Introduction

Postural Dysfunction

Ankle Dysfunction

Signs of Dysfunction

Articular Surfaces

Palpation

Capsule and Ligaments

Bursae

Nerves

Osteokinematics

Arthrokinematics

Regional Interdependence

Ankle Joint Anatomy: Talocrural, Subtalar and Tibiofibular Joints

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Ankle Joint Anatomy

Ankle Joint (Talocrural, Subtalar and Tibiofibular Joints)

This course describes ankle/foot joint anatomy, which includes the talocrural, subtalar, and tibiofibular joints. This includes descriptions of the bones, synovial joints, joint actions, ligaments, bursae, relative location, the relationship between the bones of the foot and ankle, and the muscles that cross them. Further, this course discusses palpation and introduces ankle/foot joint <a id="specificity" data-tip="1224" target="_blank" href="/glossary-term/specificity" class="glossary">specific</a> exercises, manual techniques, and interventions for dysfunction, pain, <a id="posture" data-tip="1658" target="_blank" href="/glossary-term/posture" class="glossary">posture</a>, and <a id="movement-impairment" data-tip="1575" target="_blank" href="/glossary-term/movement-impairment" class="glossary">movement impairment</a>. The ankle joint is included in the common compensation patterns known as functional pes planus (flat feet), pronation distortion syndrome, functional valgus (knee bow in), asymmetrical weight shift (AWS), and <a href="https://brookbushinstitute.com/courses/lower-leg-dysfunction">lower extremity dysfunction (LLD)</a>. Sports medicine professionals (personal trainers, fitness instructors, physical therapists, massage therapists, chiropractors, occupational therapists, athletic trainers, etc.) with advanced knowledge of the ankle joint will improve their ability to analyze human movement and develop sophisticated exercise programs and therapeutic (rehabilitation) interventions. Further, this course is essential knowledge for future courses discussing injury prevention and physical rehabilitation/physical therapy (e.g. ankle pain, ankle arthritis, <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> malleolus pain, ankle <a id="stability" data-tip="1193" target="_blank" href="/glossary-term/stability" class="glossary">instability</a>, chronic ankle sprain, ankle replacement surgery), the effect the ankle joint has on lower extremity alignment (e.g. the relationship between subtalar inversion and hip internal rotation), and ankle <a id="specificity" data-tip="1224" target="_blank" href="/glossary-term/specificity" class="glossary">specific</a> techniques for enhancing sports performance (e.g. lower body (leg) <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a>, strength, hypertrophy, agility, and <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a>).
<h4>Brookbush Institute&#x2019;s most recommended techniques for the Ankle Joint (see videos below):</h4>
<ul>
 <li>Assess: 
 <ul>
 <li><a href="https://brookbushinstitute.com/video/overhead-squat-assessment-4-feet-flat-breakdown">Overhead Squat Assessment: Feet Flatten</a></li>
 </ul>
 <a href="https://brookbushinstitute.com/video/overhead-squat-assessment-4-feet-flat-breakdown"> </a>
 </li>
 <li>Self-administered Techniques: 
 <ul>
 <li>Release: <a href="https://brookbushinstitute.com/video/calf-and-fibularis-peroneal-active-release">Gastrocnemius and Soleus Dynamic Release</a></li>
 <li>Stretch: <a href="https://brookbushinstitute.com/video/slant-board-calf-stretch">Slant Board Calf Stretch</a></li>
 <li>Activation: <a href="https://brookbushinstitute.com/video/tibialis-anterior-isolated-activation">Tibialis </a><a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">Anterior</a> Isolated Activation (No Equipment)</li>
 </ul>
 <a href="https://brookbushinstitute.com/video/tibialis-anterior-isolated-activation"> </a>
 </li>
 <li>Manual Techniques: 
 <ul>
 <li>Release: <a href="https://brookbushinstitute.com/video/fibularis-release">Fibularis Muscles Static Manual Release</a></li>
 <li>Mobilization: <a href="https://brookbushinstitute.com/video/ankle-tibiotalor-joint-anterior-to-posterior">Ankle (Talus) Manual Joint Mobilization &#x2013; </a><a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">Anterior</a> to Posterior</li>
 <li>Manipulation: <a href="https://brookbushinstitute.com/video/talocalcaneal-manipulation">Talocalcaneal Manipulation</a></li>
 </ul>
 <a href="https://brookbushinstitute.com/video/talocalcaneal-manipulation"> </a>
 </li>
</ul>
<img alt="The anatomy of the ankle joint showing the bones and boney landmarks" title="The bones and boney landmarks of the ankle/foot complex" src="https://www.datocms-assets.com/25800/1643057577-neck-of-talus.jpeg">

Course Description: Ankle Joint Anatomy (Talocrural, Subtalar and Tibiofibular Joints)

