Millions of adults in the United States suffer from osteoarthritis (OA), a degenerative joint disease that has historically been described as "wear and tear" of weight-bearing joints of the body, causing changes in the joints’ cartilage, lining and underlying bone. The goals of treating this chronic, progressive disease of aging often include pain and stiffness management, as well as joint mobility improvement.
As the largest and most complex joint in the body, the knee is a common place for people to develop osteoarthritis. And, as more and more research is suggesting, massage therapy can be beneficial. But how can you help clients manage pain between regular massage therapy sessions?
Self-massage is one answer. Read on to learn more about the role self-massage can play in helping your clients suffering from osteoarthritis of the knee.
Osteoarthritis of the Knee
Knee OA is often diagnosed by the presence of osteophytes (bone spurs) and loss of joint space seen on x-rays.1 Although scientists are unsure of the specific cause of knee OA, some influential factors include genetics, obesity, previous knee injuries and overuse.
Additionally, researchers have investigated the possible causative role of the quadriceps muscle group. The quadriceps femoris, located on the anterior thigh, is made up of four distinct muscles that have different points of origin and a common insertion around the knee. These muscles work together to extend the leg, such as in the movement you make when kicking a ball, and also help stabilize the leg while climbing up and down stairs. Joint protection and shock absorption (when walking or running) are also common functions of these muscles.
Quadriceps weakness is commonly seen in adults with knee arthritis, and researchers often debate whether it is quadriceps muscle dysfunction or knee joint changes that precipitate OA of the knee. Dysfunction or weakness of this muscle may affect balance, as well as daily activities such as standing and walking. Additionally, studies have found a correlation between quadriceps muscle weakness and increased knee pain and altered walking patterns in those with knee osteoarthritis2.
Although this condition can occur in any of the weight-bearing joints, knee OA affects approximately 9 million American adults. Unfortunately, this condition does not have a cure, and researchers predict the prevalence of this type of OA will increase as the population ages. The current combination of treatments include exercise, physical therapy, weight control, supportive devices, medications and surgery. However, conventional treatments often don’t provide enough symptom relief, and so more and more people are turning to proven alternatives for pain relief, including massage therapy. Recent studies showing the efficacy are helping drive demand, and can also facilitate better discussions between you and your clients about the benefits of massage3.
How Self-Massage Helps
As previously discussed, studies indicate a correlation among quadriceps weakness, increased pain, and altered walking patterns in aging people with OA of the knee. And it appears self-massage of the quadriceps muscles may help improve function and correct dysfunctions.
Self-massage is the application of various massage strokes to the body’s soft tissue for therapeutic purposes. You might use selfmassage to soothe tired hands and feet, for example, or to ease tension headaches.
Since self-massage research is in its infancy, there is little significant data to support its therapeutic value. Historically, however, selfmassage has been employed as an integral part of the treatment and management of chronic medical conditions. Lymphedema, for example, is a condition where chronic swelling is the result of a reduction in the transport capacity of the lymphatic system. Massage therapy and self-massage can be helpful in managing this condition.
Specific to self-massage for knee OA, a 2013 randomized, controlled trial by Atkins and Eichler examined the effects self-massage had on pain, stiffness and physical function in 40 adults diagnosed with knee OA. Participants assigned to the intervention group did a 20-minute self-massage protocol twice a week during 10 supervised and three unsupervised intervention sessions. The control group was a wait list. Between group analyses of WOMAC pain, stiffness and function subscales— and total WOMAC scores— showed significant difference between the intervention and control groups, though no difference was seen in range of motion4.
Additionally, self-massage for hand arthritis5 and carpal tunnel6 has been investigated by The Touch Research Institute at the University Of Miami School Of Medicine.
Equally important, of course, are regular exercise, proper diet and weight management. As a massage therapist, you need to keep in mind that selfmassage is not meant as a substitute for ongoing medical care or regular massage therapy. Rather, self-massage is a safe, therapeutic hands-on approach to self care that can benefit your clients between sessions and their work with other health care professionals.
If we follow the evidence, both massage and self-massage therapy can provide symptom relief to people suffering with osteoarthritis of the knee. What a hands-on gift to give our clients—both in the office and at home.
Self-Massage: A Step-by-Step Protocol
This knee self-massage protocol was founded on research linking the quadriceps muscle to knee osteoarthritis. The massage strokes chosen for this intervention are deep gliding (effleurage), tapping (tapotement), and friction.
