharp pain was curling around her kneecap. I recognized that look of dread. Try losing weight when you have knee surgery and you are going to spend a month on the couch. A few years ago she experienced that with her bad knee.
Knee pain can be anything, a testy sciatic nerve, nerve root impingement, a poorly tracking kneecap, and osteo-arthritis in the joint. But I do massage, so I follow my muse. Chances are, a sore knee is a sore, entrapped quadriceps – or more likely a sore, entrapped group of quadriceps.
It’s not the easiest massage, but opening the quads can bring a lot of relief. I have learned to start slow, with a lot of warming Swedish massage, to reduce the pain and agony of myofascial release and trigger point work on the most adhesed muscles of all.
Quadriceps that have become trapped in their fascia feel like stone. They lack the softness and rubbery bounce of muscle, feeling sharp and bumpy, almost lifeless.
Warming Swedish can get at the overlay of skin and adipose tissue but that will leave the quadriceps unchanged. Trigger point maps of the quads show so many “x” spots it is hard to see the anatomy. I have learned to start at the top of the muscle, near the trochanter and ISIS, using forearm rather than fingers. Both of these moves reduce the pain.
As trigger points fade, the muscles start to soften. Then add a layer of myofascial release, again using forearm to reduce the strain on the therapist and the client. I slowly move down each quadriceps in strips, starting with the medialis. As I work, I using overall Swedish strokes in between to structurally integrate and encourage circulation.
I am used to feeling the major changes in the quads as they soften. What is remarkable is that my client noticed this, too.
“They feel like they are getting softer and warmer,” she said.
The monster trigger points hide in the area of the vastus lateralis nearest to the knee. I work those last as they are the worst. On these points the knee pain finally subsided.
“Those ball squats you have been doing at the gym have been very effective,” I told my client. “We need to do the bad knee, too.”
