working with ankle mobility, part ii (myofascial techniques)

7/27/2019 Working with Ankle Mobility, Part II (Myofascial Techniques)

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The tibia and bula orm a ork-li ke mortise around the talus bone (orange), giving the ankle both stability and adaptabil ity. When the interosseous

membrane and tibiobular ligaments (violet) dont allow normal resilience and spring in the ankle mortise, dorsifexion will be limited. Image courtesy

Primal Pictures. Used with permission.

myofascial techniquesBY TIL LUCHAU

110 massage & bodywork may/june 2011


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an elastic rmness to their hold on

the talus. When this slight elasticityin the connective tissues is lost(through hardening due to injur y,overuse, or inecient biomechanics),the tibia and bula act more like aclamp than a spring ( Image 3, page111). When particularly xed, this

inelasticity stops the talus beore ulldorsifexion is reached, and so l imitsthe range o dorsifexion. This isoten experienced by our clients as ajamming or pinching sensation in theront o the ankle during dorsifexion.

Were reerring to this clampingaround the talus as a Type 2dorsifexion restriction (Type 1 beingrelated to shortness in the tissues othe posterior leg and plantar surace o

the oot). We discussed ways to assessthese two types o restrictions, and howto work with Type 1 restrictions in therst part o this article (MyoascialTechniques: Working with AnkleMobility, Part 1, March/April 2011,page 110). In this second part, well look

at ways to restore lost dorsifexion by

ensuring adaptability o the t ibia andbula around the wedge o the talus.

CRURAL FASCIA/RETINACULA TECHNIQUEThe crural ascia (or ascia cruris,crurismeaning leg) is a thickmembranous wrapping around thelower leg. Like built-in support hose(you didnt know you wore those,did you?), the crural ascia providesthe reinorcement, encasing, andundergirding needed by the legspowerul structures. Releasing thislayer helps prepare or the deeper workwell do with the ankle mortise itsel.

Within crural ascia are brous

bands at places o particular strainthese are the retinacula. Deep to theretinacula, cord-like tendons roundthe corner o the ankle, on their wayrom their origins in the leg to theirattachments in the oot (Image 4).This is a busy placeater al l, with theexception o a ew thigh muscles that

myofascial techniques

112 massage & bodywork may/june 2011

just make it past the knee, all lower leg

muscles cross the ankle into the oot.With the entire orce o standing andlocomotion being transmitted acrossthe ankle, the restraining structureshere are thick, resilient, and dense.This is all ne and well, except whenthey do their restraining too well.

Too-tight ret inacula can irritate thebursa underneath them; they can alsolimit the adaptability o the ankle bybinding the tendons they overlie, or byrestricting the necessary spreading othe tibia and bula around the talus.

To ensure adaptability o the cruralascia and the retinacula, well use theends o our curled ngers to eel orand release any restrictions in theseouter layers. Using just a bit o your

nails, push proximally rather than pulldistally, eeling or the brous layerso ascia just under the skin (Image5). Imagine pushing up your clientstight-but-sagging socks. The pressureis rm; your pace is slow and patient.Rather than gliding over the skin, take

The retinacula are brous bandings within the crural ascia. When restricted,

they can irritate bursa (lig ht blue) or limit the adaptability needed or ull

ankle range. Image courtesy Primal Pictures. Used with permission.

For the Crural Fascia/Retinacula Technique, use the tips o your

curled ngers, al ong with just a bit o ngernail to eel or and

release restricted areas in the crural ascia. Image courtesy

Advanced-Trainings.com.


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5/5earn CE hours at your conve nien ce: abmps onlin e educ ation center, www.abmp.com 115

myofascial techniques

part o the talar wedge can assist yourwidening o the t ibial/bular space.Your pressure is quite ull, but stillcomortable or your cl ient. The verystrong interosseous structures respond

slowly, so be sure to wait long enoughto eel the subtle release and widening

o the bula away rom the t ibia. Itcan be helpul to imagine unrollingthe two bones o the lower leg likethe two parts o a scroll. There is,in act, a small amount o externalbular rotation with dorsifexion,3 and

adding this dimension to your lowerleg work can increase its eect iveness.

Once youve elt the bularespond, shit your knuckles to anew place, repeating this techniquealong the entire length o the bula,particularly at the distal end where thetibiobular ligaments are located.

Ater working just one leg in thisway, you might ask your cl ient tostand and walk a ew steps, comparing

the let and right legs. Oten thedierence in mobility and stabilitywill be proound. (Then, be sureto work the second leg as well!)

TOO LOOSE OR TOO TIGHT?Our overall intention with thesetechniques is to improve anydorsifexion restrictions by ensuring

that the bula and t ibia can widenslightly around the wedge-shaped talus,particularly in ull dorsifexion. But

what about ank les that already seemtoo mobile, such as in overpronationpatterns, or unstable ankles that twisteasily? While both pronation andankle sprains can theoretically causelaxity in the talar mortise, in practice,both sprains and pronation are otenassociated with limited dorsifexion atthe talar/tibial joint. In the Dorsifexion

Test, youll see people using acombination o oot pronation, eversion,and external t ibial rotation whentalar dorsifexion is limited. Similarly,losing the ront/back adaptability thatdorsifexion provides can increaselateral orces on the ankle, leading toeasier ankle turning and rolling. Thereare exceptional cases where there isclearly too much laxity between thetibia and bula, oten as the result

o congenital conditions or rom anunhealed injury. These clients canbenet rom a reerral to an orthopedistor rehabilitation specialist. Empirically,weve ound that in even these cases,

and certainly in the majority o people,whenever a limitation in dorsifexionis improved, clients experienceimprovement in balance, stability, andless tendency toward overpronation,even when there is also an apparentside-to-side hypermobility.

Til Luchau is a member o the Advanced-

Trainings.com aculty, which oers distance

learning and in-person Advanced Myoascial

Techniques seminars throughout the United

States and abroad. He is also a Certied

Advanced Roler and teaches or the Rol

Institute o Structural Integration. Contact

him via [email protected] and

Advanced-Trainings.coms Facebook page.

notes1. For word bus, a plaond is an ornately decorated

ceiling. It originates rom the French plat fat, plusond bottom, base. Accordingly, the tibial plaond

could be thought o as both an ornate, wedge-shaped

ceiling or the talus, and a base or the tibia above it.

2. In contrast to an ad aptabl e land ing wit h the

midoot, a thumping heel strike is harder and less

accommodating, due in part to the wider part o

the talus being wedged between the malleoli o the

tibia and bula. The timing o the knees extension

in the gait cycle plays a large roll in determining

which part o the oot contacts the ground rst.

3. J. Forst et al., E ect o Upper Tibial Osteotomy on

Fibula Movement and Ankle Joint Motion,Archives o

Orthopaedic and Trauma Surgery 112, no. 5: 23942.

The Interosseous Membrane Technique: Ater preparing the outer layers o the lower leg , use the knuckles o a sot st to encourage the bula to release

laterally, giving more room or the talus. Use your client s active dorsifexion to bring the widest part o the talus between the tibia and bul a, augmenting the

release. Images courtesy Advanced-Trainings.com.

working with ankle mobility, part ii (myofascial techniques)

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