<h2>What&apos;s in a name</h2>
<ul>
 <li><a href="http://www.etymonline.com/index.php?term=ankle&amp;allowed_in_frame=0" target="_blank" rel="noopener">Ankle (n)</a>: &quot;Old English ancleow &quot;ankle,&quot; from PIE root *ang-/*ank- &quot;to bend&quot; (see <a class="crossreference" href="http://www.etymonline.com/index.php?term=angle&amp;allowed_in_frame=0" target="_blank" rel="noopener">angle</a> (n.)). The modern <a id="posture" data-tip="1660" target="_blank" href="/glossary-term/posture" class="glossary">form</a> seems to have been influenced by Old Norse &#xF6;kkla or Old Frisian ankel, which are immediately from the Proto-Germanic <a id="posture" data-tip="1660" target="_blank" href="/glossary-term/posture" class="glossary">form</a> of the root (source also of Middle High German anke &quot;joint,&quot; German Enke &quot;ankle&quot;); the second element in the Old English, Old Norse and Old Frisian forms perhaps suggests claw (compare Dutch anklaauw), or it may be from the influence of cneow &quot;knee,&quot; or it may be diminutive suffix -el. Middle English writers distinguished inner ankle projection (hel of the ancle) from the outer (utter or utward).&quot; (<a href="http://www.etymonline.com/index.php?term=ankle&amp;allowed_in_frame=0" target="_blank" rel="noopener">Etymology Online</a>)</li>
 <li>Joint (n): &quot;c. 1300, &quot;an (anatomical) joint, a part of a body where two bones meet and move in contact with one another, the structure that holds such bones together,&quot; from Old French joint &quot;joint of the body&quot; (12c.), from Latin iunctus &quot;united, connected, associated,&quot; past participle of iungere &quot;join&quot; (see <a class="crossreference" href="http://www.etymonline.com/index.php?term=jugular&amp;allowed_in_frame=0" target="_blank" rel="noopener">jugular</a>). &quot; (<a href="http://www.etymonline.com/index.php?term=joint" target="_blank" rel="noopener">Etymology Online</a>)</li>
 <li><a href="http://www.etymonline.com/index.php?term=tibia&amp;allowed_in_frame=0" target="_blank" rel="noopener">Tibia (n.)</a>: &quot;lower leg bone, 1726, from Latin tibia &quot;shinbone,&quot; also &quot;pipe, flute&quot; (originally one of bone), in which sense it originally came into English (1540s). Of unknown origin. The Latin plural is tibi&#xE6;. (Related: <a href="http://www.etymonline.com/index.php?term=tibia&amp;allowed_in_frame=0" target="_blank" rel="noopener">Tibial</a>).&quot; (<a href="http://www.etymonline.com/index.php?term=tibia&amp;allowed_in_frame=0" target="_blank" rel="noopener">Etymology Online</a>)</li>
 <li><a href="http://www.etymonline.com/index.php?term=fibula&amp;allowed_in_frame=0" target="_blank" rel="noopener">Fibula (n.)</a> &quot;1670s, &quot;clasp, buckle, brooch,&quot; from Latin fibula &quot;clasp, brooch; bolt, peg, pin,&quot; related to figere &quot;to drive in, insert, fasten&quot; (see <a class="crossreference" href="http://www.etymonline.com/index.php?term=fix&amp;allowed_in_frame=0" target="_blank" rel="noopener">fix</a> (v.)). In reference to brooches, the modern English word mostly is used in archaeology. As &quot;smaller bone in the lower leg&quot; from 1706, from a Latin loan-translation of Greek perone &quot;small bone in the lower leg,&quot; originally &quot;clasp, brooch; anything pointed for piercing or pinning;&quot; the bone was so-called because it resembles a clasp such as that found in a modern safety pin. Related: Fibular.&quot; (<a href="http://www.etymonline.com/index.php?term=fibula&amp;allowed_in_frame=0" target="_blank" rel="noopener">Etymology Online</a>)</li>
 <li><a href="http://www.etymonline.com/index.php?term=talus&amp;allowed_in_frame=0" target="_blank" rel="noopener">Talus (n.1)</a> &quot; &quot;anklebone,&quot; 1690s, from Latin talus &quot;ankle, anklebone, knucklebone&quot; (plural tali), related to Latin taxillus &quot;a small die, cube&quot; (they originally were made from the knucklebones of animals).&quot; <a href="http://www.etymonline.com/index.php?term=talus&amp;allowed_in_frame=0" target="_blank" rel="noopener">talus (n.2)</a> &quot; &quot;slope,&quot; 1640s, from French talus (16c.), from Old French talu &quot;slope, mound, small hill&quot; (12c.), probably from Gallo-Roman *talutum, from Latin talutium &quot;a slope or outcrop of rock debris,&quot; perhaps of Celtic origin (compare Welsh, Breton tal &quot;forehead, brow&quot;).&quot; (<a href="http://www.etymonline.com/index.php?term=talus&amp;allowed_in_frame=0" target="_blank" rel="noopener">Etymology Online</a>)</li>
 <li><a href="http://www.etymonline.com/index.php?term=calcaneus%09&amp;allowed_in_frame=0" target="_blank" rel="noopener">Calcaneus (n.)</a> &quot;from Latin (os) calcaneum &quot;bone of the heel,&quot; from calcem (nominative calx (1)) &quot;heel,&quot; a word of uncertain origin, perhaps from Etruscan. De Vaan lists as possible cognates Old Prussian culczi &quot;hip,&quot; Lithuanian kulk&#x161;nis &quot;ankle-(bone)&quot; Bulgarian kalka &quot;hip, thigh.&quot; &quot; (<a href="http://www.etymonline.com/index.php?term=calcaneus%09&amp;allowed_in_frame=0" target="_blank" rel="noopener">Etymology Online</a>)</li>
</ul>
<a href="https://www.datocms-assets.com/25800/1643057577-neck-of-talus.jpeg"><img src="https://www.datocms-assets.com/25800/1643057577-neck-of-talus.jpeg" title="The ankle joint in a cadaver dissection showing the bones and ligaments of the ankle" alt="A cadaver dissction of the ankle joint"></a>
Another depiction of a cadaver dissection of the ankle. More soft tissue than the previous image. By Anatomist90 - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=25274518[/caption]
<h4>Joint Types:</h4>
The term &quot;ankle joint&quot; often haphazardly groups the tibiotalar (talocrural) and talocalcaneal (subtalar) joints together and considers the fibula a static structure that forms the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> wall of the ankle joint mortise. A more accurate analysis of the ankle would include the tibiotalar and talocalcaneal joints separately and include <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a> of the fibula on the tibia at both <a id="proximal" data-tip="1564" target="_blank" href="/glossary-term/proximal" class="glossary">proximal</a> and <a id="distal" data-tip="1563" target="_blank" href="/glossary-term/distal" class="glossary">distal</a> ends (15).
<ul>
 <li>Tibiotalar Joint (talocrural joint): 
 <ul>
 <li>Bones: Tibia and talus</li>
 <li>Joint Type:
 <ul>
 <li>Diarthrosis</li>
 <li><a href="https://brookbushinstitute.com/courses/definitions-naming-and-types-of-synovial-joints" target="_blank" rel="noopener">Synovial Joint</a>
 <ul>
 <li><a href="https://brookbushinstitute.com/courses/definitions-naming-and-types-of-synovial-joints" target="_blank" rel="noopener">Hinge Joint (</a><a id="hinge" data-tip="1852" target="_blank" href="/glossary-term/hinge" class="glossary">Ginglymus</a>)</li>
 </ul>
 </li>
 </ul>
 </li>
 </ul>
 </li>
 <li>Talocalcaneal Joint (subtalar joint):
 <ul>
 <li>Bones: Talus and Calcaneus
 <ul>
 <li>The talocalcaneal joint is actually comprised of 3 joint surfaces, the <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a>, middle, and <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> facets. The <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> and middle facets meet in some individuals. The <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> facet comprises nearly 70% of the articular surface of the talocalcaneal joint and receives approximately 75% of the force through the joint (2).</li>
 </ul>
 </li>
 <li>Joint Type:
 <ul>
 <li>Diarthrosis</li>
 <li><a href="https://brookbushinstitute.com/courses/definitions-naming-and-types-of-synovial-joints" target="_blank" rel="noopener">Synovial Joint</a>
 <ul>
 <li><a href="https://brookbushinstitute.com/courses/definitions-naming-and-types-of-synovial-joints" target="_blank" rel="noopener">Plane Joint (</a><a id="gliding-joint" data-tip="1613" target="_blank" href="/glossary-term/gliding-joint" class="glossary">Gliding Joint</a>)</li>
 </ul>
 </li>
 </ul>
 </li>
 </ul>
 </li>
 <li>Proximal Tibiofibular Joint:
 <ul>
 <li>Bones: Tibia and fibula (head of fibula)
 <ul>
 <li>Included in this article, because the motion of the <a id="proximal" data-tip="1564" target="_blank" href="/glossary-term/proximal" class="glossary">Proximal</a> tibiofibular joint is linked to the <a id="distal" data-tip="1563" target="_blank" href="/glossary-term/distal" class="glossary">distal</a> tibiofibular joint, and the <a id="distal" data-tip="1563" target="_blank" href="/glossary-term/distal" class="glossary">distal</a> tibiofibular joint plays a role in ankle mechanics. This joint must transfer the force imparted by the <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">biceps femoris</a> and create a stable <a id="base-of-support" data-tip="1196" target="_blank" href="/glossary-term/base-of-support" class="glossary">base</a> for the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> collateral ligament of the knee, so the small amount of motion that is allowed is likely to accommodate motion of the <a id="distal" data-tip="1563" target="_blank" href="/glossary-term/distal" class="glossary">distal</a> fibula (<a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> malleolus).</li>
 </ul>
 </li>
 <li>Joint Type:
 <ul>
 <li>Arthrodial</li>
 <li><a href="https://brookbushinstitute.com/courses/definitions-naming-and-types-of-synovial-joints" target="_blank" rel="noopener">Synovial Joint</a>
 <ul>
 <li>Plane Joint</li>
 </ul>
 </li>
 </ul>
 </li>
 </ul>
 </li>
 <li>Distal Tibiofibular Joint:
 <ul>
 <li>Bones: Tibia and fibula (<a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> malleolus)
 <ul>
 <li>This articulation, along with the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> malleolus comprises the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> wall of the mortise of the ankle (the ankle joint is often referred to as a &quot;mortise&quot; due to its resemblance to the rectangular wooden joint used by carpenters). <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">Stability</a> at this joint aids in the <a id="optimal" data-tip="1571" target="_blank" href="/glossary-term/optimal" class="glossary">optimal</a> transfer of force to and from the talus and up the <a id="kinetic-chain-2" data-tip="1544" target="_blank" href="/glossary-term/kinetic-chain-2" class="glossary">kinetic chain</a>, especially in the transverse and frontal planes. Approximately 90% of forces imparted on the lower extremity are transferred through the tibia, and no more than 10% through the fibula (1, 3, 16).</li>
 </ul>
 </li>
 <li>Joint Type:
 <ul>
 <li>Synarthrosis: A joining of 2 bones with minimal motion, generally allowing a small amount of <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a>. This joint is either classified as a fibrous or cartilaginous joint.
 <ul>
 <li>Fibrous Syndesmosis Joint: Reinforced by the interosseous membrane</li>
 </ul>
 </li>
 </ul>
 </li>
 </ul>
 </li>
</ul>

