Issue link: https://www.massageandbodyworkdigital.com/i/77400
YOU CAN SEE THESE TECHNIQUES IN MASSAGE & BODYWORK'S DIGITAL EDITION, WHICH FEATURES A VIDEO CLIP FROM ADVANCED-TRAININGS.COM'S ADVANCED MYOFASCIAL TECHNIQUES DVD AND SEMINAR SERIES. THE LINK IS AVAILABLE AT BOTH MASSAGEANDBODYWORK.COM AND ABMP.COM. superficial to the short toe flexors and just deep to the subcutaneous fat of the heel. Plantar fasciitis is a common inflammatory condition of this layer. It is characterized by heel and mid-foot pain, most often with point tenderness at the plantar fascia's insertion on the distal and inferior surfaces of the calcaneus. Contributive factors include improper foot and leg biomechanics, overuse, and fascial shortness in the calf or hamstrings. Direct work with the plantar surface of the foot, including the plantar fascia, is indicated when clients report a stretch or pain in the sole with the Dorsiflexion Test. Local plantar pain, cramping, and stiffness are also indications for using this technique, as is plantar fasciitis. Because plantar fasciitis involves Use the Gastrocnemius Technique all the way to the gastrocnemii origins on the posterior side of the distal femur. Also visible in this view are the peroneus longus and brevis (transparent), which, like the gastrocnemii, can also limit dorsiflexion. Image courtesy Primal Pictures. Used with permission. dorsiflexion initiate and pace your movement. Once you've felt the outer layers lengthen, feel into the deeper Achilles tendon and the conjoined heads of the gastrocnemius and soleus itself. Continue the active movement as you gradually work deeper on each pass. Check in frequently with your client about pace and depth. As postural muscles that are always engaged when standing, the gastrocnemius complex can be particularly tender, especially at deeper levels. Since the long toe flexors can also restrict dorsiflexion, ask for active toe extension in combination with dorsiflexion. This combination of movements will increase the effects of this technique by lengthening the deepest structures in the calf. As long as your client is comfortable and able to relax into the work, you can also add an additional measure of passive gastrocnemius stretch with your leg (Image 4). Use your soft fist or gentle finger pressure to work all the way to the proximal origins of the medial and lateral gastrocnemius heads on the posterior femur (Image 5), being cautious around the nerves in the popliteal fossa at the back of the knee. PLANTAR FASCIA TECHNIQUE The sole of the foot has alternating layers of broad connective tissue strata, short strong muscles, and long cord- like tendons and ligaments. Shortness in any of these layers can limit dorsiflexion through their collective continuity with the gastrocnemius/ soleus complex (Image 1, page 110). The plantar fascia is a strong, fibrous layer covering the entire sole, lying tissue inflammation, avoid working directly on the most painful areas (usually the proximal attachments on the calcaneus). Instead, lengthen, release, and ease the entire plantar surface around the points of greatest tenderness. Recalcitrant, or stubborn, plantar fasciitis is treated surgically by "releasing" (partially severing) the plantar fascia, with the aim of relieving the strain on the inflamed attachments. Our intention is similar, even though our methods are different—instead of severing the fascia, feel for a lengthening release in both of the techniques described here. In combination with hamstring or peroneal work, clients often show tangible improvement in the degree of plantar tenderness within one or two sessions. A longer series of sessions is often necessary for chronic suffers, as well as regular stretching, a change in usage patterns, and improved biomechanics (via methods like orthotics, structural integration, movement instruction, or improved footwear). earn CE hours at your convenience: abmp's online education center, www.abmp.com 113