Cruciate & Miniscal injury

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/swelling
AROM-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/Subacute
RICE
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/Subacute
RICE
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 & gastrocnemius

Resistance 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