Introduction to Ankle Joint (Talocrural, Subtalar and Tibiofibular Joints) Anatomy

<ul>
 <li>Fibula:
 <ul>
 <li>Proximal tibiofibular joint
 <ul>
 <li>The <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> surface of the head of the fibula is typically flat or slightly oval, covered by articular cartilage, and articulates with the relatively flat, posterolateral tibial condyle. This joint must be stable to accommodate the forces imparted from the <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">biceps femoris</a>, <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> collateral ligament, and iliotibial band while allowing some motion of the fibula to accommodate the <a id="distal" data-tip="1563" target="_blank" href="/glossary-term/distal" class="glossary">distal</a> tibiofibular joint.</li>
 </ul>
 </li>
 <li>Distal tibiofibular joint
 <ul>
 <li>The articular surface on the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> side of the <a id="distal" data-tip="1563" target="_blank" href="/glossary-term/distal" class="glossary">distal</a> <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> fibula, <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> to the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> malleolus, articulates indirectly with the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> surface of the <a id="distal" data-tip="1563" target="_blank" href="/glossary-term/distal" class="glossary">distal</a> tibia via the rounded triangular <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> edge of the fibula (the surfaces are separated by fibroadipose tissue). This joint allows for a flexible mortise, rather than a rigid mortise. Although this decreases <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a>, it likely adds to the motion available at the ankle, accommodation of uneven surfaces by the foot, and aids in the dispersion of <a id="ground-reaction-force" data-tip="1397" target="_blank" href="/glossary-term/ground-reaction-force" class="glossary">ground reaction forces</a>.</li>
 </ul>
 </li>
 <li>Tibiotalar Joint
 <ul>
 <li>The <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> surface of the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> malleolus articulates with the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> surface of the talar dome. This articulation is larger than the articulation on the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> side of the talar dome, resulting in more <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a>. This larger articular surface accounts, at least in part, for the relatively small amount of eversion allowed at the ankle when compared to inversion. This also helps to explain the rather large discrepancy between the occurrence of inversion ankle sprains and the relatively uncommon eversion (high ankle) sprains.</li>
 </ul>
 </li>
 </ul>
 </li>
 <li>Tibia:
 <ul>
 <li>Proximal tibiofibular joint
 <ul>
 <li>The posterolateral surface of the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> condyle articulates with the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> side of the fibular head. Much like its counterpart, the surface of the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> condyle is typically flat and covered with articular cartilage.</li>
 </ul>
 </li>
 <li>Distal tibiofibular joint
 <ul>
 <li>The fibular notch is a triangular-shaped <a id="concave" data-tip="1283" target="_blank" href="/glossary-term/concave" class="glossary">concavity</a> on the <a id="distal" data-tip="1563" target="_blank" href="/glossary-term/distal" class="glossary">Distal</a> end of the tibia, which articulates indirectly with the <a id="distal" data-tip="1563" target="_blank" href="/glossary-term/distal" class="glossary">Distal</a> end of the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> surface of the fibula (the surfaces are separated by fibroadipose tissue).</li>
 </ul>
 </li>
 <li>Tibiotalar joint:
 <ul>
 <li>The <a id="distal" data-tip="1563" target="_blank" href="/glossary-term/distal" class="glossary">Distal</a> tibia expands to accept the wide dome of the trochlea of the talus. Although the mortise of the ankle, including the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> and <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> articular surfaces of the malleoli creates a <a id="concave" data-tip="1283" target="_blank" href="/glossary-term/concave" class="glossary">concavity</a>, the <a id="distal" data-tip="1563" target="_blank" href="/glossary-term/distal" class="glossary">Distal</a> end of the tibia that comprises the roof of the tibia is slightly <a id="convex" data-tip="1284" target="_blank" href="/glossary-term/convex" class="glossary">convex</a>, fitting a groove in the <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> surface of the talar dome.</li>
 </ul>
 </li>
 </ul>
 </li>
 <li>Talus: The talus articulates with the tibiotalar and talocalcaneal joints along with joints of the midfoot, as such, 70% of its surface is covered in hyaline cartilage (1).
 <ul>
 <li>Tibiotalar joint
 <ul>
 <li>The dome-like trochlea is covered by hyaline cartilage, with a large <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> facet, relatively small <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> surface, and large <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> surface. Although the dome-like trochlear surface is <a id="convex" data-tip="1284" target="_blank" href="/glossary-term/convex" class="glossary">convex</a> in the sagittal plane it is <a id="concave" data-tip="1281" target="_blank" href="/glossary-term/concave" class="glossary">concave</a> in the frontal plane fitting into the <a id="convex" data-tip="1284" target="_blank" href="/glossary-term/convex" class="glossary">convex</a> &quot;roof of the mortise&quot;. This may increase <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a> and aid in load transfer between these to larger surfaces, which are responsible for most of the force transferred between the weight of the body and the ankle. The <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> surface of the trochlea of the talus articulates with the relatively small <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> articular surface of the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> malleolus of the tibia, and the larger <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> surface articulates with the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> articular surface of the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> malleolus of the fibula. Although these surfaces are important for <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a>, especially in the transverse and frontal planes, they are less responsible for absorbing the forces created by the weight of the body through the ankle.
 <ul>
 <li>Special Note: The <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> and <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> tubercles and the groove between them on the posterior/medial surface of the talus serve as a pulley for the <a href="https://brookbushinstitute.com/courses/flexor-hallucis-longus-and-flexor-digitorum-longus" target="_blank" rel="noopener">flexor hallucis longus</a>; this may be the most direct action of any <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> on the talus. Note: no <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> inserts into the talus.</li>
 </ul>
 </li>
 </ul>
 </li>
 </ul>
 </li>
</ul>
<a href="https://www.datocms-assets.com/25800/1643057745-dome-of-talus.png"><img src="https://www.datocms-assets.com/25800/1643057745-dome-of-talus.png" title="A superior view of the talus with lateral and medial malleolus labeled" alt="The talus in a superior view with boney landmarks labeled"></a>
