Healthcare and Medicine Reference
muscular differentiation by adding toe flexion and
extension to the ankle movement.
Apply a broad surface of a loose fist to the dorsum of
your client's foot distal to the retinacula, while the other
hand guides the client's dorsi- and plantarflexion. Have
your client pass slowly through the sequence of motion
as you move slowly up the foot and ankle, passing
through the retinaculum and up onto the shin beyond.
If the retinacula are too tight, or if the tendons are stuck,
you will feel 'slowed' in your progress up the shin.
Using the client's movement, repeat the pass (perhaps
using a bit more pressure) until the feeling of restriction
is gone, both from your sensing hand and from the
client's feeling within the movement (DVD ref: Superfi-
cial Front Line,11.16-19:24).
Where you stop above the retinacula varies from
client to client. In some people you run out of 'juice' just
above the ankle; in others you feel as if you are 'skating'
over the surface of the shin. Stop at this point. For some,
the feeling of connecting and freeing extends well up
the shin toward the knee, and you may continue on up
as far as you still feel work is being done.
When your work does extend above the ankle, pay
attention to which side of the shin is more restricted, the
medial or the lateral. Since you began on the tendons,
the natural progression is up onto the muscles of the
anterior compartment, on the lateral side of the anterior
shin. The SFL, however, also includes the periosteum
and superficial fascial layers that pass over the tibia on
the anteromedial side (see Figs 1.1C, 4.10A and 4.11).
We have arrived at the second common pattern
problem in this area, so let us define the problem before
we finish with the technique. In any kind of forward
lean of the legs, where the knee rests posturally on a line
anterior to the ankle, the posterior calf muscles tighten
(eccentrically, or locked long), and the anterior muscles
and tissue move down (and tighten concentrically,
locked short). One of the best remedies for this is to
move the tissue of the anterior surface up again (while
the corresponding tissues of the SBL are moved
So, above the ankle, superior to the retinacula, you
can work both the muscle surface and the shinbone
surface. Since they are at angles with each other, they
can be worked sequentially, or both at once with two
hands. The two-handed technique involves putting both
hands into a loose fist, with the proximal phalanges
against the surface, one hand conforming to the front of
the anterior compartment of muscles, the other to the
anterior surface of the tibia above (DVD ref: Superficial
Front Line, 19:24-25:53). In this position, your right
and left sets of knuckles rest near or against each other.
Sink into the tissue enough to engage, but not with dig-
ging pressure that would cause pain to the tibial
Let your hands work upward in time to the client's
movement, pausing as she stretches out from under you
in plantarflexion, carrying the tissue cephalad as she
dorsiflexes, until you run out of effectiveness or reach
the top of the muscle compartment, whichever comes
Fig. 4.11 The top of the
anterior compartment leads
past the tibial tuberosity onto
the subpatellar tendon and
the quadriceps complex.
Do not fail to have your client dorsi- and plantarflex
after you have finished the treatment, since you will
often be rewarded by the exclamation of increased
Although the muscles themselves have attachments
within the anterior compartment to the tibia, fibula, and
interosseous membrane, the next station for the SFL is
at the top of both the medial and lateral side of this
track, the tibial tuberosity (Fig. 4.11).
Continuing in a straight line upward is no problem:
the quadriceps begin their upward sweep here with the
subpatellar tendon. The SFL includes the patella, the
large sesamoid bone designed to hold the SFL away
from the knee joint fulcrum so that the tissues of the
quadriceps have more leverage for extending the knee.
The patella rests in a channel in the femur, which also
assures that the quadriceps, with its several different
directions of pull, still tracks directly in front of the
hinge of the knee joint.