Massage & Bodywork

MARCH | APRIL 2023

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neural movement and frequently contribute to pain. A concern at the later stages is the development of neural sensitization. Continual irritation of the nerves can cause localized or even generalized neural hypersensitivity. As a result, any sensory irritation can exacerbate the pain beyond what should be normal. It may also cause the increased sensitivity to extend up the lower leg and potentially up through the lower extremity. There is no easy way to combat neural sensitization, but smooth, easy gliding and myofascial techniques can relax and calm the tissues. Positional release is particularly helpful as well. Beneficial techniques: 3, 4, 5, 6, 9 Morton's Neuroma: The main issue with Morton's neuroma is that the distal metatarsal heads are squeezed together, thereby pinching the digital plantar nerves. Shoes with a narrow toe box that squeeze the metatarsal heads together are the primary culprit. The best treatment strategy for this nerve compression is to relieve the pressure by choosing a shoe or boot with a wider toe box. A simple footwear change can resolve the issue. Neural mobilization, metatarsal spreading, and metatarsal mobilization will help to decrease pressure on the nerve. However, if the individual experiences the same biomechanical factors that caused the nerve compression in the first place (shoes with a narrow toe box, for example), the compression and pain will continue. The same concerns about neural sensitivity in later stages or severe conditions are applicable here. Beneficial techniques: 1, 2, 7, 8, 9 Muscle-Tendon Pathology Muscles in the posterior leg have tendons that extend into the bottom of the foot. When these muscle-tendon units are under high tension, they can pull on their attachment sites on the plantar surface of the foot, causing plantar foot pain. This pain is often due to hypertonicity and dysfunction of the muscles. Any muscles in the lower leg or foot that act on the bones of the foot may be involved in muscle or tendon pathology. Treatment often involves working on the lower-leg muscles, as the contractile portion of these muscles is in the lower leg, even though their tendons reach into the foot. Massage techniques should aim to address not only the directly affected muscles but also other muscles in the kinetic chain. Reducing symptoms helps calm the nervous system, even if long-term physical changes to the tissues are not being made. As mentioned earlier, chronic irritation from nerve compression can lead to neural sensitization. It is also feasible that continual irritation from muscle-tendon pathology, trigger points, or unresolved pain could lead to neural sensitization. The most helpful massage strategies will address the affected muscles and other associated muscles that are part of the kinetic chain in the region. Keep in mind that the key rehabilitation goal is to reduce symptoms and settle the nervous system. We don't need to make long-term physical changes to these tissues to have beneficial treatment effects. Beneficial techniques: 1, 2, 3, 4, 6 IN SUM Foot pain can be debilitating and lead to serious conditions that limit physical activity. We put extraordinary loads on the lower extremities daily. The simple act of walking or running can put several times our body weight on each foot strike. These cumulative loads can lead to any foot and leg complaints discussed in this article series. Unfortunately, the feet and legs are sometimes ignored in massage treatment. Yet lower-extremity massage has resounding effects throughout the kinetic chain of our body. Pain that we might think is in the upper back and cervical region may have initiated in the lower extremities. We help our clients the most when we address the entire body and appreciate the role of the lower extremity. Massage is a powerful treatment for lower-body conditions, bringing clients back to function after severe pain and dysfunction. Whitney Lowe is the developer and instructor of one of the profession's most popular orthopedic massage training programs. His text and programs have been used by professionals and schools for almost 30 years. Learn more at academyofclinicalmassage.com. L i s te n to T h e A B M P Po d c a s t a t a b m p.co m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 25 TECHNIQUE 3

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