Issue link: https://www.massageandbodyworkdigital.com/i/1013756
A B M P m e m b e r s e a r n F R E E C E a t w w w. a b m p . c o m / c e b y r e a d i n g M a s s a g e & B o d y w o r k m a g a z i n e 91 A B M P m e m b e r s e a r n F R E E C E a t w w w. a b m p . c o m / c e b y r e a d i n g M a s s a g e & B o d y w o r k m a g a z i n e 91 CLINICAL E XPLORATIONS the person is still likely to continue overpronating. If the strengthening is done in conjunction with orthotics or other interventions that alter motor recruitment patterns, there is a greater likelihood that they will have lasting results. So what role does massage or soft-tissue treatment play in addressing overpronation? While there are no research-based treatment protocols, there are a number of common suggestions for helping overpronation with massage. Suggestions include moderately deep and tissue-specific compression and stripping techniques along the plantar surface of the foot and along the tibial border to access the deep posterior compartment (Image 5). The described intention of these approaches is to increase extensibility of the tissue and make it free to move and reduce overuse trauma. However, a primary issue in overpronation is that the tibialis posterior is not functioning adequately to resist overpronation, so the problem is not that the muscle is too short or contracted. Therefore, the goal may be to reduce hypertonicity, but generally should not be to increase too much extensibility in that tissue. There are some massage technique descriptions that advocate stimulating the muscle and encouraging it to "turn on" or increase motor activity and gain strength. However, there is no significant research to support the idea that any massage technique can strengthen a muscle. That doesn't mean massage is not beneficial in addressing overpronation, but the way in which we use it for this purpose may be different than what we generally think of. Our understanding of the primary effects of massage has changed in recent years. Some of the most profound effects seem to be mostly associated with changes in the nervous system. Consequently, these approaches are helpful to improve proprioceptive responses from the foot and ankle complex to adjust faulty biomechanical patterns. Yet, remember that just because a person is overpronating does not mean there is a pathological issue that has to be fixed. Many people can function just fine with less than ideal biomechanical patterns. The key challenge for us is to determine if it is a mechanical pattern that is leading to other soft-tissue pain and injury problems or if it is an incidental finding that may not necessarily be a root cause of the client's current complaint. Changing the neurological and motor control associated with a particular biomechanical pattern is a complex process. We now recognize that many soft-tissue interventions aren't mechanically changing tissue as much as they are helping make new connections in the brain and nervous system with how the tissues feel and function. Massage therapy remains one of the most powerful and effective strategies for soft- tissue intervention, so despite the fact that we may not be changing structure within the body significantly, what we're doing in treating conditions like overpronation is still incredibly valuable. Whitney Lowe is the developer and instructor of one of the profession's most popular orthopedic massage training programs. His texts and programs have been used by professionals and schools for almost 30 years. Learn more at www.academyofclinicalmassage.com. 5 Conduct deep longitudinal stripping along the tibial border to best access the tibialis posterior. Massage therapy remains one of the most powerful and effective strategies for soft- tissue intervention, so despite the fact that we may not be changing structure within the body significantly, what we're doing in treating conditions like overpronation is still incredibly valuable.