A Massage Therapist Can Help Knee Pain
As people age, their knees often fall victim to strains, sprains, and resulting pain. As one of the body’s primary weight-bearers, your knees often take the brunt of activity, and you feel it, especially as you age. About 30 percent of adults 65 years of age and over-reporting knee pain or stiffness in the past 30 days, according to the American Pain Institute. According to orthopedic massage expert Whitney Lowe, director of the Orthopedic Massage Education & Research Institute in Sisters, Oregon, there are many different causes of knee pain, some related to muscles, some related to joints. If you experience pain in your knee for more than a week, see your doctor for a diagnosis. Depending on that diagnosis, massage therapy might be a beneficial means of addressing your pain. However, if arthritis is the diagnosis, the benefits of massage will be limited, according to Lowe.
“Arthritis involves degenerative changes in the joint surfaces, and those surfaces are inaccessible to massage treatment,” he said. “With other conditions, such as patellar tracking disorders and patellar tendinosis, massage is a very valuable approach because it helps reduce stress on the soft tissues that are damaged from overuse.” To find a massage therapist trained in basic Swedish massage, which involves long, gentle strokes and kneading, use the location service of the Associated Bodywork & Massage Professionals website or the American Massage Therapy Association.
Specialized Massage Techniques
Swedish massage consists of long, sweeping strokes and kneading. This may be all you need. However, there are specialized types of therapeutic touch available as well. Some techniques to look for including Myofascial Release, which unwinds tight fascia (the web of material joining all the body’s muscles); Rolfing, which involves 10 sessions of very deep bodywork; and Active Isolated Stretching, whose practitioners help clients perform specific stretches. Search online for any of these terms to find practitioners. “As a general guideline, most knee-pain disorders are helped with any techniques that reduce tension in the quadriceps muscle group,” Lowe said. “Patellar tracking disorders and tendinosis are greatly helped by deep friction massage [a Swedish massage technique] applied to the soft tissue around the patella.”
Healthy Knees Through Self-Care
Self-massage is something you can do for yourself, between professional massage sessions. Hot baths, stretching, weight loss, and exercise are also steps to consider to lessen knee pain. Many of today’s massage lotions, which you can find at your health-food store or online, contain pain-relieving ingredients, such as menthol, Arnica, wintergreen, or a Chinese herbal blend. Many such lotions affect heat or cold (cryo) therapy and can be added to your self-care routine for added pain relief. Self-massage won’t be as relaxing or effective as getting a massage from a professional, but it can help loosen the muscles and ligaments around the knee, reducing pain and helping you get back on track.
Millions of adults in the United States suffer from osteoarthritis (OA), a degenerative joint disease that has historically been described as “wear and tear” of weight-bearing joints of the body, causing changes in the joints’ cartilage, lining, and underlying bone.
The goals of treating this chronic, progressive disease of aging often include pain and stiffness management, as well as joint mobility improvement.
As the largest and most complex joint in the body, the knee is commonplace for people to develop osteoarthritis. And, as more and more research is suggesting, massage therapy can be beneficial. But how can you help clients manage pain between regular massage therapy sessions?
Self-massage is one answer. Read on to learn more about the role self-massage can play in helping your clients suffering from osteoarthritis of the knee.
Osteoarthritis of the Knee
Knee OA is often diagnosed by the presence of osteophytes (bone spurs) and loss of joint space seen on x-rays.1 Although scientists are unsure of the specific cause of knee OA, some influential factors include genetics, obesity, previous knee injuries, and overuse.
Additionally, researchers have investigated the possible causative role of the quadriceps muscle group. The quadriceps femoris, located on the anterior thigh, is made up of four distinct muscles that have different points of origin and a common insertion around the knee. These muscles work together to extend the leg, such as in the movement you make when kicking a ball, and also help stabilize the leg while climbing up and downstairs. Joint protection and shock absorption (when walking or running) are also common functions of these muscles.
Quadriceps weakness is commonly seen in adults with knee arthritis, and researchers often debate whether it is quadriceps muscle dysfunction or knee joint changes that precipitate OA of the knee. Dysfunction or weakness of this muscle may affect balance, as well as daily activities such as standing and walking. Additionally, studies have found a correlation between quadriceps muscle weakness and increased knee pain, and altered walking patterns in those with knee osteoarthritis2.
Although this condition can occur in any of the weight-bearing joints, knee OA affects approximately 9 million American adults. Unfortunately, this condition does not have a cure, and researchers predict the prevalence of this type of OA will increase as the population ages.
The current combination of treatments includes exercise, physical therapy, weight control, supportive devices, medications, and surgery. However, conventional treatments often don’t provide enough symptom relief, and so more and more people are turning to proven alternatives for pain relief, including massage therapy.
Recent studies showing the efficacy are helping drive demand, and can also facilitate better discussions between you and your clients about the benefits of massage3.
How Self-Massage Helps Osteoarthritis
As previously discussed, studies indicate a correlation among quadriceps weakness, increased pain, and altered walking patterns in aging people with OA of the knee. And it appears self-massage of the quadriceps muscles may help improve function and correct dysfunctions.
Self-massage is the application of various massage strokes to the body’s soft tissue for therapeutic purposes. You might use self-massage to soothe tired hands and feet, for example, or to ease tension headaches.