<a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">Superior</a> View of Talus - By Henry Vandyke Carter - Henry Gray (1918) Anatomy of the Human Body (See &quot;Book&quot; section below)Bartleby.com: Gray&apos;s Anatomy, Plate 270, Public Domain, https://commons.wikimedia.org/w/index.php?curid=792352
<ul>
 <li>Talocalcaneal joint
 <ul>
 <li>The plantar surface of the talus features <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a>, middle, and <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> facets that articulate with the matching facets on the calcaneus. The <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> and middle facets of the talus are slightly <a id="convex" data-tip="1284" target="_blank" href="/glossary-term/convex" class="glossary">convex</a> (and may be joined in some individuals) and are smaller than the slightly <a id="concave" data-tip="1281" target="_blank" href="/glossary-term/concave" class="glossary">concave</a>, oval, <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> facet (this articulation makes up 70% of the joint, and bears roughly 75% of the load) (3, 17). The <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> and middle facet share a joint capsule with the talonavicular joint. The <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> facet, separated from the <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> and middle facets by the tarsal canal (sinus tarsi), has its own joint capsule. Articular cartilages cover these surfaces and run continuous, in part, with the articular cartilage of the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> face of the talar dome.</li>
 </ul>
 </li>
</ul>
<a href="https://www.datocms-assets.com/25800/1643057811-sulcus-tali-2.jpeg"><img src="https://www.datocms-assets.com/25800/1643057811-sulcus-tali-2.jpeg" title="An image of the talus and calcaneus bones of the body" alt="The talus and calcaneus bones "></a>
Sulcus Tali - Note the groove between the <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> and middle facets and larger <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> facet of the <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a> talus) By Anatomist90 - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=17431664
<ul>
 <li>Calcaneus: The calcaneus is the largest of the tarsal bones well suited to accept the forces of heel strike during gait.
 <ul>
 <li>Talocalcaneal Joint
 <ul>
 <li>The <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> surface has facets matching those on the <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a> surface of the talus. These surfaces are relatively flat; however the <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> and middle facets are slightly <a id="concave" data-tip="1281" target="_blank" href="/glossary-term/concave" class="glossary">concave</a>, and the large <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> facet is slightly <a id="convex" data-tip="1284" target="_blank" href="/glossary-term/convex" class="glossary">convex</a>. On the posteromedial surface, the sustentaculum talus (translation: &quot;shelf for the talus&quot;) lies under and supports the middle facet of the talus. Between the middle and <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> facets runs the calcaneal sulcus, a groove where many of the ligaments binding the calcaneus and talus attach. This sulcus becomes the tarsal sinus when the talus and calcaneus are articulated.</li>
 </ul>
 </li>
 </ul>
 </li>
</ul>
<a href="https://www.datocms-assets.com/25800/1643057853-ankle-frontal-cross-section.png"><img src="https://www.datocms-assets.com/25800/1643057853-ankle-frontal-cross-section.png" title="The ankle joint with the muscles and connective tissue labeled" alt="The joint surfaces of the ankle "></a>
Joint Surfaces of the Ankle - By Henry Vandyke Carter - Henry Gray (1918) Anatomy of the Human Body (See &quot;Book&quot; section below)Bartleby.com: Gray&apos;s Anatomy, Plate 357, Public Domain, https://commons.wikimedia.org/w/index.php?curid=566495
<h4>Alignment:</h4>
<ul>
 <li>
 The alignment of the foot is affected by the alignment of the knee and hip. Excessive genu valgum and/or coxa valgus may result in excessive eversion/pronation, and excessive genu varum and/or coxa varus can result in excessive inversion/supination. Further, femoral anteversion and/or femoral torsion angle may have an effect on tibial torsion and/or foot position. The position of the ankle and rearfoot can also be influenced by leg length discrepancies - both structural and functional.
 </li>
</ul>
Axis of the Ankle Joint: The ankle, although conventionally explained as a <a id="hinge" data-tip="1628" target="_blank" href="/glossary-term/hinge" class="glossary">hinge</a> joint, moves on an oblique axis. This obliquity is created by the tibial torsion angle, the longer and slightly <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> fibula, and the shape of the talus and mortise of the tibiotalar joint. Although somewhat variable between individuals the axis of rotation is approximately:
<ul>
 <li>10&#xB0; of inversion in the frontal plane</li>
 <li>6&#xB0; of <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> rotation in the transverse plane</li>
</ul>
<a href="https://www.datocms-assets.com/25800/1643057907-ankle-joint-angle.jpeg"><img src="https://www.datocms-assets.com/25800/1643057907-ankle-joint-angle.jpeg" title="The range of motion of the ankle joint with axis of rotations labeled" alt="The axis of the ankle joint"></a> Axis of Ankle Joint - Donald A. Neumann, &#x201C;Kinesiology of the Musculoskeletal System: Foundations of Rehabilitation &#x2013; 2nd Edition&#x201D; &#xA9; 2012 Mosby, Inc.[/caption]
<h4>Tibial Torsion (transverse plane)</h4>
<ul>
 <li>
 Is a <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> rotation of the tibia that is formed between a line through the center of the malleoli and a line through the center of the knee joint. 15 &#x2013; 20&#xBA; is considered normal; a larger than normal tibial torsion angle may result in &#x201C;toeing in&#x201D;, gait impairments, and place excessive stress on the hip and knee.
 </li>
 <li>Normal: 15 &#x2013; 20&#xBA;
 <ul>
 <li>Excessive: &gt; 20&#xBA; (may present with &#x201C;toeing in&#x201D;)</li>
 </ul>
 </li>
</ul>
<a href="https://www.datocms-assets.com/25800/1643058005-tibial-torsion-2.jpeg"><img src="https://www.datocms-assets.com/25800/1643058005-tibial-torsion-2.jpeg" title="Illustration of the femoral torsion (anteversion) on the left, and tibial torsion angle on the right" alt="Tibial torsion with axis of rotations labeled"></a>
Illustration of the femoral torsion (anteversion) on the left, and tibial torsion angle on the right.
<h4>Talar Neck Angle (Sagittal Plane)</h4>
<ul>
 <li>
 <a href="https://www.datocms-assets.com/25800/1643058071-talus-neck-angle.png"></a>Angle between the neck of the talus and the sagittal plane
 </li>
 <li>Normal: 30&#xBA; <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> to the sagittal plane
 <ul>
 <li>Excessive: &gt; 30&#xBA; (increased inversion - seen in small children)</li>
 <li>Inadequate: &lt; 30&#xBA;</li>
 </ul>
 </li>
</ul>
<img src="https://www.datocms-assets.com/25800/1643058071-talus-neck-angle.png" width="421" height="510" title="Talus neck angle which depicts a slight medial angle of the talar neck" alt="The talus neck angle">
Talus Neck Angle - Although the top angle is labeled wrong (note: 155 degrees and 20 degrees does not equal 180, the top angle should be 25 - 30 degrees), this picture does depict the slight <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> angle of the talar neck.

