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ESSENTIAL SKILLS CONCLUSION The fibularis brevis and longus play an important role in supporting the lateral foot, leg, and ankle. When these structures get injured, the most important step is an accurate assessment, which can sometimes be tricky; in particular, it's easy to overlook a fibularis tendon injury when a lateral ankle sprain is present as well (which happens quite frequently). Once you've pinpointed the damaged fibers, the treatment for these easily accessible structures is relatively straightforward. When treatment is given twice a week, standard healing times are 4–6 weeks for minor strains and 8–12 weeks for more serious strains, with many clients healing more quickly. Overall, the long-term prognosis for these injuries is very good. Inner-Ankle Lift This exercise requires the same props as the Outer-Ankle Lift, but is done from a sitting position. To begin, have the client sit in a chair and cross the injured leg over the good leg, with either the weight apparatus or the loaded shopping bag across the forefoot (the front part of the foot, just behind the toes). Now instruct the client to raise the foot toward the ceiling 5–10 times, take a brief rest, and repeat (Images 8 and 9). Don't use too much weight to start; begin with a lighter weight and gradually build up to using 5–10 pounds over the course of the treatment. The client should begin to feel tired after 5–10 repetitions. These exercises should not cause any pain. If either of them does, it means the person is using too much weight or is not yet ready to begin that exercise. ACTIVE ISOLATED STRETCHING TECHNIQUE Practitioners who are trained in Active Isolated Stretching (AIS, described in my articles in the May/June 2010 and July/August 2010 issues, pages 88 and 90, respectively) will want to perform a number of AIS techniques for the lower leg. The following stretch targets the fibularis muscles and is particularly beneficial. To stretch the fibularis, lift the leg on the injured side until the hamstring is taught and the knee wants to bend. Now put the lower calf on your shoulder and ask the client to invert the foot. Wrap your hands around the foot and ask the person to pull the toes toward the nose (dorsiflex the foot). Do this about 10 times, stretching for no more than two seconds each time. ORTHOTICS In some cases, an orthotic device can help to relieve stress on the muscles and tendons of the foot, helping to prevent future damage from occurring. If you think that foot alignment or structural issues may have contributed to the client's injury, refer the person to a podiatrist. in education and sports medicine. He is founder of the Muscular Therapy Institute. Benjamin has been in private practice for more than 45 years and has taught communication skills as a trainer and coach for more than 25 years. He teaches extensively across the country on topics including orthopedic massage, Active Isolated Stretching and Strengthening, SAVI communications, and ethics, and is the author of Listen to Your Pain (Penguin, 2007), Are You Tense? (Pantheon, 1978), and Exercise Without Injury (MTI, 1979), and coauthor of The Ethics of Touch (Sohnen-Moe Associates, 2003). He can be contacted at 4bz@mtti.com. Ben E. Benjamin, PhD, holds a doctorate Editor's note: Massage & Bodywork is dedicated to educating readers within the scope of practice for massage therapy. Essential Skills is based on author Ben E. Benjamin's years of experience and education. The column is meant to add to readers' knowledge, not to dictate their treatment protocols. connect with your colleagues on massageprofessionals.com 95