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CLINICAL E XPLORATIONS flexion. The client is instructed to keep a slow and rhythmic movement of dorsiflexion and plantar flexion. The practitioner applies short stripping techniques to the PT along the medial border of the tibia each time the client moves the foot into dorsiflexion. This technique is most effective if it is applied as the muscle elongates (the movement of dorsiflexion). One theory about the effectiveness of active engagement techniques is that the process of actively contracting the muscle while it is being worked helps encourage proper neurological signaling of the muscle and may simultaneously reduce some of the noxious sensory input that causes pain. The amount of pressure applied to the PT should be closely monitored with this technique. It is common for PT treatment to be uncomfortable and tender for the client with only a moderate amount of pressure. It's not helpful to cause additional pain with treatment, so keep pressure levels adjusted accordingly. Eventually, and once excessive hypertonicity in the muscle is reduced, it may be helpful to encourage strengthening and functional movement activities to restore proper biomechanical function and increase tendon conditioning. A beneficial strengthening exercise for the client is standing on their toes. Also helpful is pulling the foot into inversion against resistance, such as with an elastic resistance band. IN SUM The PT is a key player in numerous foot and lower leg problems. In addition, biomechanical results from PT weakness, such as collapsed arches, can contribute to problems much further up the kinetic chain. Massage will not reduce the fallen arch, but is an important strategy in managing the condition and decreasing pain and chronic hypertonicity in the muscles. Your understanding of key biomechanical principles and function of the PT greatly benefit your client's treatment when they face the challenges of this condition. Notes 1. S. K.-K. Ling and T. H. Lui, "Posterior Tibial Tendon Dysfunction: An Overview," Open Orthopaedics Journal 11, Suppl-4, M12 (2017): 714–23. https:// doi.org/10.2174/1874325001711010714. 2. M. Guelfi et al., "Anatomy, Pathophysiology and Classification of Posterior Tibial Tendon Dysfunction," European Review for Medical and Pharmacological Sciences 21, no. 1 (2017): 13–19. 3. K. Yao, T. X. Yang, and W. P. Yew, "Posterior Tibialis Tendon Dysfunction: Overview of Evaluation and Management," Orthopedics 38, no. 6 (June 2015): 385– 91. https://doi.org/10.3928/01477447-20150603-06. 4. B. Durrant, N. Chockalingam, and C. Morriss- Roberts, "Assessment and Diagnosis of Posterior Tibial Tendon Dysfunction: Do We Share the Same Opinions and Beliefs?," Journal of the American Podiatric Medical Association 106, no. 1 (Jan-Feb 2016): 27–36. https://doi.org/10.7547/14-122. Whitney Lowe is the developer and instructor of one of the profession's most popular orthopedic massage training programs. His texts and programs have been used by professionals and schools for almost 30 years. Learn more at www.academyofclinicalmassage.com. Yo u r M & B i s w o r t h 2 C E s ! G o t o w w w. a b m p . c o m / c e t o l e a r n m o r e . 95 5 Treating the posterior tibialis in a side-lying position. Massage will not reduce the fallen arch, but is an important strategy in managing the condition, and decreasing pain and chronic hypertonicity in the muscles.