ACL Post Surgery

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Hi All,

Has anyone worked with a client with excessive scar tissue following ACL surgery?

I have a client I am seeing in a couple of days and this is her case in one of her knees that she had ACL surgery on...her other one which also needed the ACL repair is fine.

She is two years post surgery and I let her know that I doubt at this point that massage is going to be able to break up the collagen that has already been laid down in the new tendons of her new makeshift ACL band. That it is really a few months out after surgery after recovery from the acute seforum.xxxes after surgery that massage can affect scar tissue. Although I do believe massage can effectively support the muscles around the knee and only benefit her.

I also let her know that I do not specialize in Sports Medicine Massage or Physical therapy and I may refer her out.

Ideas?

Thanks!
 


I haven't worked with a case like this, but I would say that although you are right that the most help can be given soon after surgery, I don't think your efforts will be futile even this far out. It make take longer, and be slower, but I do think scar tissue can be reduced using slow deep structural bodywork techniques, melting the connective tissue, especially if she is motivated to make change through bodywork. However, if you're not familiar with techniques like these you may want to refer her out, though they're not hard to apply.
 


Thank you Shivashiva for your reply.

My deep tissue work is much like myofascial release - I am not certified but the school I went to taught a deep tissue work steeped in the myofascial release tradition.

As well, I have taken one structural integration class however it dealt mostly with the spine so yes, referral may be in order.

We shall see.

I get the feeling she mostly was scheduling a relaxation massage at present and then called with the ACL issue as an afterthought.

Thanks for your insight and I agree that any work we can do to surrounding muscles and tendon as well as work with ACL can only help. Maybe some PNF too.
 


I would think that MFR would be a good fit. As you mentioned going very slow.

WaltFritz might have some suggestions, being a P.T. and a background in JFB MFR, that might be different than what those of us with a massage background might recommend. You could PM him and direct him to this thread perhaps...

Either way, if you work on her yourself or refer out, will you keep us posted on the situation? Thanks!
 


Here's a quick anatomy review on AMTCs myspce of the knee in 3D for fun.

http://vids.myspace.com/index.cfm?fuseaction=vids.individual&VideoID=34236651

Since the ACL is deep in the joint your limited on how much you can address a 2 year old scar. MF Unwinding may get some but if it were me I would mainly concentrate on all the muscle that cross the knee joint. Hamstrings, Quads, Adductors and IT Band, calfs, Achellis tendon and planter fascia. Make sure the fascia around the knee slides on the bone so to speak as well. There are some specialized moves but I won't get into them by text on the web.


Heat the tissue around the knee well. Work the anterior fascia superiorly and the posterior fascia inferiorly. As well the lateral fascia superiorly and the adductors inferiorly. Include Gluteals, especially Glut Max as it has a common attachment with the IT Band.

I agree with maetra as well, good PT work might do more than massage but massage has it's place here. Keep in mind the body didn't lay down a pretty and neat scar. A lot of the surrounding tissue around the knee is glued I am sure. If just from lack of movement. If the client has had PT, I would suggest they start back on some of their exercises and stretches. There is a good chance they had minimal PT after surgery these days and this might not apply.

Hope that helps. These can be rewarding sessions if you stick with it. ~peter
 


Thanks Nola and Maestra! Such helpful advice and resources.

I will keep you posted on how it goes.

She did have extensive PT in both cases of surgery the first time she said it hurt so badly to do her extension exercises that she didn't do them as much as she could while with the second surgery on the other knee she was told to take pain medication then do the extension exercises so she did and she feels this cut down on the scar tissue.

I told her to not beat herself up that it may not be an issue with lack of work on her part but it could be as simple as a compensatory pattern in her body that created a different tension on one of her knees than the other...

It should be interesting. I want her to get the treatment that she needs so I will access and see if I feel my work will benefit her specifically as she would like otherwise we will find the appropriate therapist and work.
 


Just a couple of thoughts. While the overall effecacy of the work may largelly be determined by the extent of the fascial build up/scar tissue, I think it's important that you communicate and believe the possibility of the work working without advancing any promises. By you doing this, you and your client remain open to possibilities.

