wk9 - front of leg protocol

Question 1

What are the effects of the Front of Leg Protocol?

Answer 1

• Open & stimulate the ST, GB, LV & SP channels
• Facilitate qi & blood circulation to & through the lower limb
• Relax the muscles & their attachments: hip flexors, quadriceps muscles, tibialis anterior, calf muscles
• Decompress & realign joints of the hip, knee & ankle

Question 2

What are the indications for the Front of Leg Protocol?

Answer 2

• Hip pain
• Osteoarthritis hip / knee / ankle
• ITB syndrome
• ACL / Meniscus tears
• MCL / LCL tears
• Patellofemoral syndrome / Chondromalacia / Runner’s knee
• Shin splints
• Achilles tendonitis
• Calf cramping / pain / tightness
• Ankle pain / sprain (chronic or acute)

Question 3

What are the 11 steps of the Back of Leg Protocol?

Answer 3

1) Pinch / Grasp thigh (anterior, medial, lateral compartments – 3x each)
2) Dredge GB channel (3-5x)
3) Gently move patella (side to side, up & down – note restrictions)
4) Palm edge Rub-Roll above & below patella (~10 sec)
5) Hammer patella (~10 sec, from 45 degrees, above & below – gently)

BEND LEG

6) Separate the gastrocnemius (3x)
7) Sinew Divide between tibia & fibula (3x)
8) Thumb Press / Round Rub release of calf attachments (3x) (at tib/gastroc & fib/gastroc)
9) Squeeze the calf (3x)

STRAIGHTEN LEG

10) Round Rub around malleoli, heel & between metatarsals
11) Foulage the leg (3-5x)

Question 4

What is the benefit of Pinching / Grasping the thigh?

Answer 4

• Moves qi & blood through the ST, LV, SP, KD & GB channels

- Relaxes tightness in the thigh

Question 5

What is the benefit of Dredging the GB channel?

Answer 5

• Dredges qi through the GB channel

- Relaxes the IT Band & Peroneus

Question 6

What is the benefit of gently moving the patella from side to side, up & down?

Answer 6

Assess ROM of patella up/down, medial/lateral

Question 7

What is the benefit of Palm edge Rub-Roll above & below patella?

Answer 7

• Relaxes tightness in quadriceps tendon & patellar ligament
• Normalizes the movement of patella
• Warms the knee
• Breaks stagnation
• Disperses cold

Question 8

What is the benefit of Hammering the patella?

Answer 8

• Relaxes tightness in quadriceps tendon & patellar ligament
• Normalizes movement of the patella
• Disperses stagnation around the patella

Question 9

What is the benefit of Separating the gastrocnemius?

Answer 9

• Relax spasm in the calf

- Course qi through UB channel

Question 10

What is the benefit of Sinew Divide between tibia & fibula?

Answer 10

• Move qi through GB & ST channel
• Relax tightness in tibialis anterior & peroneus muscles
• Spreads interosseous membrane between tibia & fibula

Question 11

What is the benefit of Thumb Press / Round Rub release of calf attachments?

Answer 11

• Course qi through SP, LV & GB channels

- Relax tightness in the calves

Question 12

What is the benefit of Squeezing the calf?

Answer 12

• Relaxes spasms
• Brings qi & blood to the calf
• Realigns joints

Question 13

What is the benefit of Round Rubbing around malleoli, heel & between metatarsals?

Answer 13

• Relaxes tightness and moves qi & blood at the ankle, heel, and between metatarsals
• Encourages flexibility of the foot & ankle

Question 14

What is the benefit of Foulaging the leg?

Answer 14

• Disperse stagnation, move qi & blood through the whole lower limb
• Loosens joints, encourages normal ROM of joints
• Realigns joints

Question 15

How do you Pinch / Grasp front of thigh?

Answer 15

• Pinch or Grasp from proximal to distal, pumping energy in one direction
• Each pinch or grasp should be close to the one
• When pinching, fingers are straight like a pincer
• When grasping, use fingers to hold & lift a specific tissue

Question 16

How do you Dredge the GB channel?

Answer 16

• Have patient lay on side with bottom leg bent & top leg straight, knee over knee (foot of straight leg is firmly resting on table)
• Use forearm to dredge along IT Band at upper leg, and peroneus at lower leg

Question 17

How do you Palm edge Rub-Roll above & below patella?

Answer 17

• Use hands like a saw, with fingers straight and pinky-side of palm above & below patella
• Chafe to relax tendons & generate heat 5-10 sec

Question 18

How do you Hammer the patella?

Answer 18

• Use pinky-side of palm

- Gently hammer above & below patella 5-10 sec

Question 19

How do you Separate the gastrocnemius?

Answer 19

• Bend patient’s leg and support their foot either with your inner thigh or your buttock
• With fingers back to back, press along midline of calf between heads of gastrocnemius
• Fingers press in and move up & down to agitate
• Thumbs stay back to back throughout (on the front of shin)

Question 20

How do you Sinew Divide between tibia & fibula?

Answer 20

• Feel for depression between muscles
• With thumbs back to back, press deeply & rotate outward slightly (like lateral decompressions on Back Protocol)
• Thumbs stay back to back throughout

Question 21

How do you Thumb Press / Round Rub release the calf attachments?

Answer 21

• Place thumb tips behind the tibia & fibula

- Press in and rotate towards each other

Question 22

How do you Squeeze the calf?

Answer 22

With fingers interlaced, squeeze & pull calf muscles away from leg

Question 23

How do you Round Rub around malleoli, heel & between metatarsals?

Answer 23

• Stand at patient’s foot, either hand over ankle
• Round rub the side where the thumb lands, then switch directions
• On the other side, switch hand and use the other thumb

Question 24

which technique aims to spread and relax the interosseous membrane bt the tibia and fibula?

Answer 24

sinew dividing

Question 25

when rotating a patient’s left ankle, the practitioner should hold the patient’s ankle around the malleoli with his/her ____ hand and hold the ball of the foot with his/her ____ hand.

Answer 25

Right

Left

Question 26

which technique can soften tightness in tibialis anterior and peroneus muscles:

Answer 26

sinew dividing

Question 27

To Dredge the GB channel, how do you have the patient lay?

Answer 27

On their side, with top leg straight and bottom knee bent, knee stacked on knee.