Massage & Bodywork

July/August 2013

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technique @work | the science of movement | | Energy work | Myofascial techniques Working with the Fibula By Til Luchau The fibula gets short shrift. Overlooked and underrated as a mere "outrigger" of the leg, the fibula is one of the body's many structures that help balance the exquisitely paradoxical qualities of stability and adaptability (Image 1). As such, fibular mobility plays an important role in normal movement and in recovery from ankle injuries (of which there are an estimated 25,000 per day), yet many hands-on practitioners ignore it. While modern Latin-derived languages call it the "peroneal bone" (from the Greek word for "pin"), for about 300 years, English texts have used the Latin word fibula, which also signifies the pin of a brooch, buckle, or clasp. It is this clasp-like relationship of the fibula with the tibia, much like the two sides of a safety pin (Image 2), which helps the ankle mortise to hold the foot's talus bone in a springy but firm grip at the distal tibiofibular joint (Image 3). It is this joint's combination of resilience and firmness that allows the ankle hinge to be stable enough to support our weight, but to swing freely in plantarflexion and dorsiflexion. 1 It is the ankle's strong ligaments that give it the adaptability to spring back (in most cases) when stressed. When forces are too great for the ligaments, they can slightly, partially, or completely tear—known as Grade I, II, or III sprains, respectively. The tibia, fibula, and talus can also fracture in more severe injuries. Ankle injuries of all severities cause damage to the joint capsules, tendons, retinacula, and fascial layers of the lower leg, which are often responsible for much of an injury's swelling, pain, and discoloration. Injury to these connective-tissue structures is more common than serious ligamentous or bone damage. While many sources agree that some of the ankle's connective tissues can recover from many injuries relatively quickly, the conventional view is that if the ligaments themselves are compromised, recovery can take anywhere from 6 weeks to 1 year for moderate to severe sprains, according to the American Academy of Orthopaedic Surgeons, which also advises that "patience and learning to cope with an injury is essential to recovery."1 Or it may take even longer—one study says that as many as 30 percent of those who injure their ankles still have pain after one year.2 Views vary though, and others claim that by encouraging gentle movement and increased blood flow early in an injury (rather than 2 Analogies used to understand the fibula's function include a canoe's outrigger (Image 1) and a safety pin (Image 2). Fibula means pin or clasp. 114 massage & bodywork july/august 2013 3 An X-ray image of the ankle mortise—the fibula and tibia's clasp-like relationship with the foot's talus bone. Balanced bony mobility is crucial to protect the thin articular surfaces from stress and degeneration.

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