So#- Tissue Manipula0on: Supine

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2 So#- Tissue Manipula0on: Supine Gastrocnemius and soleus stretch Use stretching in the later stages of rehabilita0on Check in with the client as you go to avoid painful tearing Perform joint mobiliza0on of the ankle joint Instruct the client: Tell me when this is a good stretch for you. Move into the stretch un0l the clients says that it is a good stretch Hold the stretch for three of your breaths Slowly release and mobilize the ankle again

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4 What is the defini0on of shin splints? Shin splints Collec0on of overuse pathologies of the lower leg including perios00s, strain, stress fracture, and compartment syndrome.

5 What is the defini0on of shin splints? Perios44s Inflamma0on of the periosteum. Strain Muscle injury involving torn muscle fibers and the produc0on of scar 0ssue. Caused by trauma or overuse. Stress fracture Hairline fractures in bone that don t heal unless ac0vity is suspended. Compartment syndrome Pressure inside a fascial compartment that can lead to starva0on and death of muscle and nerve cells. Caused by injury or repe00ve stress.

6 What is the defini0on of shin splints? Shin splints Collec0on of overuse pathologies of the lower leg including perios00s, strain, stress fracture, and compartment syndrome. Caused by repe00ve overuse O#en related to running or dancing There are two types of shin splints: Anterior shin splints Medial 0bial stress syndrome

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8 What are anterior shin splints? o Pain is felt in the proximal 1/3 of the anterior compartment. o Usually accompanies a history of eccentric overload of ankle dorsiflexors such as found in walking or running down a steep hill.

9 What is the anterior compartment? o Tibialis anterior, extensor digitorum longus, and extensor hallucis longus o Anterior 0bial artery and vein o Deep peroneal nerve o All of the above structures are contained in a rela0vely unyielding fascial compartment. o Dorsiflexion is the primary responsibility for these muscles

10 Origins: What are the OIAs of extensor digitorum superficialis? Proximal anterior sha# of the fibula Interosseous membrane Inser4ons: Middle phalanges of toes 2-5 Distal phalanges of toes 2-5 Ac4ons: Extension of toes 2-5 Ankle dorsiflexion Foot eversion

11 Origins: What are the OIAs of extensor hallucis longus? Middle anterior surface of the fibula Interosseous membrane Inser4ons: Distal phalanges of the first toe (great toe) Ac4ons: Extension of the first toe (great toe) Ankle dorsiflexion Ankle inversion

12 Lower Leg Cross Sec0on Extensor Digitorum Longus Extensor Hallucis Longus Tibialis Anterior Soleus Gastrocnemius Peroneus Longus Peroneus Brevis Flexor Digitorum Longus Tibialis Posterior Flexor Hallucis Longus

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14 What is medial 0bial stress syndrome? o Pain is felt in the medial and distal 0bia region pertaining to the 0bialis posterior and soleus muscles o Forefoot running puts excessive tensile stress on 0bialis posterior o Tibialis posterior works eccentrically during normal gait mechanics to prevent overprona0on.

15 What are the OIAs of 0bialis posterior? Origins: Proximal posterior sha# of the 0bia Proximal fibula Interosseous membrane Inser4ons: Navicular Cuneiforms (medial, intermediate, and lateral) Cuboid Bases of metatarsals 2-4 Ac4ons: Ankle plantarflexion

16 Lower Leg Cross Sec0on Extensor Digitorum Longus Extensor Hallucis Longus Tibialis Anterior Soleus Gastrocnemius Peroneus Longus Peroneus Brevis Flexor Digitorum Longus Tibialis Posterior Flexor Hallucis Longus

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18 Ortho4cs What are some tradi0onal treatments for shin splints? Effec0ve: if dysfunc0onal biomechanics are a cause Avoid or reduce offending ac4vi4es Effec0ve: allows the 0ssues to heal An4- inflammatory medica4ons Effec0ve: for reducing inflamma0on due to perios00s Cryotherapy Effec0ve: for reducing pain and inflamma0on

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20 What are some considera0ons and cau0ons for shin splints? o Shin splint pain of both types is most pronounced hours a#er the ac0vity that ini0ated the problem. o Alter treatment intensity to accommodate the severity of the symptoms. o Only use ac0ve movement and ac0ve movement techniques in the later stages of rehabilita0on. o Alterna0ve causes could be a stress fracture or compartment syndrome. Refer you client to another health professional is necessary.

