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CONNECTIONS Be sure to become skilled in joint mobilization techniques on the joint itself to help restore proper mechanics. All of these complex feedback loops occur from the simple restriction to knee extension. Remember the chicken- egg relationship with the joint and the muscles. The lack of proper joint movement will cause the muscles to shorten, but these shortened muscles will solidify improper joint movement if the walking pattern becomes ingrained. Be sure to become skilled in joint mobilization techniques on the joint itself to help restore proper mechanics. The best news is that these techniques work equally well for restoring proper movement patterns after injury to the feet, ankles, and hips. Although one can understand these kinesiological principles at a cerebral level, by far the best way to understand what is happening in your client's body is to feel the sensations in your own experience by mimicking the limping pattern. What joints aren't moving? What muscles are contracting improperly? If you simply concentrate to prevent your knee from straightening, you will experience the profound compensations from the toes up through the hips as you walk. In classes, I actually have students tape their knees to prevent full knee extension. I also have them experiment with placing a pebble in the forefoot or heel of their shoes. This is an excellent way to feel both the joint and muscular adaptations to pain or discomfort, and will enable a strategy for treatment. TREATMENT 7: BALANCING SECONDARY COMPENSATIONS Now we can move to some techniques to return proper function to secondary areas that respond to knee dysfunction. Work to satellite areas is extremely important because of their tendency to reinforce limping patterns. Until proper function is returned to the primary site of injury, the secondary compensatory patterns will persist. It is perfectly appropriate to work on secondary compensations throughout your treatments because they often cause discomfort as they adapt. However, your primary goal should be to return the primary injury site to health as soon as possible, and then focus on the feet and hips. FREEING THE TOES, TRANSVERSE ARCH, AND PLANTAR FASCIA With a limping gait, the feet become stiff and inflexible as they land similar to wearing a very stiff-soled shoe that prevents the toes from flexing and providing power on toe off. Working in the end range of motion is the key to this technique. With soft fingers, bend the toes as far as possible into an upward dorsiflexed extension. With knuckles or fingers patiently work the area of the metatarsal heads with both cross- fiber strokes and in the direction of lengthening of tissue. Broaden your goals to soften the entire planar fascia. The biomechanics of stretching the foot into dorsiflexion in either the prone or supine position can be difficult when the leg is straight. This technique offers the advantages of using your body weight, being able to exert strong pressure to dorsiflex the ankle, and the use of the broad and comfortable tool of your forearm. This technique is also useful to treat plantar fasciitis. IMPROVING ANKLE MOVEMENT The front of the ankle is surrounded by a fibrous retinaculum that can stiffen the ankle joint like an Ace bandage, limiting both plantar flexion and 92 massage & bodywork january/february 2009