The ankle joint is a great joint for sharpening your palpation skills. Although the bones and landmarks are fairly small and close to one another, they are mostly superficial.
<ol>
 <li>Lateral and <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">Medial</a> Malleolus (fibular): Palpation of the ankle is likely easiest if we start with the two large bumps on either side of the ankle. With your partner lying <a id="supine" data-tip="1562" target="_blank" href="/glossary-term/supine" class="glossary">supine</a> or seated, explore the size and shape of each malleolus (the large bumps). Notice how the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">Lateral</a> malleolus is larger, or at least longer, than the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">Medial</a> malleolus. Keep in mind, that the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">Lateral</a> malleolus is part of your fibula, and your <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">Medial</a> malleolus is part of your tibia. You can trace the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">Medial</a> malleolus up the <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> tibia (shin), but tracing up your <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">Lateral</a> malleolus results in the bone disappearing under your fibularis muscles. Palpate the ligaments projecting from the bottom of your malleoli - the fan-shaped deltoid ligaments projecting from the bottom of the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">Medial</a> malleolus, and the prominent calcaneofibular ligament projecting straight down from the end of the fibula.</li>
 <li>Malleolar Grooves: If you continue your palpation to the <a id="distal" data-tip="1563" target="_blank" href="/glossary-term/distal" class="glossary">distal</a>, <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> end of your malleoli and press a bit deeper into the tissue you will feel grooves in the back of each. The tendons of the <a href="https://brookbushinstitute.com/courses/tibialis-posterior" target="_blank" rel="noopener">tibialis posterior</a> and <a href="https://brookbushinstitute.com/courses/flexor-hallucis-longus-and-flexor-digitorum-longus" target="_blank" rel="noopener">flexor digitorum longus</a> run in the groove of the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> malleolus, which then leads to the tarsal tunnel where you can find &quot;Tom Dick And Very Nervous Harry&quot; - <a href="https://brookbushinstitute.com/courses/tibialis-posterior" target="_blank" rel="noopener">Tibialis </a><a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a>, <a href="https://brookbushinstitute.com/courses/flexor-hallucis-longus-and-flexor-digitorum-longus" target="_blank" rel="noopener">Flexor Digitorum Longus</a>, <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> Tibial Artery, and Vein, Tibial <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">Nerve</a>, and <a href="https://brookbushinstitute.com/courses/flexor-hallucis-longus-and-flexor-digitorum-longus" target="_blank" rel="noopener">Flexor Hallucis Longus</a>. The tendons of the <a href="https://brookbushinstitute.com/courses/fibularis-muscles" target="_blank" rel="noopener">Fibularis Longus and Brevis</a> run in the groove in your <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> malleolus.</li>
 <li>Fibular Head The fibular head (articulation of the <a id="proximal" data-tip="1564" target="_blank" href="/glossary-term/proximal" class="glossary">proximal</a> tibiofibular joint) can be palpated by tracing the fibularis muscles proximally from the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> malleolus until your fingers get caught under the <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a> portion of the fibular head. Or, you can fall off the tibial tuberosity (discussed in the <a href="https://brookbushinstitute.com/courses/knee" target="_blank" rel="noopener">Knee</a> article) laterally 5 - 6 centimeters to end up on the <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> aspect of the fibular head. Continuing your palpation to fall off the top (superior/proximal) of the fibular head, you will find a depression (just <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a> to the femoral condyle) where a little deeper palpation and exploration will reveal the knee joint line and <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> collateral ligament (LCL) Take the time to explore the shape, size, and depressions on the fibular head. This is an important palpation for manual therapists.</li>
 <li>Calcaneus - Walk your fingers down and back toward the heel and allow your fingers to sink into the soft tissue. The bone you are feeling is the calcaneus or &quot;heel bone&quot;. Notice how the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> and <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> sides are rigid and cratered, compared to the round flat surface of the <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> and plantar aspects of the calcaneus (the tuberosity of the calcaneus). Consider how this is important to the function of the calcaneus and how this may be related to gait.</li>
 <li>Sustentaculum Tali - In seated or lying, passively invert your partner&apos;s foot and depress your thumb into the soft tissue just below the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> malleolus. About 2 centimeters <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a> and slightly <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> to the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> malleolus you will feel a raised ridge. This ridge is your sustentaculum tali, the structure that supports the middle facet of the talus. (Note: ensure you are not <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> to the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> malleolus, as the ridge located there is the navicular tubercle)</li>
 <li>Peroneal Trochlea - In seated or lying, almost opposite the sustentaculum tali, on the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> aspect of the calcaneus, about 2 centimeters <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a> to the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> malleolus is a raised ridge known as the &quot;peroneal trochlea&quot;. Passively evert the foot to soften the tissues of the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> ankle. The tendons of the <a href="https://brookbushinstitute.com/courses/fibularis-muscles" target="_blank" rel="noopener">fibularis longus and brevis</a> pass under this trochlea, but not the tendon of the <a href="https://brookbushinstitute.com/courses/extensor-hallucis-longus-and-extensor-digitorum-longus-fibularis-tertius" target="_blank" rel="noopener">fibularis tertius</a>.</li>
 <li>Head of Talus - The head of the talus can be located by first finding the navicular tubercle. The navicular tubercle is a raised bump about a centimeter <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a> and 2 centimeters <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> to the <a id="distal" data-tip="1563" target="_blank" href="/glossary-term/distal" class="glossary">distal</a> end of the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> malleolus. (This was discussed above, as the sustentaculum tali is just <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a> and <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> to the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> malleolus.) Once you have located the navicular tubercle, passively invert the foot to soften tissues and allow your thumb to depress between the navicular tubercle and <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> malleolus. Moving your thumb back-and-forth in this depression, you should feel a ridge distally that is the head of the talus, and a flattened section of bone proximally that is the anterolateral aspect of the neck of the talus.</li>
 <li>Neck of Talus - From the depression between the navicular tubercle, across the front of the ankle, to the anterior/inferior aspect of the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> malleolus you can run your thumb over the neck of the talus. You can also find the neck of the talus by imagining a line through the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> and <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> malleoli and pressing your thumb in the center of that line, on the front of the ankle, deep to the tendons of the <a href="https://brookbushinstitute.com/courses/video-tree-search" target="_blank" rel="noopener">tibialis anterior</a>, <a href="https://brookbushinstitute.com/courses/extensor-hallucis-longus-and-extensor-digitorum-longus-fibularis-tertius" target="_blank" rel="noopener">extensor hallucis longus, and extensor digitorum longus</a>.</li>
 <li>Trochlea of Talus - The trochlea of the talus can be felt using the same palpation as you used for the neck of the talus. Place your thumb in the center of a line between the malleoli, on the front of the ankle, and deep to the tendons of the <a href="https://brookbushinstitute.com/courses/tibialis-anterior" target="_blank" rel="noopener">tibialis anterior</a>, and <a href="https://brookbushinstitute.com/courses/extensor-hallucis-longus-and-extensor-digitorum-longus-fibularis-tertius" target="_blank" rel="noopener">extensor digitorum longus</a>. Now, with your other hand, pull your partner&apos;s foot into plantar flexion. As you pull the foot into plantarflexion, the talar dome will <a id="glide" data-tip="1815" target="_blank" href="/glossary-term/glide" class="glossary">slide</a> under your finger, and you should notice a mild depression, and/or two raised ridges move under your finger. You can imagine the trochlea as the &quot;valley&quot; between the two raised &quot;ridges&quot;.</li>
</ol>
<a href="https://www.datocms-assets.com/25800/1643058289-ankle-1.png"><img src="https://www.datocms-assets.com/25800/1643058289-ankle-1.png" title="Illustration of the fibular, tibia, calcaneus, and talus and the connecting ligaments and tendons of the ankle joint" alt="The bones and ligaments of the ankle joint"></a>
Simple Illustration of bones and ligaments of the ankle joint By An svg version of image:Ankle.PNG by me (Jak). - A vector version of the original image found here [1], Public Domain, https://commons.wikimedia.org/w/index.php?curid=1981086