Whether you work on her or you refer her out, the chances of an overnight success is not likely. If she and you are committed (spelling) to the work, the progress may be slow but it will likely hold as fascial release techniques tend to 'last' longer.

I agree with nolalmt in that you've been given the opportunity to work on a number of areas that may have strain/counterstrain functional problems.

Have fun! Keep us posted.
 


Thanks for the input Gaspen - will keep you posted.

She is very concerned about the scar tissue and was considering a second surgery which I let her know could create even more scar tissue possibly...so what I need to ask her when she comes in is how is the scar tissue affecting her? Is it causing pain, loss of ROM, etc...and then go from there.

And yes, you are right I need to realize the power of myofascial work and how just easing the muscle tension in surrounding muscles and fascia, even those elsewhere could have an extremely powerful effect.
 


One of my clients has had successful knee repair surgery, BUT, was extremely lax in the follow-up exercises for extension and as a result, much more difficulty with walking, "locking" the knee when standing, etc. We tried upteen thousand different techniques [or at least it seemed like it] to ease some of the internal issues with the joint.....

Very long story very short......... one day I got fed up with the whining and bellyaching and said, "Look, when I put my hand on your shin, move it like you are straightening your leg out to raise it [sitting on side of table at the time].... he obeyed and gained a bit more flexion / extension in the joint..... so, we kept at it for about 15 mins using varying positions to use as much ROM as possible with the strain /counterstrain. With the very first millimeter of improvement the client said, "Guess I should have listened to the doctor, hulh?!" :banghead: About that time a good "thunk" like in the V8 commercials would have come in handy..... LOL

Don't know if strain / counterstrain would help your client, but, it sure helped mine.... his extension is now w/in .25 mm of the "healthy" knee.
 


Thank you all for all of your advice and input.

The appointment went really well last Saturday and I can thank you all for the resources you provided as a brush up on my anatomy.

The scar tissue was minimal and really was mostly in the patellar tendon which I think was resulting from where the surgeon had removed tendon there to repair the ACL although I will say it was not on the left knee.

There were definite restrictions and/or adhesions in the fascial compartments between Peroneus Longus and Brevis on the side of the ACL repair and some issues in the Adductors, and Gracilis.

So I think the work was very effective and brought some awareness around for the client around the muscles surrounding the knee, not just the knee.

I really enjoyed working with this client and pushing myself to delve into detail in regards to an injury which is not something I do a lot of with my practice since I am giving a lot of massages focusing on stress relief and tension patterns, not sports massage yet.

I am going to be taking some CEUs in just specific injuries and how to most effectively work with the clients who have them. As well, I think I am going to just start making it part of my weekly study to produce a pretend client with a specific injury and research how exactly I would work with it to get myself on a new level in practice. Some I know already but I really want to delve into what happens with specific surgeries for instance like this ACL example where a tendon is repaired by using the tissue of a different one and how that ultimately can effect not just the repaired one but everything around it.

I love this forum and all of the great members that contribute.

Thanks again!
 


I am going to be taking some CEUs in just specific injuries and how to most effectively work with the clients who have them. As well, I think I am going to just start making it part of my weekly study to produce a pretend client with a specific injury and research how exactly I would work with it to get myself on a new level in practice. Some I know already but I really want to delve into what happens with specific surgeries for instance like this ACL example where a tendon is repaired by using the tissue of a different one and how that ultimately can effect not just the repaired one but everything around it.