Guidelnes for Practice
Use common sense when following directions and make adjustments when necessary. For example, if a person has difficulty using the suggested heel of hand, suggest they use a two-handed, one hand on top of the other approach.
- Wear comfortable, loose clothing that allows easy access to the thigh.
- Maintain good posture and balance.
The technique can be done safely on the skin with or without lubrication, or on top of most clothing with the exception of jeans, wool or corduroy.
The Rocking: Forward and backward motion during each glide stroke done with the heel of hand uses the weight of the upper-body rather than the arm’s muscles. This protects the arm and wrist from overuse. This is achieved by holding the arm and hand, flexed at wrist, in position while applying deep pressure while rocking forward and backward with each gliding stroke to the quadriceps muscle of the thigh. Also, keep foot flat on floor for knee stabilization.
The first five steps include the warm-up phase to stretch the upper body in preparation to safely massage the quadriceps muscles.
The warm-up includes: Three deep breaths > Three alternate shoulder shrugs > Three alternate arm raises to shoulder > Three alternate arm raises to the ceiling > Three alternate knee raises
Massage strokes to use: Deep gliding massage strokes (effleurage)—performed with or without lubrication—work to soften and lengthen muscle fibers. The heel of the hand is ideal, but knuckles, forearm or elbow can be used according to the client’s needs or desired results.
Tapping (tapotement) is applied with loose fist to stimulate circulation and warm soft tissue.
Friction strokes are applied with no lubrication by pressing fingers firmly into the tissue and compressing a small area while moving the tissue back and forth using short strokes.
1. Thigh Tapping to Anterior Thigh
Tap both hands with a soft closed fist rhythmically at the same time on the upper, then middle, then lower thigh. Repeat 10 times.
Repeat sequence three times, taking three deep breaths.
2.Front Thigh Glide
Seated, move hips forward, extend right leg with foot flat on floor and place heel of right hand on top of right thigh. Glide down using heel of hand. End at the top of knee and release. Bring hand back to starting position. Repeat this sequence 5 times.
Now repeat the same sequence on the left leg, using left hand.
3. Outside Thigh Glide
Place heel of the right hand on top outside right thigh. Glide down outside thigh. End at the top of the knee and release. Repeat this sequence 5 times.
Now repeat the same sequence on the left leg, using your left hand.
4. Inner Thigh Glide
Seated, place heel of the left hand on top inner right thigh. Glide down with heel of hand. End at top of knee and release. Repeat this sequence 5 times.
Now repeat the same sequence on the left leg, using your right hand.
5. Knee Friction
Without lubrication, strokes are applied around knees. Press four fingertips firmly into tissue, compressing small area while moving tissue up and down using five short strokes around knee—bottom, outside, top and inside.
6. Finishing Glide Stroke
Sit with both feet flat on floor. Place one hand palm down on each upper thigh. Glide down over knee caps across to outside thigh and up to starting position using light to medium pressure.
Repeat five times. End with three deep breaths.
Massage Therapy for Osteoarthritis | 2 Credit Hours
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Dorothea Atkins Th.D., RN, LMT has more than 20 years of experience in massage therapy. Dr. Atkins is founder and CEO of Holos Touch LLC, her New Jersey private practice that focuses on massage therapy, focuses on education, workshops, self-massage classes and self-help approaches to pain management. She is also an active member of AMTA.
1. Peter Layon et al., “Radiographic Assessment of Symptomatic Knee Osteoarthritis in the Community: Definitions and Normal Joint Space,” Annals of the Rheumatic Diseases 57, no. 10 (October 1998): 600.
2. Kim L. Bennell et al., “Role of Muscle in the Genesis and Management of Knee Osteoarthritis,” Rheumatic Disease Clinics of North America 34 (2008):749.
3. Adam Perlman et al., “Massage Therapy for Osteoarthritis of the Knee,” Archives of
Internal Medicine 166 (2006): 2533-38.
4. Atkins DV, Eichler DA. The Effects of Self-Massage on Osteoarthritis of the Knee: a randomized, controlled trial. International Journal of Therapeutic Massage and Bodywork. 2013;6 (1):4–114. PMC3577640
5. Tiffany Field et al., “Hand Arthritis Pain is Reduced by Massage Therapy,” Journal of Bodywork and Movement Therapies 11 (2007) 33.
6. Tiffany Field et al., “Carpal tunnel Syndrome Symptoms are Lessened Following Massage therapy,” Journal of Bodywork and Movement Therapies 11 (2004): 13