Massage & Bodywork

July/August 2012

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technique CLASSROOM TO CLIENT | @WORK | ESSENTIAL SKILLS | MYOFASCIAL TECHNIQUES Working with Hammertoes: the Lower Leg By Til Luchau Small things can have very big effects. Toes are an excellent case in point: when they are painful or don't bend properly, as in a hammertoe condition (Image 1), they make standing unbearable, throw off your stride, affect your balance, and cause other troublesome compensations throughout your body. In our last article (May/June 2012, "Working with Hammer Toes: the Foot," page 112), I described the mechanisms of hammertoe contracture, specifically the tendency for both the extensors and flexors of the toes to be simultaneously contracted (Image 2). I also talked about ways to work with the short toe flexors and extensors, as well as with the ligaments and tissues of the toes themselves. When shortened, these are the main structures within the foot itself that contribute to hammertoe conditions; however, the foot structures are just part of the picture. 1 Flexors Hammertoes involve simultaneous shortening of the toe flexors and extensors (Images 1 and 2). The extensor (red) and flexor (green) digitorum longus (red, in anterior tibia) originate in the lower leg (Image 3). Also pictured are the flexor digitorum brevis and minimus (red, in foot), discussed in the previous article. Image 1 courtesy Healthwise; Image 2 courtesy Advanced-Trainings. com; Image 3 courtesy Primal Pictures. All used by permission. Extensors 2 FLEXOR DIGITORUM LONGUS TECHNIQUE While working with the shorter structures within the foot is an essential part of addressing hammertoe patterns, the long toe flexors and extensors (Image 3) exert even more contractile force than their shorter brevis cousins. Originating in the lower leg, the long flexors and extensors cross the ankle and attach to the most distal bones of the toes, powerfully assisting in balance, jumping, stride push-off, toe pointing, etc. As with their shorter brevis cousins within the foot, when both the long flexors and extensors are shortened, they buckle the distal interphalangeal (DIP) and proximal interphalangeal (PIP) joints (the joints of the toe itself ), as well as the metatarsal phalangeal (MTP) joint at the base of the toe. Even though they affect the toe joints, the main part of the long toe flexors and extensors are in the lower leg. We'll release them there by utilizing the Golgi tendon organ reflex. When stimulated with a combination of pressure and active movement, the Golgi tendon organs (which are often concentrated near a muscle's attachments to the periosteum) signal the motor units' alpha motor neurons (via synapses in the spinal cord) to lower that muscle's firing rate. With a minimum of effort on the part of the practitioner, working a muscle's attachments and stimulating this Golgi response results in a reduction in local tone, and finer global movement coordination.1 3 114 massage & bodywork july/august 2012

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