Superficial Stroking to the Thigh

Both hands reach around the thigh, covering it as much as possible, and stroke from the anterior superior iliac spine (ASIS) of the ilium to the knee. The stroke may be performed with the hands working alternately or simultaneously (Figure 7-1). The technique is repeated four times.

Figure 7-1 Superficial stroking to the thigh.

Palmar Kneading to the Quadriceps Muscle

Palmar kneading is a modified squeeze kneading technique that begins with the ulnar border of the right hand placed below the patella and the thumb on its lateral border. The fingers are placed on the medial border of the patella. The left hand picks up the distal portion of the muscle above the patella (Figure 7-2, A). The right hand strokes over the patella toward the left hand as the ulnar border maintains firm contact during the upward pressure. The muscle is grasped between the thumb and the fingers using a lumbrical action to draw the tissues into the palms of the hands. The palmar surface of the fingers of the left hand pulls the muscles laterally as the surface of the abducted right thumb and palm simultaneously push the tissues medially (Figure 7-2, B). Then the surface of the palm and abducted thumb of the left hand push the muscles medially as the palmar surface of the fingers of the right hand pulls the tissues laterally (Figure 7-2, C). This push-pull movement is carried along the muscle, progressing from the distal part of the quadriceps to the proximal part. Movement is accomplished with gliding of the hands on the pull stroke of the kneading movement. This is not a pinching movement. The thumb and fingers of each hand sustain their relationship to each other during the entire movement. The push and pull are accomplished chiefly by flexion and extension of the arms at the shoulders and elbows as the movement progresses along the thigh. As the origin of the muscle is approached, the left hand is removed, and the right hand gently squeezes out at the origin of the muscle (Figure 7-2, D) and returns to the lower border of the patella with a superficial stroke. These movements are repeated three times.

Figure 7-2 Palmar kneading to the quadriceps muscle.

Palmar Kneading to the Posterior Thigh

The hip and knee are flexed a little and the thigh rotated slightly externally. Both hands reach across the medial surface of the thigh, grasping the flexors at the knee (Figure 7-3, A), in a manner similar to the movement that was performed on the quadriceps muscle, except that the hands are held more transversely to the muscles as the hands progress along the muscle (Figure 7-3, B).

Figure 7-3 Palmar kneading to the posterior thigh muscles.

The movement is terminated a few inches below the hip joint. The left hand is removed; it crosses over the right hand to grasp the muscles above the knee (see Figure 7-3, C), and the right hand returns along the medial surface of the thigh with a superficial stroke. The movement is repeated three times.

Palmar Kneading to the Medial and Lateral Thigh Muscles

The hip may be slightly flexed and laterally rotated for this stroke, or it may be performed with the limb straight. Both hands grasp around the upper portion of the thigh (Figure 7-4, A); the hands perform the basic circular kneading technique, alternately rolling the muscles between the palms with firm pressure upward and relaxation while moving down the thigh toward the knee (Figure 7-4, B). Both hands return to the starting position with a deep stroke. The stroke is repeated three times.

Figure 7-4 Palmar kneading to the medial and lateral thigh muscles.

Deep Stroking to the Thigh

Both hands grasp around the thigh just proximal to the knee joint, with the thumbs abducted and the fingers held together. The fingertips of opposing hands are in contact with each other on the posterior surface. With firm pressure of the entire palmar surface, the hands stroke upward to the upper portion of the thigh and then return to the knee with a superficial stroke. These movements are repeated three times.

Superficial Stroking to the Leg

Both hands stroke from the knee to the ankle in the standard method for this technique, covering the entire surface of the leg (Figure 7-5). This movement is also repeated three times.

Figure 7-5 Superficial stroking to the leg.

Thumb Pad Kneading to the Anterior Tibial Muscles

The thumb pad (distal phalanx) of each hand is placed in firm contact at the origin of the anterior tibial muscles; the remainder of the hand rests lightly on the surface of the leg (Figure 7-6, A). The thumbs move alternately in the basic manner for kneading, applying pressure in a circular manner. The hands glide to the more distal adjacent area as each circle is made. The movement progresses in this manner (Figure 7-6, B) to the ankle joint (Figure 7-6, C). The hands return to the starting position as the thumbs give deep stroking and the rest of the hand maintains light contact. The movements are repeated twice.

Figure 7-6 Thumb pad kneading to the anterior tibial muscles.

Kneading to the Calf Muscles

Kneading to the calf muscles is a modified squeeze kneading technique in which the right hand supports the slightly flexed knee joint at the medial border. The left hand grasps the lateral part of the muscle group just distal to the knee, and the muscles are pulled toward the lateral border of the leg with the palmar surface of the fingers exerting pressure (Figure 7-7, A). The palmar surface of the abducted thumb and thenar eminence push the muscles upward and toward the medial border of the leg (Figure 7-7, B). The fingers then glide distally, and these movements are repeated until the hand reaches the ankle (Figure 7-7, C). The hand returns to the knee with a deep stroke over the muscles. These movements are repeated three times.

Figure 7-7 Kneading to the calf muscles.

The therapist then changes hands to massage the medial part of the muscle group. Supporting the knee with the left hand, the therapist repeats the procedure with the right hand three times.

Palmar Kneading to the Muscles of the Leg

The basic circular kneading stroke is performed as both hands grasp around the muscles at the knee and alternately roll the muscles between the palms with firm pressure upward, working toward the ankle. The hands are returned to the knee with a deep stroke over the muscles. (This is the same technique used in palmar kneading of the thigh; see Figure 7-4.) These movements are repeated three times.

Stroking around the Patella

The heels of both hands are placed at the lower border of the patella; the palmar surfaces of the distal phalanges of the fingers are in contact with the skin above the superior border of the patella (Figure 7-8, A). The thenar eminences of both hands stroke firmly around the patella in a circular movement by allowing the fingers to flex while the tips maintain light contact (Figure 7-8, B). The heels of the hands return to the beginning position with a superficial stroke distally, allowing the thumbs to glide lightly over the patella. These movements are repeated four times.

Figure 7-8 Stroking around the patella.

Deep Stroking to the Popliteal Space

The fingertips of both hands are placed together at the distal border of the popliteal space. Then they stroke firmly to the proximal border and return to the starting position with a superficial stroke. These movements are repeated four times.

Deep Stroking with Both Hands to the Entire Leg

Both hands begin the stroke at the ankle in a position similar to that shown in Figure 7-6, C. Both hands then stroke firmly toward the knee, returning to their starting position with a light, superficial stroke. These movements are repeated three times.