Orthopedic massage protocol for post ACL reconstruction patellofemoral pain syndrome

The intent of this study is to determine the effectiveness of orthopedic massage in the rehabilitation of post anterior cruciate ligament (ACL) reconstruction patellofemoral pain syndrome (PFPS). The primary complications following surgical repair of the ACL and classified as PFPS are hamstring flexion contracture and quadriceps weakness, leading to patellofemoral dysfunction and retropatellar pain. Treatment included lymphatic drainage, myofascial release, neuromuscular therapy including trigger point release, muscle energy techniques and cross-fiber friction. Orthopedic physical assessment tests were used to track effectiveness of massage as well as subjective reporting on pain level and function. Results of this study showed a decrease in pain levels, hamstring flexion contracture, and lateral tracking of the patella. Orthopedic massage was determined to be an effective complimentary therapy in the treatment of PFPS.

This paper was just published in the newest International Journal of Therapeutic Massage & Body Work, a free peer-reviewed journal put out by the Massage Therapy Foundation. The journal is brand new (this is only number 2 of volume 1) and will hopefully help to bring sound research and information to massage therapy and soft tissue work.

This particular paper was a case study of a female athlete who had ACL reconstruction and developed patellofemoral pain (knee pain) following the surgery (which can happen).

Before I go on, I know most die-hard research junkies out there are saying “Case studies are bull sh^t and they don’t give us valid information.” While I do agree that you can’t just take a case study and apply it to everyone, one of the major limitations of research in soft tissue therapies for sports injuries is that you can’t find people who have the exact same problem (IE, the exact same tear in the exact same muscle at the exact same place) and there is a lot obasically means a lot of what happens in the treatment room is dependant on the skills and knowledge off variation in the way people respond to certain treatments, which the therapist.

In addition, most research on massage therapy for sports, uses a generic protocol (IE, 5min of gliding strokes, 10min. of kneading strokes, 3min. of static stretching) in order to keep things uniform and make the research valid. Anyone who knows anything about working with individuals obviously understands that this doesn’t work! You have to give the tissue what it needs! One size does not fit all and one method is not better than another. They are all good, you just have to understand when to use one over another. While many people are a fan of one specific type of soft tissue work (Active Release, Neuromuscular, Myofascial Release, etc) I tend to favor whatever works! I am a fan of results. Case studies give us the ability to see through another therapists eyes and understand their clinical reasoning and thought processes. It allows us to get a different perspective on situations or injuries that we may approach differently and it gives us the ability to question ourselves and look for the answers to make changes in the way we practice to help ourselves evolve as professionals.

So, do case studies give us concrete evidence and statistical power? NO.

Do they give us the opportunity to ask more questions and develop our thinking? YES!

Moving on…

I enjoyed this case study and it appears that the therapist was skilled in sports massage and had a very thought out plan of attack for treating her patient. I felt that the results were great, especially since I have seen people go through other methods of rehabilitation and get virtually nowhere in the same amount of time with the same types of issues.

The unfortunate thing about this study was that a year following the last treatment, the athlete was to have a follow up visit to see how well she had progressed. Two weeks prior to the follow up visit, the athlete had re-injured the knee in a soccer game. She did however state that prior to the injury she was pain free and fully capable of doing the things she used to do. The paper did not state how the athlete injured her knee (contact injury or non-contact injury). Since I am fascinated by movement and strength and conditioning, one of the things I wonder is – had this been a non-contact injury, could the injury possibly have been avoided had the athlete been placed into the care of someone who would strength her lower extremity, and restore functionality back to the way that she moves?

Massage therapists can do wonderful things with the soft tissue of their clients. But, what happens when you are finished improving tissue quality and restoring length to a muscle? At some point, we have to be placed in a situation to retrain that new mobility that we have gained. We have to retrain the muscles to fire and behave the way we want them to behave, otherwise we just feed into poor patterns and patterns of compensation, create (or re-create) tissue stress, and lead ourselves back down the road of re-injury.

I think an effective partnership could be between sports massage therapists and strength and conditioning coaches or trainers that have a comprehensive movement assessment and can determine what limiting factors the athlete has and how to correct those problems. Re-education of movement following soft tissue work is vital to enhancing performance and possibly preventing future injuries.

Patrick

patrick@optimumsportsperformance.com