Glad it went well for you. This type of work can be career saving as it stimulates your thought processes for years and I personally don't get as burnt out.
I highly recommend Whitney Lowes "Functional Assessment in Massage Therapy". The book was written for LMTs as a quick reference and we use it as our curriculum book. We study it extensively. Too bad you aren't in our part of the country. What you want to learn is a big part of our program. 8)
 
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  32. AliceSpa:
    THURSDAY at ๐—”๐—Ÿ๐—œ๐—–๐—˜ ๐—ฆ๐—ฃ๐—”.4915 Steeles Ave. E, Scarborough ๐Ÿฐ๐Ÿญ๐Ÿฒ-๐Ÿฎ๐Ÿต๐Ÿด-๐Ÿฌ๐Ÿด๐Ÿต๐Ÿด. 3 girls here today at ALICE SPA. Open 10am to 9pm: BEBE is a young slim Vietnamese girl with a beauty face, C Cup, 5'2" & 100 Lbs, student and model looks, vg at fs multiple positions, bbbj ymmv must be clean and respectful. KITTY (12pm-9pm) is a new Korean girl, super busty, small body, new to the business.
  33. Moneylee:
    All season wellness center: Young girl big boobs beautiful face deep massage Midi,Young girl big boobs beautiful face deep massage Tina ,Young girl big breasted beautiful buttocks charming temperament big boobs Cindy ,Student big boobs buttocks Vicky, Enchanting sexy petite deep massage Sherry ,๐Ÿ address: #5-30 Rambler dr Brampton ,Ontario L6W 1E2โ˜Ž๏ธ4376655510 ๐Ÿˆต๏ธ๐Ÿˆต๏ธ๐Ÿฆต๐Ÿฆต๐Ÿ‘…๐Ÿ‘…๐Ÿ‘„๐Ÿ‘„
  34. SL East Spa:
    ๐Ÿ’†โ€โ™€๐Ÿ’–Terrific Thursday ๐Ÿ’– Ultimate destination for Asian massages๐ŸŽ‰ Two fab spots: SL Richmond Hill & SL West Oakville โœจ Your passport to paradise with 9 enchanting girls fr China, HK โ€” ๐Ÿ†•Tiffany, Joey, Julie, Aaliyah, Coco, Yui, Meghan, Julia & New 34D Jasmineโ€”โ€” ready to pamper you๐ŸŽ๐Ÿ Ring us ๐Ÿ“ž647-695-6354 or text us ๐Ÿ“ฑ647-578-8169โœจ 160 East Beaver Cr., Unit 12, RichmondHill ๐Ÿ’ฐWhere Eastern charm meets Western comfort - your bliss awaits๐Ÿ™Œ
  35. Moneylee:
    Full season wellness center: young girl pretty face nice figure Thai deep massage Vivian , pretty face nice figure Thai deep massage Yuki ,Young girl big breasted beautiful buttocks charming temperament big boobs Anjoo ,Young girl Big breasted saucy naughty Ella,Enchanting sexy petite deep massage Mary. 2560 Shepard ave Mississauga unit 1 .โ˜Ž๏ธ4379857899๐Ÿ‘…๐Ÿ‘…๐Ÿˆต๏ธ๐Ÿˆต๏ธ๐Ÿ‘„๐Ÿ‘„๐Ÿฆต๐Ÿฆต
  36. Lilyspa1:
