wk9 - front of leg protocol Flashcards
What are the effects of the Front of Leg Protocol?
- 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
What are the indications for the Front of Leg Protocol?
- 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)
What are the 11 steps of the Back of Leg Protocol?
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)
What is the benefit of Pinching / Grasping the thigh?
- Moves qi & blood through the ST, LV, SP, KD & GB channels
- Relaxes tightness in the thigh
What is the benefit of Dredging the GB channel?
- Dredges qi through the GB channel
- Relaxes the IT Band & Peroneus
What is the benefit of gently moving the patella from side to side, up & down?
Assess ROM of patella up/down, medial/lateral
What is the benefit of Palm edge Rub-Roll above & below patella?
- Relaxes tightness in quadriceps tendon & patellar ligament
- Normalizes the movement of patella
- Warms the knee
- Breaks stagnation
- Disperses cold
What is the benefit of Hammering the patella?
- Relaxes tightness in quadriceps tendon & patellar ligament
- Normalizes movement of the patella
- Disperses stagnation around the patella
What is the benefit of Separating the gastrocnemius?
- Relax spasm in the calf
- Course qi through UB channel
What is the benefit of Sinew Divide between tibia & fibula?
- Move qi through GB & ST channel
- Relax tightness in tibialis anterior & peroneus muscles
- Spreads interosseous membrane between tibia & fibula
What is the benefit of Thumb Press / Round Rub release of calf attachments?
- Course qi through SP, LV & GB channels
- Relax tightness in the calves
What is the benefit of Squeezing the calf?
- Relaxes spasms
- Brings qi & blood to the calf
- Realigns joints
What is the benefit of Round Rubbing around malleoli, heel & between metatarsals?
- Relaxes tightness and moves qi & blood at the ankle, heel, and between metatarsals
- Encourages flexibility of the foot & ankle
What is the benefit of Foulaging the leg?
- Disperse stagnation, move qi & blood through the whole lower limb
- Loosens joints, encourages normal ROM of joints
- Realigns joints
How do you Pinch / Grasp front of thigh?
- 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
How do you Dredge the GB channel?
- 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
How do you Palm edge Rub-Roll above & below patella?
- 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
How do you Hammer the patella?
- Use pinky-side of palm
- Gently hammer above & below patella 5-10 sec
How do you Separate the gastrocnemius?
- 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)
How do you Sinew Divide between tibia & fibula?
- 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
How do you Thumb Press / Round Rub release the calf attachments?
- Place thumb tips behind the tibia & fibula
- Press in and rotate towards each other
How do you Squeeze the calf?
With fingers interlaced, squeeze & pull calf muscles away from leg
How do you Round Rub around malleoli, heel & between metatarsals?
- 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
which technique aims to spread and relax the interosseous membrane bt the tibia and fibula?
sinew dividing
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.
Right
Left
which technique can soften tightness in tibialis anterior and peroneus muscles:
sinew dividing
To Dredge the GB channel, how do you have the patient lay?
On their side, with top leg straight and bottom knee bent, knee stacked on knee.
