Issue link: https://www.massageandbodyworkdigital.com/i/72103
YOU CAN SEE THESE TECHNIQUES IN MASSAGE & BODYWORK'S DIGITAL EDITION, WHICH FEATURES A VIDEO CLIP FROM ADVANCED-TRAININGS.COM'S ADVANCED MYOFASCIAL TECHNIQUES DVD AND SEMINAR SERIES. THE LINK IS AVAILABLE AT WWW.ABMP.COM. time to feel for and get hold of the tough layers just deep to the dermis. Feel for fibrous banding here, and for any adhesion to the layers below. Ask for slow, active dorsiflexion and plantarflexion. Apply sensitive but firm proximal pressure to these areas; wait for release. Work the crural fascia of the entire lower half of the leg, as well as the retinacula of the ankle and the fascia dorsalis pedis of the instep. TIBIALIS ANTERIOR TECHNIQUE Although the tibialis anterior muscle won't usually restrict ankle dorsiflexion directly, we include it in our protocol here as preparation for the Interosseous Membrane Technique. The tibialis anterior and the long toe extensors that lie deep to it need to be released before work with the deepest interosseous layer is comfortable for the client. Additionally, some clients will feel discomfort or cramping in the tibialis anterior region with the Dorsiflexion Test ("Working with Ankle Mobility, Part 1," March/April 2011, page 111). This usually accompanies a Type 2 dorsiflexion restriction (related to tibia/fibula mortise restrictions, rather than shortened ankle plantarflexors). Using a soft fist or the flat of your forearm, slowly glide along the length of the tibialis anterior, encouraging length and release as your client actively dorsiflexes and plantarflexes the ankle. Feel for release particularly on the eccentric (plantarflexion) phase. Once the outer layers have been worked, repeat the technique, adding active toe flexion and extension to access and release the deeper extensor digitorum longus and extensor hallucis longus (Image 6). Although direction of work (proximal to distal, or the reverse) is usually not a crucial factor in our approach, you'll often find that one direction feels more effective to you and to the client. As an experiment, check both directions, and get descriptive feedback about the difference. Use a soft fist, combined with active dorsiflexion, in the Tibialis Anterior Technique. Image courtesy Advanced-Trainings.com. INTEROSSEOUS MEMBRANE TECHNIQUE Remember that the tibia and fibula will limit dorsiflexion if they can't spread slightly around the widest part of the talar wedge. The deepest and strongest structures that restrict this widening are the interosseous membrane and its associated tibiofibular ligaments. Even after preparing the outer layers of the lower leg with the two preceding techniques, we aren't able to directly touch the deep interosseous membrane of the leg—at least not comfortably. To work it, we can use the fibula as a convenient handle to laterally stretch the tough membrane and ligaments that join it to the tibia. Fibula is Latin for "brooch," after its resemblance (along with the tibia) to a clasp, with the fibula being the pin. This technique opens the clasp, allowing more room for the talus to move. Use the knuckles of both soft fists to pull on the medial side of the fibula, using your weight rather than muscular strength (Images 7 and 8, page 115). Ask your client for full dorsiflexion, pausing at the end range of the movement so that the widest earn CE hours at your convenience: abmp's online education center, www.abmp.com 113