Cruciate & meniscal injury
It is important as RMT to be able to differentiate between cruciate or meniscal injuries and collateral Lig injuries
Massage has a direct effect on collateral ligaments b/o its anatomical location (palpable)
Assessment
Acute w/swellingAROM-limited, PROM-mxl guarding
mxl strength testing: mxl crossing the knee should be Painless and indicated normal strength
If there is pain, accompanying mxl might be injured
Presence of swelling
Early/Late subacute and Chronic
AROM-limited, PROM-limited where jt locking is present, unable to fully extend the knee
Mxl strength: Quadriceps may be reduced with disuse atrophy
Special test: Lachman's test, Ant./Post. drawer test, Valgus/Varus test
Miniscal injury:McMurray's test, Bragard's sign, Apley's compression test, Helfet's test
Massage of cruciate injury
Acute/SubacuteRICE
Elevate the limb
Primary focus of tx is the compensating structures (High tone, TrP)
ACL injury: Initial focus of AROM is on hamstrings
Lymph drainage tech proximal to the knee could be used to reduce swelling
Isometric full knee extension against the gravity
Distally, mxl squeezing and careful jt play for the ankle and foot are indicated
Chronic
After 4-6 weeks focus on both affected and unaffected knee and lower back
Fascial tech, skin rolling, cross fibre friction can be used
Heat hydrotherapy
Massage of Meniscal injuries
Acute/SubacuteRICE
Patellofemoral Jt mobs, Gentle PROM into pain free extension
In the late subacute, cross fibre friction to the lision are indicated
Chronic
Lower back, Gluteals, and legs being treated for hypertonicity, fascial retractions and TrP
Caution: Joint play for the tibiofemoral joint can be introduced in the 3rd week if hypo mobility is present
Self Care
Acute/Subacute
Straight leg raise, hip adduction, gastrocnemius setting in week 1
Chronic
If there is tear or partial menisctomy has full ROM, Isometric exercise are progressed to isotonic exercise for quadriceps & hamstrings & gastrocnemiusResistance exercise are added over 3-week period
Healing time
Grade 3 sprain takes up to 4 months to recover
Minor meniscal tear takes 3-4 weeks
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