Massage & Bodywork

September/October 2009

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ANTERIOR TIBIALIS INJURIES In the last issue ("Posterior Tibialis Injuries," Massage & Bodywork, July/August 2009, page 92), we looked at the posterior tibialis, a muscle-tendon unit located at the posterior medial lower leg. In this article, we'll examine its counterpart at the anterior portion of the leg: the anterior tibialis. Contraction of this muscle-tendon unit both inverts and dorsiflexes the foot. The anterior tibialis plays a key role in walking and running, helping to control the foot's descent to the ground as the muscle lengthens (eccentric contraction) and to lift the foot off the ground as the muscle shortens (concentric contraction). If you dorsiflex your foot with your shoes and socks off, you can see the anterior tibialis tendon protruding at the anterior aspect of your ankle. Try tracing the tendon's path with your finger. As you follow it distally, it crosses the center of the ankle and extends to the middle of the medial arch on the medial aspect of the foot. As you follow it proximally, it leads to its controlling muscle (Image 1). The anterior tibialis muscle originates at the lateral condyle of the tibia and the upper portion of ANTERIOR TIBIALIS puffiness at the front of the ankle or a creaking sound when the foot is moved. (The creaking sound indicates an inflammation of the thin sheath covering the tendon, a condition referred to as tenosynovitis.) This injury can easily be confused with a compression of the L4 nerve root by a protruding disc, a serious low-back injury that causes loss of control of the foot during walking ("foot drop"). Injuries to the anterior tibials ANTERIOR TIBIALIS TENDON muscle are colloquially referred to as "shin splints." When the tendon is strained, pain may be felt anywhere from the inner arch of the foot to about four inches above the ankle. In some cases, only a small portion of the tendon is painful; in others, pain is felt throughout the entire tendon. Putz/Pabst: Sobotta, Atlas der Anatomie des Menschen, 21st ed. 2000 © Elsevier GmbH, Urban & Fischer München the lateral surface of the tibia. As it progresses distally toward the foot, it attaches to various structures, including the interosseous membrane between the tibia and fibula, the deep surface of the fascia, and the intermuscular septum, ending at the anteriomedial dorsal aspect of the foot. It inserts into the medial cuneiform bone and the base of the first metatarsal bone. When the anterior tibialis muscle- tendon unit is injured, it is painful to walk. There may also be some HOW AND WHY THESE INJURIES OCCUR On occasion, a severe anterior tibialis injury may happen suddenly as the result of a fall, a long jump, or another event that causes extreme stress, such as running a marathon without adequate preparation. Typically, however, these injuries develop slowly, gradually worsening over a period of several weeks or months. Often, the discomfort first appears after a hard volleyball or soccer game, a long run, a rigorous hike, or another strenuous activity that causes the muscle to fatigue and excess stress to be absorbed by the tendon. While the pain is not too bothersome at first, as the weeks progress it is present more often and for longer periods of time. It seems better with rest, but gets bad again when the person is active. When the injury becomes severe, simply walking or dorsiflexing the foot causes pain. If only the muscle fibers are connect with your colleagues on massageprofessionals.com 103

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