 For a left knee, the right thumb pushes the patella in a medial direction. The left hand is in supination ; the ring finger, reinforced by the middle finger, exerts an anterior pressure on the back of the patella.
The deep friction massage is the normal execution, i.e. a reserve of skin in a cranial direction, then pressure is applied, the active phase is a caudal movement with pressure in an anterior direction. It is an arm not a finger movement. The forearm remains parallel to the patient's leg. For practical reasons, the deep friction is done in a caudal direction.
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