Since self-massage research is in its infancy, there is little significant data to support its therapeutic value. Historically, however, self-massage has been employed as an integral part of the treatment and management of chronic medical conditions. Lymphedema, for example, is a condition where chronic swelling is the result of a reduction in the transport capacity of the lymphatic system. Massage therapy and self-massage can be helpful in managing this condition.
Specific to self-massage for knee OA, a 2013 randomized, controlled trial by Atkins and Eichler examined the effects self-massage had on pain, stiffness, and physical function in 40 adults diagnosed with knee OA.
Participants assigned to the intervention group did a 20-minute self-massage protocol twice a week during 10 supervised and three unsupervised intervention sessions. The control group was a waitlist.
Between-group analyses of WOMAC pain, stiffness, and function subscales— and total WOMAC scores— showed a significant difference between the intervention and control groups, though no difference was seen in the range of motion4.
Additionally, self-massage for hand arthritis5 and carpal tunnel6 has been investigated by The Touch Research Institute at the University Of Miami School Of Medicine.
Equally important, of course, are regular exercise, proper diet, and weight management. As a massage therapist, you need to keep in mind that self-massage is not meant as a substitute for ongoing medical care or regular massage therapy. Rather, self-massage is a safe, therapeutic hands-on approach to self-care that can benefit your clients between sessions and their work with other health care professionals.
If we follow the evidence, both massage and self-massage therapy can provide symptom relief to people suffering from osteoarthritis of the knee. What a hands-on gift to give our clients—both in the office and at home.
Self-Massage: A Step-by-Step Protocol
This knee self-massage protocol was founded on research linking the quadriceps muscle to knee osteoarthritis. The massage strokes chosen for this intervention are deep gliding (effleurage), tapping (tapotement), and friction.
Guidelines for Practice
Use common sense when following directions and make adjustments when necessary. For example, if a person has difficulty using the suggested heel of the hand, suggest they use a two-handed, one hand on top of the other approach.
- Wear comfortable, loose clothing that allows easy access to the thigh.
- Maintain good posture and balance.
The technique can be done safely on the skin with or without lubrication, or on top of most clothing with the exception of jeans, wool, or corduroy.
The Rocking: Forward and backward motion during each gliding stroke done with the heel of the hand uses the weight of the upper body rather than the arm’s muscles. This protects the arm and wrist from overuse. This is achieved by holding the arm and hand, flexed at the wrist, in position while applying deep pressure while rocking forward and backward with each gliding stroke to the quadriceps muscle of the thigh. Also, keep your foot flat on the floor for knee stabilization.
The first five steps include the warm-up phase to stretch the upper body in preparation to safely massage the quadriceps muscles.
The warm-up includes: Three deep breaths > Three alternate shoulder shrugs > Three alternate arm raises to shoulder > Three alternate arm raises to the ceiling > Three alternate knee raises
Massage strokes to use: Deep gliding massage strokes (effleurage)—performed with or without lubrication—work to soften and lengthen muscle fibers. The heel of the hand is ideal, but knuckles, forearm or elbow can be used according to the client’s needs or desired results.
Tapping (tapotement) is applied with a loose fist to stimulate circulation and warm soft tissue.
Friction strokes are applied with no lubrication by pressing fingers firmly into the tissue and compressing a small area while moving the tissue back and forth using short strokes.
1. Thigh Tapping to Anterior Thigh
Tap both hands with a softly closed fist rhythmically at the same time on the upper, then the middle, then lower thigh. Repeat 10 times.
Repeat sequence three times, taking three deep breaths.
2. Front Thigh Glide
Seated, move hips forward, extend right leg with foot flat on floor and place heel of the right hand on top of the right thigh. Glide down using the heel of the hand. End at the top of the knee and release. Bring your hand back to the starting position. Repeat this sequence 5 times.
Now repeat the same sequence on the left leg, using the left hand.
3. Outside Thigh Glide
Place heel of the right hand on top outside right thigh. Glide down outside thigh. End at the top of the knee and release. Repeat this sequence 5 times.
Now repeat the same sequence on the left leg, using your left hand.
4. Inner Thigh Glide
Seated, place the heel of the left hand on top inner right thigh. Glide down with the heel of the hand. End at top of knee and release. Repeat this sequence 5 times.
Now repeat the same sequence on the left leg, using your right hand.
5. Knee Friction
Without lubrication, strokes are applied around the knees. Press four fingertips firmly into the tissue, compressing a small area while moving tissue up and down using five short strokes around the knee—bottom, outside, top, and inside.
6. Finishing Glide Stroke
Sit with both feet flat on the floor. Place one hand palm down on each upper thigh. Glide down over knee caps across to outside thigh and up to starting position using light to medium pressure.
Repeat five times. End with three deep breaths.
*Disclaimer: This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider.
Please consult your healthcare provider with any questions or concerns you may have regarding your condition.
The information provided is for educational purposes only and is not intended as diagnosis, treatment, or prescription of any kind. The decision to use, or not to use, any information is the sole responsibility of the reader. These statements are not expressions of legal opinion relative to the scope of practice, medical diagnosis, or medical advice, nor do they represent an endorsement of any product, company, or specific massage therapy technique, modality, or approach. All trademarks, registered trademarks, brand names, registered brand names, logos, and company logos referenced in this post are the property of their owners.