Ankle Joint Palpation

<h3>Non- contractile/ passive tissue</h3>
<table>
 <tbody>
 <tr>
 <td>
 <h4>Name</h4>
 </td>
 <td>
 <h4>Attachments</h4>
 </td>
 <td>
 <h4>Course</h4>
 </td>
 <td>
 <h4>Restricted Motions</h4>
 </td>
 </tr>
 <tr>
 <td>ProximalTibiofibular Joint Capsule and Ligaments</td>
 <td>Surrounding the proximal tibiofibular joint, and attaching just past the joint line. Communicating with the knee capsule in approximately 10% of individuals (18).</td>
 <td>Laterally oriented fibers, with a slight obliquity from superior medial (tibia) to inferior lateral (fibula) - strengthened by anterior and posterior ligaments.</td>
 <td>Restricts motion in all directions</td>
 </tr>
 <tr>
 <td>Lateral Collateral Ligament (of the knee)</td>
 <td>
 <ul>
 <li>Femoral Attachment: <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">Lateral</a> epicondyle</li>
 <li>Fibular Attachment: Fibular head blending with the tendon of the <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">biceps femoris</a></li>
 </ul>
 </td>
 <td>Follows a nearly vertical course, slightly posterior to the axis of rotation of the knee.</td>
 <td>Resists tibiofibular inferior glide, posterior and anterior glide with the knee in extension and may provide some resistance to anterior dislocation when the knee is flexed.</td>
 </tr>
 <tr>
 <td>Distal Tibiofibular Joint Ligaments</td>
 <td>This joint has no capsule but is supported by anterior and posterior ligaments that attach just beyond the joint line, and an extension of the interosseous membrane known as the interosseous ligament which attaches superior to, and between the two bones.</td>
 <td>The anterior and posterior ligaments course laterally, while the interosseous ligament maintains the same crosshatched fiber orientation of the interosseous membrane.</td>
 <td>All of the ligaments will resist the anterior and posterior glide of the lateral malleolus, the anterior ligament will resist external rotation, and the posterior ligament will resist medial rotation. However, the most important role of these ligaments is to resist the separation of the fibula and tibia.</td>
 </tr>
 <tr>
 <td>Interosseous Membrane</td>
 <td>The interosseous membrane extends most of the length of the internal surface of the tibia and fibula, attaching to the &quot;interosseous crest&quot; of each bone.</td>
 <td>Most of the fibers course from superior/medial on the tibia to inferior/lateral on the fibula. Some fibers crosshatch these fibers in the opposite direction.</td>
 <td>While this membranous sheath of connective tissue will resist the extremes of all motions of the fibula, it primarily resists the separation of the tibia and fibula.</td>
 </tr>
 <tr>
 <td>Tibiotalar (Talocrural) Joint Capsule</td>
 <td>The capsule of the tibiotalar joint extends just past the joint line, encircling the mortise of the ankle. The proximal attachment includes the distal portions of the medial and lateral malleoli and distal tibia, and the distal portion attaches just beyond the dome of the talus.</td>
 <td>The fiber direction of the capsule is complex and reinforced by several ligaments (discussed below); however, the general direction of fibers is vertical.</td>
 <td>Resists extreme plantar flexion, dorsiflexion, or lateral tilt in either direction. The capsule is thinner on the anterior and posterior sides, likely relying on reinforcement from the strong plantar flexors and dorsiflexors of the ankle (2).</td>
 </tr>
 <tr>
 <td>Medial Collateral Ligaments(Deltoid Ligaments)</td>
 <td>Tibial Attachment:
 <ul>
 <li><a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">Medial</a> malleolus</li>
 </ul>
 Distal Attachments:
 <ul>
 <li>Tibionavicular fibers: Navicular (near tuberosity)</li>
 <li>Tibiocalcaneal fibers: Sustentaculum tali</li>
 <li>Tibiotalar fibers: <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">Medial</a> tubercle &amp; adjacent part of the talus</li>
 </ul>
 </td>
 <td>The direction of fibers from the origin on medial malleolus:
 <ul>
 <li>Tibionavicular fibers: Anterior/inferior</li>
 <li>Tibiocalcaneal fibers: <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">Inferior</a> and slightly posterior</li>
 <li>Tibiotalar fibers: <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">Inferior</a> and posterior</li>
 </ul>
 </td>
 <td>Limits the following joint motions:
 <ul>
 <li>Tibionavicular fibers:
 <ul>
 <li>Eversion</li>
 <li>Plantar flexion by limiting <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a> of the talus</li>
 </ul>
 </li>
 <li>Tibiocalcaneal fibers:
 <ul>
 <li>Tibiotalar &amp; Talocalcaneal eversion</li>
 </ul>
 </li>
 <li>Tibiotalar fibers:
 <ul>
 <li>Eversion</li>
 <li>Dorsiflexion by limiting <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a> of the talus</li>
 </ul>
 </li>
 </ul>
 </td>
 </tr>
 <tr>
 <td>Lateral Collateral Ligaments (see below)</td>
 <td></td>
 <td></td>
 <td></td>
 </tr>
 <tr>
 <td style="text-align: left;">AnteriorTalofibular Ligament</td>
 <td>Fibular Attachment:
 <ul>
 <li>Anterior/lateral portion of <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> malleolus</li>
 </ul>
 Talar Attachment:
 <ul>
 <li>Neck of the talus</li>
 </ul>
 </td>
 <td>From the fibula this ligament has a primarily horizontal fiber direction, sloping dorsal and medial toward its attachment on the neck of the talus.</td>
 <td>Limits:
 <ul>
 <li>Plantar flexion by limiting <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a> of the talus</li>
 <li>Inversion, especially with full plantar flexion</li>
 <li>Adduction</li>
 </ul>
 Weakest &amp; most commonly injured ligament with inversion sprains (19)
 </td>
 </tr>
 <tr>
 <td style="text-align: left;">Posterior Talofibular Ligament</td>
 <td>Fibular Attachment:
 <ul>
 <li>Posterior/medial surface of <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> malleolus</li>
 </ul>
 Talar Attachment:
 <ul>
 <li><a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">Lateral</a> tubercle of the talus</li>
 </ul>
 </td>
 <td>From the fibula this ligament has a primarily horizontal fiber direction, sloping from anterolateral to posteromedial to its attachment on the talus.</td>
 <td>Limits:
 <ul>
 <li>Dorsiflexion by limiting <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a> of the talus</li>
 <li>Abduction</li>
 <li>Inversion</li>
 </ul>
 </td>
 </tr>
 <tr>
 <td style="text-align: left;">Calcaneofibular Ligament</td>
 <td>
 <ul>
 <li>Tibial Attachment: Apex of <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> malleolus</li>
 <li>Calcaneal Attachment: <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">Lateral</a> surface</li>
 </ul>
 </td>
 <td>Vertically: Inferiorly and posteriorly</td>
 <td>Limits:
 <ul>
 <li>Dorsiflexion by limiting <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a> of the talus</li>
 <li>Inversion, especially with full dorsiflexion</li>
 </ul>
 </td>
 </tr>
 <tr>
 <td>Inferior transverse ligament</td>
 <td>
 <ul>
 <li>Fibular Attachment: Posteromedial surface of <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> malleolus</li>
 <li>Tibial Attachment: <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">Posterior</a> <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> malleolus</li>
 </ul>
 </td>
 <td>Considered an expansion of the posterior talofibular ligament, courses posteriorly and medially, and may help to form the posterior wall of the tibiotalar joint.</td>
 <td>
 <ul>
 <li>Limits dorsiflexion by limiting <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a> of the talus</li>
 </ul>
 </td>
 </tr>
 <tr>
 <td>Talocalcaneal Capsule</td>
 <td>Each of the three articulations of the talocalcaneal joint is enclosed in its own joint capsule</td>
 <td>The anterior and middle facet capsules may be joined, whereas the posterior facet is separated from the anterior and middle facets by the tarsal sinus and is reinforced by three ligaments (medial, lateral, and posterior talocalcaneal ligaments) indistinguishable from the capsule itself.</td>
 <td>The posterior facet capsule provides the most support of the three joint capsules. All capsules resist talocalcaneal eversion and inversion and resist distraction helping to maintain joint congruence.</td>
 </tr>
 <tr>
 <td>Medial, Lateral &amp; Posterior Talocalcaneal Ligaments</td>
 <td>Most often indistinguishable from the capsule of the posterior facet.</td>
 <td>Vertical orientation coursing the short distance between calcaneus and talus.</td>
 <td>Resists talocalcaneal eversion and inversion, and resist distraction helping to maintain joint congruence.</td>
 </tr>
 <tr>
 <td>Talocalcaneal (Interosseous) Ligament</td>
 <td>Talar Attachment:
 <ul>
 <li>Talar sulcus and adjacent regions</li>
 </ul>
 Calcaneal Attachment:
 <ul>
 <li>Calcaneal sulcus</li>
 </ul>
 </td>
 <td>Two distinct flat bands (anterior and posterior) with an oblique fiber arrangement, these two bands cross as they course the short distance between talar sulcus and calcaneal sulcus.</td>
 <td>Limits extremes of motion, especially inversion</td>
 </tr>
 <tr>
 <td>Cervical Ligament</td>
 <td>
 <ul>
 <li>Talar Attachment: Inferolateral surface of the neck of the talus</li>
 <li>Calcaneal Attachment: <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">Lateral</a> calcaneal sulcus (on the neck of the calcaneus)</li>
 </ul>
 </td>
 <td>Oblique fiber direction, coursing from the talus inferolateral to the calcaneal sulcus</td>
 <td>Limits extremes of motion, especially inversion</td>
 </tr>
 </tbody>
</table>
<h3><img src="https://www.datocms-assets.com/25800/1643058355-interosseous-membrane.jpeg" title="The fibular, tibia, calcaneus, talus, bones of the foot, and interosseous membrane" alt="Interosseous membrane of the lower leg"></h3>
Interosseous Membrane - By Anatomist90 - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=25485637