    Lily Spa :๐Ÿ’•๐Ÿ’•Thursday Schedule ๐Ÿ‡ฎ๐Ÿ‡ณ๐Ÿ‡ฎ๐Ÿ‡ณSana 23, , Punjabi girl , very pretty 36 DDD ๐Ÿ˜ˆGFE โค๏ธElena ( Latino ) Big Nature Boobs & SuSu ( Asian )Slim , ๐Ÿ˜๐Ÿ˜Porn Service ๐Ÿ”ฅDuo ๐Ÿ”ฅ,โ˜Ž๏ธ 6475318288
  37. Golden Flower Spa:
  38. BlueXado Therapy & Spa:
  39. Pink Flower Spa:
  40. Golden Sunshine Spa:
    โœจClick on our Username and FOLLOW US for updates and special services ! โœ… Click Here Today๐ŸŒธCassy๐ŸŒธAkame๐ŸŒธIsabella๐ŸŒธVivian๐ŸŒธCindy Call us โ˜Ž 905 - 265 - 2158โ˜Ž๏ธ Your ultimate service awaits! โœจ
  41. HollywoodSpa:
    ๐ŸŽญ๐—›๐—ข๐—Ÿ๐—Ÿ๐—ฌ๐—ช๐—ข๐—ข๐—— ๐—ฆ๐—ฃ๐—”๐ŸŽญ is now CLOSED as of April 30, 2025, due to land use changes. Thanks to all our loyal clients. We hope to reopen soon in a new location. ๐Ÿคž๐Ÿ™
  42. ForeverWarden:
    Thursday at ๐Ÿซฆโค๏ธ๐Ÿ”ด๐ŸŸฅโ™พ๏ธ๐“•๐“ž๐“ก๐“”๐“ฅ๐“”๐“ก ๐“ข๐“Ÿ๐“โ™พ๏ธ๐ŸŸฅ๐Ÿ”ดโค๏ธ๐Ÿซฆ๐Ÿซฆ2190 Warden Ave, Unit 201, Scarborough ๐Ÿฐ๐Ÿญ๐Ÿฒ-๐Ÿด๐Ÿฌ๐Ÿฌ-๐Ÿณ๐Ÿด๐Ÿด๐Ÿณ: Cindy, Sophia & Tracy. Cindy is a slim beauty, 5โ€™4โ€, natural C Cups. Her massage is nice, her services will drive you wild & her finish is a dream come true. Sophia is a sweet & pretty Chinese lady with natural B Cups and an awe-inspiring smooth rounded ass. Sophia can provide top notch services
  43. wilson holistic centre:
    new girl Tina works at ๐Ÿ’‹535 Evans Ave today ๐Ÿ’•๐Ÿ’•๐Ÿ’•โ˜Ž๏ธโ˜Ž๏ธ416-531-6969โ˜Ž๏ธโ˜Ž๏ธ
  44. HolidaySpa:
    Thursday at ๐ŸŒด๐Ÿ˜Ž๐ŸŒ…๐“—๐“ธ๐“ต๐“ฒ๐“ญ๐“ช๐”‚ ๐“ข๐“น๐“ช๐ŸŒ…๐Ÿ˜Ž๐ŸŒด3517 Kennedy Rd, Unit 4, Scarborough โ˜Ž๏ธ๐Ÿฐ๐Ÿฏ๐Ÿณ-๐Ÿฎ๐Ÿฐ๐Ÿณ-๐Ÿญ๐Ÿญ๐Ÿต๐Ÿตโ˜Ž๏ธ: ANGELA, LUCY & CINDY. Angela is versatile and responsive. LUCY is a beautiful and slim Asian lady with a happy disposition and great services. CINDY is a slim & incredibly sexy lady with a smile that will melt your heart, & an ass that will fire up your spirit.
  45. SugarLoveSpa:
    Thursday at โค๏ธ๐Ÿ’™ ๐Ÿ’œโŽ๐—ฆ๐—จ๐—š๐—”๐—ฅ ๐—Ÿ๐—ข๐—ฉ๐—˜ ๐—ฆ๐—ฃ๐—”โŽ ๐Ÿ’–๐Ÿ’—๐Ÿ’˜: LUNA, MIA, SARA & TIFFANY. 1270 Finch Ave W (at Keele St), Unit 18. North York, ON โ˜Ž ๐Ÿฐ๐Ÿฏ๐Ÿณ-๐Ÿฏ๐Ÿฒ๐Ÿฑ-๐Ÿฎ๐Ÿฒ๐Ÿด๐Ÿด โ˜Ž LUNA is a slim, VERY PETITE and capable Vietnamese beauty, nice natural 34C Cups. Luna can do everything. MIA is a young & slim ๐™Ž๐™‹๐™„๐™‰๐™‰๐™€๐™, very PRETTY & PETITE Vietnamese beauty with perfect natural A Cups, 5โ€™1โ€ & 90 Lbs, very versatile. Come and enjoy.
  46. wonderspa:
    ๐ŸŒบwelcome to wonder spaโ˜Ž๏ธ416-5000-800,L6a4H8๏ผŒopen10 to10.on Thursday ,Ensuit shower available ๐Ÿ…beautiful Jessica come back,deep tissue to relax massage and nice body slide๐Ÿ…sunny very good looking,big breasted sweet sensual touch really popular ๐ŸŒนlong hair young beautiful Lucy,friendly smile,back walk ,strong massage,hot stone,got more experience,relief your stress๐Ÿ”ฅmust try
  47. Annie Spa:
    Our famous sexy superstar Suki is BACK @ ANNIE SPA and working today Thursday May 1st with busty 36DD new young girl Bobo, Sexy Little Kitten Kitty and Sweet Sensual Busty Coco๐Ÿ”ฅ๐Ÿ˜˜ Suki only works on Thursdays and her schedule gets booked up very quickly so book your appointments well in advanceโ€ฆitโ€™s always a very special and busy day at Annie Spa when Suki is working ๐Ÿ’ฏ๐Ÿ˜˜โค๏ธ๐Ÿฅฐ Call Annie Spa and ask for May to book appointments ๐Ÿ’ฏโค๏ธ๐Ÿ™๐Ÿป 1001 Sandhurst Circle Unit #7 Finch and McCowan
  48. Jennyโ€™s Spa:
    ๐ŸŽ‰๐Ÿ’JENNYโ€™S SPA๐ŸŽ‰๐Ÿ’ โœ…5170 DUNDAS STREET WESTโœ… ๐Ÿ‘ŒETOBICOKE ONTARIO M9A 1C4๐Ÿ‘Œ โ˜Ž๏ธ( 647-893-5196)โ˜Ž๏ธCall or Text โ˜Ž๏ธ( 437-888-3759)โ˜Ž๏ธCall Only (ETOBICOKE) OPEN 10am to 9pm MONDAY to SUNDAY ๐Ÿ”ฅโœ…GRAND OPENING๐Ÿ’ฏNEW GIRLS EVERYDAY๐Ÿ”ฅEXCELLENT MASSAGE + SERVICE QUEENS NOW AVAILABLE AT JENNYโ€™S SPA FOR ALL YOUR MASSAGE AND SPECIAL EXTRA NEEDS๐Ÿ”ฅ๐Ÿ’ฏ๐Ÿ˜˜๐Ÿ”ฅโค๏ธ๐Ÿ‘Œ ๐Ÿ”ฅTWO BEAUTIFUL NEW YOUNG ASIAN GIRLS EVERYDAY๐Ÿ”ฅ ๐Ÿ’ฏREAL PICTURES OF ATTENDANTS๐Ÿ’ฏ ๐Ÿ”ฅ๐Ÿ’‹Limited Time Special Promotion๐Ÿ”ฅ๐Ÿ’‹ โœ…๐Ÿ’ฆ30 Minutes Nude Mass
  49. luckywellness:
    Lucky Wellness Center 4379721888 295 Eglinton Ave E,Unit 7,Mississauga Today we had two girls, Suki and Kiki. They were both young, pretty and cute. The massage and back massage were both great.
  50. Lulu1980:
    Phoenix Blossom Spa ๐ŸŒน๐ŸŒน๐ŸŒน2 girls๏ผŒNina ใ€Cindy ๐Ÿ”ฅ๐Ÿ”ฅ๐Ÿ”ฅ5124 Dundas St W Etobicokeโ˜Ž๏ธ416-817-3366๐Ÿ‘ Table Shower Sea Salt Bath Body Scrub๐Ÿ˜˜ Japanese girl Nina โค๏ธ Natural Big Boobs 38 DD ๐Ÿ˜˜Pink Mini Nipples Hot body slide, super enjoyable๐Ÿ˜˜๐Ÿ˜˜๐Ÿ˜˜๐Ÿ˜˜ very provocative service๐Ÿ˜˜๐Ÿ˜˜๐Ÿ˜˜, professional super Nice Mia sexy girl 1.65 M.pretty boobs 36D๐Ÿ˜˜Superb service ๐Ÿ‘ massage, has therapeutic effect to loosen bones and relieve muscle pressure and will bring you unexpected service effects, she will bring
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