Healthcare and Medicine Reference
In-Depth Information
locked knees are all signs of excessive tension in the
SFL.
NOTE: Once again, as with the stretches offered in Chapter
3, caution is urged in assigning or attempting these stretches
(see note on p. 90).
• Kneeling on the toes in plantarflexion and sitting
into the heels is an easy way to test the ability of
the lowest part of the SFL to stretch.
• The 'cobra' stretch is an easy way to extend the
stretch into the belly from the toes (Fig. 4.25A). Be
aware of the head: if there is too much
hyperextension in the neck, the stretch in the
belly will be counteracted by the shortening of the
SCM. Keep the chin tucked in a little, and the head
high.
• Leaning back into hip extension (fully supported
for most beginners; meaning enough support to
completely avoid lumbar strain or pain) extends the
stretch of the SFL above the knee to the hip (Fig.
4.25B).
• The 'bridge' provides another intermediate stretch
for the upper part of the SFL (Fig. 4.25C). Keep the
neck flat to extend the mastoid process away from
the sternal notch. Keep the toes pointed in
plantarflexion to include the legs.
• The backbend is the most complete stretch for the
SFL, for those with the strength and flexibility to
sustain it. It is not recommended for the beginner,
though a physioball is a great support to give the
beginner a feeling for what a full opening of the
SFL would involve (see Fig. 4.7A).
Palpating the Superficial Front Line
The departing station of the SFL is clearly palpable on
the tops of the five toes, with the first track running back
with the tendons onto the dorsum of the foot. The short
extensor muscles of the toes can be felt on the lateral
side of the upper foot, while the long tendons stay the
course under the retinaculum and on up into the leg.
The tibialis anterior tendon can be clearly seen and felt
when the foot is dorsiflexed and inverted. If you dorsi-
flex and evert the foot, you may find the peroneus tertius
tendon (if you or your model has one), just lateral to the
little toe tendon, going down to the middle of the 5th
metatarsal (Fig. 4.11).
All of these tendons run under the retinacula to
gather into the anterior compartment of the leg. The
thickened areas of the retinacula can sometimes be felt
when the foot is strongly dorsiflexed, just to either side
of these tendons, running to both malleoli.
In the leg, the individual toe extensor muscles disap-
pear under the tibialis anterior, which can be followed
right up to the bump of the tibial tuberosity below the
knee. The lateral edge of the anterior compartment is
marked by the anterior intermuscular septum, which
can be traced by walking your finger up from the lateral
malleolus while dorsiflexing and plantarflexing the foot.
The tibialis - anterior to the malleolus - will be active
on dorsiflexion, while the neighboring peroneals, in the
compartment posterior to and superior to the malleolus,
will be active on plantarflexion. The septum is the wall
between the two. If you follow it accurately, you will
reach the top of the septum just in front of the fibular
head.
The subpatellar tendon can be easily palpated
between the tibial tuberosity and the patella. With an
extended knee, the tendon of the rectus femoris is also
easily palpable, as is the muscle, which can usually be
'strummed' horizontally most of the way up to the AIIS.
As you approach the top of the thigh, the sartorius and
tensor fasciae latae can be felt converging toward the
ASIS, while the rectus, in most cases, dives down
between these two, creating a small but palpable 'pocket'
on its way to the AIIS (Fig. 4.12).
The rectus abdominis is easily felt between the pubis
and the ribs by having the client lift his head and chest
as in a sit-up. It begins as two round tendons palpable
on the superior aspect of the pubic bone. It widens as it
passes up the body to the 5th rib (Fig. 4.19).
The sternalis and its fascia can sometimes be
'strummed' horizontally above the 5th rib and medial
to the pectoralis, but the fascia over the sternochondral
joints can be readily felt at the bumpy outer edges of the
sternum.
The SCM can also be easily distinguished by having
the supine client rotate the head to one side and lift it
against resistance, such as a hand resting on the fore-
head (Fig. 4.22). Both the sternal head and the clavicular
head can be felt, and the muscle followed up to its
attachment to the mastoid process, and beyond onto the
skull.
Fig. 4.25 Common stretches for parts or all of the SFL.
110
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