Ankle Joint Connective Tissues: Capsule, Ligaments, and Menisci

<ul>
 <li>Retrocalcaneal (Subtendinous) Bursa: Lies between the Achilles tendon and the <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> aspect of the calcaneus, and is believed to aid in reducing friction between the two structures (20).</li>
 <li>Subcutaneous Bursa of the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">Lateral</a> Malleolus: Lies between the skin and <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">Lateral</a> malleolus, aiding in dispersing forces and reducing the risk of abrasion from contact between the skin, <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">Lateral</a> malleolus, and the environment.</li>
 <li>Subcutaneous Bursa of the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">Medial</a> Malleolus: Lies between the skin and <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">Medial</a> malleolus, aiding in dispersing forces and reducing the risk of abrasion from contact between the skin, <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">Medial</a> malleolus, and the environment,</li>
 <li>Subcutaneous Calcaneal Bursa: Lies between the skin and Achilles tendon where the tendon inserts into the calcaneus, aiding in dispersing forces and reducing the risk of abrasion from contact between the skin, Achilles tendon, calcaneus, and the environment, This bursa likely plays a large a role in reducing the pressure on the heel created by footwear.</li>
</ul>
<a href="https://www.datocms-assets.com/25800/1643058463-bursa-and-sheaths-of-ankle.jpeg"><img src="https://www.datocms-assets.com/25800/1643058463-bursa-and-sheaths-of-ankle.jpeg" title="Muscles, tendons, and bursae of the &lt;a id=" lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">Lateral</a> ankle joint&quot; alt=&quot;The bursae of the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">Lateral</a> ankle joint&quot;&gt; Bursae and Tendinous Sheaths of <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">Lateral</a> Ankle

