Issue link: https://www.massageandbodyworkdigital.com/i/135515
In working with any of these gliding motions, your grip is firm but comfortable. Feel bone rather than soft tissue, sensing for a small 1–3 millimeter yielding in each direction, comparing anterior with posterior movement. As long as there is no pain, lean into the more-restricted direction and wait for a release. With any of these techniques, excessive mobility accompanied by joint pain with passive fibular motion may indicate ligamentous damage. In this case, you can be helpful by working very gently, without causing any pain, to encourage subtle mobility and circulation, rather than trying to release bigger mobility restrictions using the deeper pressure more appropriate to scarred tissues or restricted joints. Referral to a rehabilitation specialist may also be indicated. 5 The Distal Tibiofibular Joint Technique combines passive dorsiflexion with pressure into the cleft between the tibia and fibula to restore lateral movement of the fibula. Images courtesy AdvancedTrainings.com. Used by permission. 6 Feel for the gap between the distal end of the tibia and fibula with your thumb (Images 5 and 6) or another tool. Once you've located this fissure between the bones (it's often more lateral than you think), bring your client's ankle into passive dorsiflexion. When the distal end of the fibula is free, this fissure will open or deepen slightly with your passive dorsiflexion as the wedge-shaped talus pushes the fibula laterally. There should be no pain or discomfort; be precise with your touch, but don't be too sharp or pointed. Wait for the joint to respond by a softening or slight widening. While you're here, you can use a similar hand position to assess and release anterior/posterior fibular glide. Feel for evenness of fibular mobility at its distal end by stabilizing the tibia's medial malleolus with your medial hand and using a thumb pad or other broad tool to push the fibula's lateral malleolus posteriorly, feeling for quality and amount of gliding motion. Compare this to pulling the malleolus anteriorly. You can also use your thenar eminence or palm to check for superior glide of the fibula, gently pushing upward on the underside of the lateral malleolus. Pressure in this direction, in combination with a bit of posterior glide, often brings relief after an inversion ankle injury, as these injuries frequently displace the fibula anteriorly in relationship to the tibia.8 116 massage & bodywork july/august 2013 Fibular Head Technique The fibula doesn't have just one end. Although the distal joint takes the brunt of most activities, your work will be more complete if you include the proximal end of the fibula in your work with the ankle. The proximal end of the fibula articulates with the tibia via a synovial joint, which allows a bit of gliding movement in each direction, as well as a small amount of rotation. In addition to being a different kind of joint than the distal syndesmosis, the proximal joint has smoother articular surfaces than the stiffer distal juncture, so is more suited to gliding and translation. Even though the proximal joint is a more mobile structure, in biomechanical testing, it usually moves less than the sturdier distal joint, reflecting the much greater forces at work on the distal end. With your client's knee up (to slacken the biceps femoris, which could otherwise immobilize the fibula), begin by finding a comfortable grip on the distal end of the fibula (Images 7 and 8). Check with your client to be sure you've avoided the common peroneal nerve where it passes just behind the fibular head (Image 9). In contrast to the firm, subtle movement of the distal end, the synovial joint of the proximal head will have a distinct glide to it, with a clear start and stop to its mobile range. Check for front/back fibular mobility against the tibia. As with the lower end, balance the fibula's mobility by comparing one direction to the other and waiting for a softening response in the stiffer direction. Some interesting trivia about the nontrivial fibula: • There are seven named muscles that pull downward or distally on the fibula (extensor hallucis and digitorum longii; peroneus longus, brevis, and tertius; tibialis posterior; and soleus), but only one (biceps femoris) that pulls proximally, leading some anatomists to speculate that the fibula is more often displaced inferiorly.