Healthcare and Medicine Reference
In-Depth Information
the bottom of the foot, the flexor hallucis longus can be
clearly felt. Extend (lift) your big toe to tighten the
tendon, and it will be clearly palpable along the medial
edge of the plantar fascia, under the medial arch (Fig.
9.4 and DVD ref: Deep Front Line, Part 1, 23:46-26:18).
The tendons can be felt along the medial side of the
foot and ankle, in roughly the same way the peroneal
tendons run on the outside of the foot, and all three of
them can be felt here. Place a finger directly under the
medial malleolus, and invert and plantarflex the foot;
the large tendon that pops under your finger is the tibi-
alis posterior. The flexor digitorum runs about one
finger width posterior to the tibialis posterior, and can
be felt when the smaller toes are wiggled. The big toe
flexor lies posterior and deep to these two: put a thumb
or finger into the space in front of the Achilles tendon
and press into the posteromedial aspect of your ankle,
taking care not to press on the nerve bundle, and have
your model flex and extend the big toe - the substantial
tendon of flexor hallucis longus will slide under your
finger (DVD ref: Deep Front Line, Part 1, 08:05-09:18).
These three muscles are covered completely by the
soleus about three inches (7 cm) above the malleolus as
they pass up into the deep posterior compartment (Fig.
9.9), just behind the interosseous membrane between the
tibia and fibula (Fig. 9.10). Reaching this myofascial com-
partment manually is difficult. It is possible to stretch
these muscles by putting the foot into strong dorsiflex-
ion and eversion, as in the Downward-Facing Dog pose
or by putting the ball of your foot on a stair and letting
the heel drop. It is, however, often difficult for either
practitioner or client to discern whether the soleus (SBL)
or the deeper muscles (DFL) are being stretched.
It is possible to feel the state of the compartment in
general by feeling through the soleus, but only if the
soleus can be relaxed enough to make such palpation
possible. In our experience, trying to work these muscles
through the soleus is either an exercise in frustration or
a way to damage the soleus by overworking it - almost
literally poking holes in it - in the attempt to reach these
muscles deep to it (DVD ref: Deep Front Line, Part 1,
20:11-23:45). An alternative way to reach this hidden
layer is to insinuate your fingers close along the medial
posterior edge of the tibia, separating the soleus from
the tibia in order to get to the underlying (and often very
tense and sore) muscles of the deep posterior compart-
ment (Fig. 9.11 and DVD ref: Deep Front Line, Part 1,
09:20-15:03).
Another hand can approach this from the outside by
finding the posterior septum behind the peroneals, and
'swimming' your fingers into this 'valley' between the
peroneals and the soleus on the lateral side. In this
manner you have the fascial layer of the deep posterior
compartment between the 'pincers' of your hands (Fig.
9.10 and DVD ref: Deep Front Line, Part 1, 15:03-20:10).
Couple this firmly held position with client movement,
dorsi- and plantarflexion, and you can help bring mobil-
ity to these deeper tissues. Multiple repetitions may be
necessary as the leg becomes progressively softer and
more accessible, and movement more differentiated
between the superficial and deep compartments.
Fig. 9.8 The deep posterior compartment lies behind the
interosseous membrane between the tibia and fibula. Notice that
each of the fascial compartments of the lower leg ensheathes one
of the Anatomy Trains lines.
Fig. 9.9 A medial view of the lower leg, with the DFL structures
highlighted. They can only be palpated directly just above the
ankle.
joint (TMJ) syndrome, swallowing and language diffi-
culties, and general core collapse.
Palpation guide 1: deep posterior
compartment
Although it is next to impossible to feel the tendons of
the flexor digitorum longus or the tibialis posterior on
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