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22 So#- Tissue Manipula0on: Overview Supine Anterolateral lower leg Superficial fascia assessment Myofascial release Anterior compartment Swedish Deep longitudinal stripping Deep fiber spreading Deep fiber spreading with ac0ve shortening Deep longitudinal stripping with ac0ve lengthening Prone Tibialis anterior stretch Side- Lying Posi0oning and Draping Tibialis posterior Swedish Deep longitudinal stripping Deep longitudinal stripping with ac0ve lengthening Deep longitudinal stripping with isometric plantarflexion

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24 So#- Tissue Manipula0on: Supine Anterolateral lower leg superficial fascia assessment Use your palm and fingers to apply light tangen0al pulling pressure Place your hand flatly on the skin surface Press in just enough to trac0on the superficial fascia without sliding Slowly trac0on in all direc0ons taking note of restric0ons Use before and a#er trea0ng superficial fascia to gauge progress

25 So#- Tissue Manipula0on: Supine Anterolateral lower leg myofascial release Work without lubricant facing down the table Place your hand flatly on the skin surface Press in just enough to trac0on the superficial fascia without sliding Use your palm and fingers to apply light tangen0al pulling pressure Hold. Wait for a palpable 0ssue release or indica0on from the client Repeat to address restric0ons in the en0re anterolateral area

26 So#- Tissue Manipula0on: Supine Anterior compartment Swedish Work from general to specific to general Effleurage, fulling, and thumb compressions Repeat un0l the muscles are thoroughly warmed and so#ened

27 So#- Tissue Manipula0on: Supine Anterior compartment deep longitudinal stripping Use finger0ps or thumbs Working proximally in 2-4 inch sec0ons Pause or repeat in areas of palpated or reported tension Progress from moderate to deep pressure within client comfort

28 So#- Tissue Manipula0on: Supine Anterior compartment deep fiber spreading Use two thumbs side- by- side or hand- fist tool Start just lateral to the 0bia and move laterally Cover the en0re length, but work either proximally or distally

29 Note: this technique uses fiber spreading during ac0ve movement that shortens the muscle. It deac0vates trigger points, removes fascial restric0ons, and So#- Tissue Manipula0on: Supine Anterior compartment deep fiber spreading with ac4ve shortening Use two thumbs side- by- side or hand- fist tool Start just lateral to the 0bia and move laterally Cover the en0re length, but work either proximally or distally Instruct the client: Slowly alternate between flexing and extending your foot. During dorsiflexion, perform the stroke. Pause during plantarflexion.

30 So#- Tissue Manipula0on: Supine Anterior compartment deep longitudinal stripping with ac4ve lengthening Use thumbs Working proximally in 2-4 inch sec0ons Pause or repeat in areas of palpated or reported tension Progress from moderate to deep pressure within client comfort With one hand, offer resistance to dorsiflexion Instruct the client: Slowly alternate between plantarflexion and dorsiflexion. During plantarflexion, strip proximally. Pause during dorsiflexion.

31 So#- Tissue Manipula0on: Supine Tibialis anterior stretch Perform joint mobiliza0on of the ankle joint Instruct the client: Tell me when this is a good stretch for you. Move into the stretch un0l the client indicates that it is good. Hold the stretch for three of your breaths Slowly release and mobilize the ankle again

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33 So#- Tissue Manipula0on: Supine Posi4oning and Draping Bolster the head using the face cradle cushion Top leg is res0ng on a bolster with the hip and knee slightly flexed Bofom femur is poin0ng toward the foot of the table Bofom knee is slightly flexed to prevent joint pain during strokes Slide the sheet under the front side of the leg to uncover from the patella down

34 So#- Tissue Manipula0on: Supine Tibialis posterior Swedish Work from general to specific to general on the bofom leg Effleurage, kneading, and fulling Repeat un0l the muscles are thoroughly warmed and so#ened

35 So#- Tissue Manipula0on: Supine Tibialis posterior deep longitudinal stripping Use finger0ps or thumbs Work proximally along the medial border of the 0bia Work in 2-4 inch sec0ons. Pause or repeat in areas of palpated or reported tension Progress from moderate to deep pressure within client comfort

36 So#- Tissue Manipula0on: Supine Tibialis posterior deep longitudinal stripping with ac4ve lengthening Use thumbs on the bofom leg Instruct the client: Slowly alternate between flexing and extending the foot. Strip proximally during dorsiflexion. Pause during plantarflexion. Working proximally in 2-4 inch sec0ons Pause or repeat in areas of palpated or reported tension Progress from moderate to deep pressure within client comfort Tibialis posterior deep longitudinal stripping with isometric plantarflexion

37 Problem Solving Ankles and Feet