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Myofascial techniques However, the interosseous membrane of the leg (Image 4) resists this imbalanced downward pull on the fibula through its obliquely angled fibers, which are oriented to stabilize the fibula against the downward pull of the numerous leg muscles. • The middle part of the fibula is sometimes used for bone graft reconstruction of the mandible. When "harvested," the fibula's ends are carefully left in place—the distal end, because of its special role in forming the ankle mortise, and the proximal end because of its close association with the peroneal nerve. • The fibula does not articulate with the femur, of course, making it functionally related more to the ankle than the knee, at least in humans; in some animals, the fibula does not articulate with their foot bones or their femurs, making their fibulae free at both ends. In horses, the tibia and fibula form a single joined bone. Working the fibula is part of a bigger picture, of course. For example, you can prepare for the techniques in this article by addressing any restrictions related to tight gastrocnemius or soleus ("Working with Ankle Mobility, Part 1," Massage & Bodywork, March/April 2011, page 110), which are a logical compliment to the work described here. Ankle pronation/ supination, hip/knee/ankle alignment, as well as hip and femur rotation are all aspects to consider and address as part of your overall work with ankle and lower leg issues ("Working with Hip Mobility," Massage & Bodywork, March/April 2012, page 114). Notes 1. American Academy of Orthopaedic Surgeons, "Sprains and Strains: What's the Difference?" accessed June 2013, http://orthoinfo. aaos.org/topic.cfm?topic=A00111. 2. K. L. Margo, "Review: Many Adults Still Have 3. D. Hartzell and M. Shimmel, Don't Ice that Ankle Sprain! (Ohio: Jump Stretch Inc., 2006). 4. I. A. Kapandji, Physiology of the Joints Volume II, 5th ed. (Philadelphia: Elsevier, 1987), 164. 5. There is some disagreement about the way in which fibular rotation is coupled with ankle movement. 7 Although Kapandji The Fibular Head Technique. Check for and release anterior/posterior (1987) describes mobility. Avoid pressure on the common peroneal nerve (yellow, Image 9) the opposite, most where it lies posterior to the fibular head. (The fibula is colored green; the references surveyed knee's many bursa are shown in blue.) Images 7 and 8 courtesy Advanced- for this article agree that the fibula rotates Trainings.com. Image 9 courtesy Primal Pictures. Used by permission. externally when the ankle dorsiflexes. One study [M. Bozkurt et al., "Axial Rotation and Mediolateral Translation of the Fibula During Passive Plantar Flexion," Foot Ankle International 29, no. 5 (2008): 502–7] showed variations in extension-coupled rotational direction 9 8 between different individuals. There is also little agreement on the amount of rotation, with cited measurements ranging from 2 degrees [A. Beumer et al., "Kinematics of the Distal Tibiofibular Syndesmosis: Radiostereometry in 11 Normal Ankles," Acta Orthopaedica Scandinavica 74, no. 3 (2003): 337–43] to 30 degrees (Kapandji, 1987) of malleolus rotation. 6. J. H. Calhoun et al., "A Comprehensive Study of Pressure Distribution in the Ankle Joint Til Luchau is a member of the AdvancedTrainings.com faculty, which offers distance learning and in-person seminars throughout the United States and abroad. He is a Certified Advanced Rolfer and the originator of the Advanced Myofascial Techniques approach. Contact him via info@advanced-trainings.com and Advanced-Trainings.com's Facebook page. with Inversion and Eversion," Foot & Ankle International 15, no. 3 (1994): 125–33. 7. T. P. Rüedi et al., eds., AO Principles of Fracture Management (Switzerland: AO Foundation Publishing, 2007). 8. B. Vicenzino et al., "Mulligan's MobilizationWith-Movement, Positional Faults and Pain and Subjective Instability at 1 Year Pain Relief: Current Concepts from a After Acute Lateral Ankle Sprain," Evidence- Critical Review of Literature," Manual Based Medicine 13, no. 6 (2008): 187. Therapy 12, no. 2 (2007): 98–108. www.abmp.com. See what benefits await you. 117