Issue link: https://www.massageandbodyworkdigital.com/i/77400
MYOFASCIAL TECHNIQUES In this first of two articles, I'll begin by discussing ways to help the soft tissues on the back of the lower limb be as long and responsive as possible (in other words, ways to work with a Type 1 restriction). We'll examine a Type 2 restriction—a fixed relationship between the tibia and fibula—in Part 2. DORSIFLEXION TEST We can assess the amount of dorsiflexion available, and identify the primary type of restriction, by asking our client to do a deep knee bend. Look at the angle of the lower leg in relationship to the foot (Images 2 and 3, page 111). How deep can the knee bend go before the available dorsiflexion is used up and the heels have to come off the ground? In general, the more dorsiflexion, the better, even for people with frontal plane ankle instabilities, such as pronation, supination, or a tendency toward ankle sprains. (Having greater adaptability in the sagittal plane can reduce the lateral forces that cause ankle turns or overpronation.) Once you've assessed the amount of dorsiflexion, you'll need to determine where to work. Your client will usually be able to direct you toward the predominant restriction. At the full limit of dorsiflexion, ask: "What stops you from going farther? Where exactly do you feel that?" The most common answers are a stretch in the back of the calf, sometimes including the plantar fascia (Type 1 restriction); or, a jamming, crunching, or pinching at the anterior fold of the ankle (indicating a Type 2 restriction).2 Let's look at two techniques that will help address the first type of restriction—shortness in the posterior of the leg and foot. THE SOFT FIST Both of the techniques to address Type 1 restriction use the practitioner's "soft fist" as a tool. This has several advantages over using a palm, In the Gastrocnemius Technique, use a soft fist combined with assisted dorsiflexion via the practitioner's leg to address Type 1 restriction. Image courtesy Advanced-Trainings.com. fingers, or other parts of the hand traditionally used in massage therapy: • Once you're accustomed to using a soft fist, you'll find that it can give you greater specificity with particular structures and tissue layers. • By keeping your wrist aligned with the metacarpals of your hand, you can transmit pressure with almost no muscular effort. • The neutral position of the wrist keeps the carpal tunnel open, preventing the neurovascular compression that can accompany frequent or habitual wrist extension. The keys to a sensitive, comfortable soft fist are to keep your wrist straight, your hand open, and let the knuckles of the middle fingers do the work. GASTROCNEMIUS/ SOLEUS TECHNIQUE As the strongest and largest muscle group on the back of the leg, the 112 massage & bodywork march/april 2011 gastrocnemius/soleus complex is a logical place to work when you see limited dorsiflexion. Injuries or strains of the gastrocnemius and soleus are common, especially with activities such as racquet sports, basketball, skiing, and running. Tissue shortening that results from injury, or simply normal use, can reduce the ankle's ability to dorsiflex. With your client prone and with his or her feet off the end of your table, use your soft fist to anchor the stocking-like outer layers of fascia (the superficial and crural fascias). Work one layer at a time, releasing each one before going deeper. Ask your client for slow, deliberate ankle movement (plantar and dorsiflexion). Use the lengthening effects of dorsiflexion to release any shortened or tighter lines of tissue (Image 4) as you apply a slight cephalad (headward) resistance to the tissues under your touch. Although your touch will slide slightly, let your client's active ankle