I would like to share a sports massage and remedial exercise case study from my clinic in Brackley.
My client, Neil, had a nasty injury during a football match in which we suspect his patella (knee cap) briefly dislocated to the outside of his knee as he attempted to quickly change direction.
Neil attended A&E immediately after the injury where they confirmed that there was no fracture and checked for damage to the ligaments.

Treatment One

A few days after the injury, Neil came to see me at my treatment room at B3 Fitness, Brackley.

Neil’s range of movement (ROM) at the knee was very limited. The end of range in both flexion (bending) and extension (straightening) was also very painful. Neil’s knee joint was extremely swollen.

The aim for my first session with Neil was to reduce pain and swelling. I used massage to facilitate the reduction of fluid from the knee joint. I used passive soft tissue release -guided by Neil’s pain limits- to encourage any scar tissue to form in a strong alignment (think dry spaghetti formation rather than a birds nest). Muscle Energy Technique (MET) helped to relax the quadriceps.

I used massage and trigger point therapy on the muscle on the front of the shin (tibialis anterior) which had been upset during the injury. I also used massage in the calf muscles to facilitate circulation and avoid accumulation of blood or fluid in the lower part of the limb.

Lastly, I released through Neil’s opposite hip. This aimed to reduce the risk of overuse injury in the hip muscles whilst Neil’s “good leg” compensated for the injury.

At the very end of the treatment I applied athletic tape to Neil’s knee to help reduce pain and swelling.

After his treatment i emailed Neil some care advice and a home exercise plan that aimed to restore range of movement at the joint, and stretch the opposite hip muscles.

Treatment Two

Neil had a follow up treatment 9 days later. His range of motion was much better and the swelling had dramatically reduced. Neil’s pain levels had dropped, though not entirely.
I treated Neil with massage again focussing on the quadriceps, hamstrings, and calf muscles of the injured leg and the hip of the opposite leg. Neil was able to tolerate deeper massage in the quadriceps this time so I addressed the quality of the tissue using trigger point therapy and more specific soft tissue release.
At the end of the treatment we went over a few exercises to strengthen the quadriceps muscles. Neil’s rehab exercises had a particular focus on the inner quadricep (vastus medial is, VMO) as a preventative measure to reduce risk of re-injury.
Neil is a keen runner and didn’t want to lose too much cardiovascular fitness due to his injury. Roughly 3 weeks post injury, I encouraged him to try using the reclining bike at his gym, which would help to create movement in the knee joint, strengthen the quadriceps, and maintain Neil’s cardiovascular fitness.
Neil's view from the reclining bike. I love the Simpsons too - good choice of entertainment Neil!

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