Issue link: https://www.massageandbodyworkdigital.com/i/588318
F r e e S O A P n o t e s w i t h M a s s a g e B o o k f o r A B M P m e m b e r s : a b m p . u s / M a s s a g e b o o k 101 FOOT & LEG REGION Another key factor in MMS is excessive pronation and the corresponding internal tibial rotation. The tibialis posterior is the primary muscle resisting overpronation, and these increased demands can cause overuse problems in the muscle. Stretching a muscle through its range of motion is one way to prevent the detrimental effects of overuse. However, there are anatomical limitations that prevent the tibialis posterior from being stretched to its full length, and, therefore, it is susceptible to developing tightness and myofascial trigger points. The tibialis posterior is also challenging to treat because it is difficult to reach in the deep posterior compartment of the leg. Static compression or active stripping techniques applied during eccentric elongation of the tibialis posterior are very effective to address tightness in this muscle. Static compression techniques can be applied to tight areas of the tibialis posterior by pressing the fingertips right along the medial tibial border. The goal is not to press directly into the tibia, but to press on the soft tissue close to the bone to get at the short fibers of the muscle deep in the posterior compartment. Active stripping techniques for the tibialis posterior are most effectively performed with the client in a side-lying position with the leg being treated lying flat on the table and the medial side facing up (Image 5). Position the lower leg so the foot is off the end of the table and can move freely. Instruct the client to move the foot back and forth slowly through a full range of dorsiflexion and plantar flexion. During the dorsiflexion movement, perform a short stripping technique along the medial tibial border to encourage lengthening of the tibialis posterior. This will reduce chronic tension or trigger points that may have developed in the muscle. It may be difficult to get adequate pressure into this muscle group without any resistance. There simply isn't enough muscular effort required to move the foot through this range of motion while not in a weight-bearing position. Offering additional resistance during stripping or elongation techniques will magnify the effectiveness of this approach. Begin with the client's foot in plantar flexion. Place one hand on the plantar surface of the client's foot near the metatarsal heads while the other hand is used to apply treatment to the tibialis posterior. Instruct the client to hold the position while you attempt to push the foot into dorsiflexion. Once a level of muscle contraction is established, instruct the client to slowly let go of that pressure as you slowly push their foot into dorsiflexion (Image 6) and apply a slow stripping technique along the tibialis posterior, covering about 3–4 inches with each pass. It may take several passes to cover the full length of the muscle. This technique can be painful, so be cautious and check in with your client frequently. IN SUM MMS is a complex biomechanical pattern with numerous challenging components. As noted, some components, such as the broad pelvis or femoral anteversion, are the result of skeletal structure and can't be changed. Other facets have significant ramifications that appear as soft-tissue dysfunction. However, it is important not to "pathologize" someone just because some or all of these postural challenges are present. In many cases, people can adapt to certain postural aberrations without having a problem. When soft-tissue dysfunction does result from some of these postural challenges, these massage strategies can help the client manage those conditions and find pain relief. Note 1. John Fairclough et al., "The Functional Anatomy of the Iliotibial Band During Flexion and Extension of the Knee: Implications for Understanding Iliotibial Band Syndrome," Journal of Anatomy 208, no. 3 (March 2006): 309–16. Learn about Whitney Lowe's innovative, engaging, and interactive instructional designs. Lowe's texts and courses have benefited professionals and schools for more than 25 years. For more information, visit www.academyofclinicalmassage.com. CLINICAL APPS Using additional resistance during stripping techniques will increase your effectiveness. Use active stripping techniques for the tibialis posterior, with the client in a side-lying position. 5 6