Ankle Joint Bursae

<ul>
 <li>Sensory Innervation of Joints:
 <ul>
 <li>Proximal Tibiofibular Joint Capsule: Innervated by branches from the common fibular and popliteal nerves (21).</li>
 <li>Distal Tibiofibular Joint: (No Capsule) Innervated by branches of the sural, deep fibular, and tibial nerves.</li>
 <li>Ankle (Tibiotalar) - Innervated by <a id="distal" data-tip="1563" target="_blank" href="/glossary-term/distal" class="glossary">Distal</a> branches of all 5 major nerves of the lower leg, including the saphenous (<a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> ankle and malleolus), tibial (<a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a>, <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a>, and talocalcaneonavicular), sural (<a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a>), superficial peroneal (<a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> and <a id="ventral" data-tip="1553" target="_blank" href="/glossary-term/ventral" class="glossary">ventral</a>), and deep peroneal <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a> (<a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> ankle) (22, 23).</li>
 <li>Talocalcaneal - The <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> facets are likely innervated by the deep peroneal <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a>, the sural nerves have branches that penetrate the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> joint line, this joint may also receive innervation from the tibial and <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> plantar nerves (22, 24).</li>
 </ul>
 </li>
</ul>
<table class="aligncenter">
 <tbody>
 <tr>
 <td width="322">
 <h4 style="text-align: left;">Muscles Crossing the Joint</h4>
 </td>
 <td width="315" style="text-align: left;">
 <h4>Neural Innervation</h4>
 </td>
 <td width="170" style="text-align: left;">
 <h4>Nerve Root</h4>
 </td>
 </tr>
 <tr>
 <td width="322">Fibularis Longus</td>
 <td width="315">Superficial fibular nerve</td>
 <td width="170">L5, S1 (sometimes L4)</td>
 </tr>
 <tr>
 <td>Fibularis Brevis</td>
 <td>Superficial fibular nerve</td>
 <td>L5, S1 (sometimes L4)</td>
 </tr>
 <tr>
 <td width="322">Fibularis Tertius</td>
 <td width="315">Deep Fibular Nerve</td>
 <td width="170">L4 - S1</td>
 </tr>
 <tr>
 <td width="322"><a href="https://brookbushinstitute.com/courses/tibialis-anterior" target="_blank" rel="noopener">Tibialis Anterior</a></td>
 <td width="315">Deep fibular nerve</td>
 <td width="170">L4, L5 (sometimes S1)</td>
 </tr>
 <tr>
 <td width="322"><a href="https://brookbushinstitute.com/courses/extensor-hallucis-longus-and-extensor-digitorum-longus-fibularis-tertius" target="_blank" rel="noopener">Extensor Digitorum Longus</a></td>
 <td width="315">Deep fibular nerve</td>
 <td width="170">L5, S1 (sometimes L4)</td>
 </tr>
 <tr>
 <td width="322"><a href="https://brookbushinstitute.com/courses/extensor-hallucis-longus-and-extensor-digitorum-longus-fibularis-tertius" target="_blank" rel="noopener">Extensor Hallucis Longus</a></td>
 <td width="315">Deep fibular nerve</td>
 <td width="170">L5, S1 (sometimes L4)</td>
 </tr>
 <tr>
 <td width="322">Plantaris</td>
 <td width="315">Tibial nerve</td>
 <td width="170">L5, S1 (sometimes L4 or S2)</td>
 </tr>
 <tr>
 <td><a href="https://brookbushinstitute.com/courses/tibialis-posterior" target="_blank" rel="noopener">Tibialis Posterior</a></td>
 <td>Tibial nerve</td>
 <td>L5, S1 (sometimes L4)</td>
 </tr>
 <tr>
 <td width="322"><a href="https://brookbushinstitute.com/courses/flexor-hallucis-longus-and-flexor-digitorum-longus" target="_blank" rel="noopener">Flexor Digitorum Longus</a></td>
 <td width="315">Tibial nerve</td>
 <td width="170">L5-S2</td>
 </tr>
 <tr>
 <td width="322"><a href="https://brookbushinstitute.com/courses/flexor-hallucis-longus-and-flexor-digitorum-longus" target="_blank" rel="noopener">Flexor Hallucis Longus</a></td>
 <td width="315">Tibial nerve</td>
 <td width="170">L5-S2</td>
 </tr>
 <tr>
 <td width="322">Gastrocnemius</td>
 <td width="315">Tibial nerve</td>
 <td width="170">S1, S2 (sometimes L5)</td>
 </tr>
 <tr>
 <td width="322"><a href="https://brookbushinstitute.com/courses/soleus" target="_blank" rel="noopener">Soleus</a></td>
 <td width="315">Tibial Nerve</td>
 <td width="170">S1, S2 (sometimes L5)</td>
 </tr>
 </tbody>
</table>
<img src="https://www.datocms-assets.com/25800/1643058571-posterior-nerves-of-leg.jpeg" title="The muscular innervation of the nerves in the lower leg" alt="Nerves of the posterior leg">
Nerves of the <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">Posterior</a> Leg and Muscular Innervation

Ankle Joint Nerves

<h3>Osteokinematics:</h3>
Included in this section are the <a id="osteokinematic-motion" data-tip="1797" target="_blank" href="/glossary-term/osteokinematic-motion" class="glossary">osteokinematics</a> of the talotibial (talocrural) and talocalcaneal (subtalar) joints. The <a id="distal" data-tip="1563" target="_blank" href="/glossary-term/distal" class="glossary">distal</a> and <a id="proximal" data-tip="1564" target="_blank" href="/glossary-term/proximal" class="glossary">proximal</a> tibiofibular joints are not included as they display a small amount of motion that would be best described as <a id="arthrokinematics" data-tip="1701" target="_blank" href="/glossary-term/arthrokinematics" class="glossary">arthrokinematic motion</a>.
<h3>Ankle Kinematics</h3>
Note: The axis of rotation for the ankle is not strictly parallel to the frontal or transverse planes of motion. It is not a simple frontal plane axis that results in the primary actions of the ankle running parallel to the sagittal plane. The true axis of the ankle can be imagined as a line through the <a id="distal" data-tip="1563" target="_blank" href="/glossary-term/distal" class="glossary">distal</a> tips of the malleoli; with the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> malleolus extending further inferiorly and being slightly <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> to the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> malleolus. This creates an axis 10&#xB0; from the frontal plane and 6&#xB0; from the horizontal plane. Due to the slight obliquity of the axis of rotation of the tibiotalar joint, dorsiflexion along this axis would appear to include slight abduction and eversion (often referred to as pronation) whereas plantar flexion would appear to include slight adduction and inversion (often referred to as supination). Note, abduction and adduction are not active motions, and eversion and inversion of the tibiotalar joint are not active either. As these motions are not active, they are not included in the analysis below and are rather assumed as slight deviations from the sagittal plane during dorsiflexion and plantar flexion. Eversion and inversion of the talocalcaneal joint may be active and is included below. The Brookbush Institute prefers to use the terms &quot;pronation&quot; and &quot;supination&quot; to refer to a combination of joint actions that results in rotation of the forefoot (as the terms are commonly used by Podiatrists (DPM)), similar to how the terms are used for the forearm. Our decisions for how joint actions and terminology are used are not in defiance or disagreement of biomechanical principles, but they are based on function, clarity, and usefulness in practice. For example, although we may not be able to change the axis of rotation of the tibiotalar joint and affect the &quot;abduction&quot; component of &quot;tibiotalar pronation&quot;, we can address excessive eversion of the talocalcaneal joint by addressing altered <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity and lengths of the muscles crossing the talocalcaneal joint, further, the talocalcaneal joint may be mobilized. The neutral position of the tibiotalar joint is considered 90&#xB0; by convention when measured between the 5th metatarsal and center of the tibia, and the talocalcaneal joint is considered in a neutral position at 180&#xB0; by convention, or when the Achilles tendon forms a straight line between the center of the calcaneus, talus, and tibia.
<h3>Tibiotalar (talocrural) Joint Actions</h3>
<ul>
 <li>Dorsiflexion
 <ul>
 <li>Dorisflexors: <a href="https://brookbushinstitute.com/courses/tibialis-anterior" target="_blank" rel="noopener">Tibialis anterior</a>, <a href="https://brookbushinstitute.com/courses/extensor-hallucis-longus-and-extensor-digitorum-longus-fibularis-tertius" target="_blank" rel="noopener">extensor digitorum longus, extensor hallucis longus, fibularis tertius</a></li>
 <li>Limited by: Gastrocnemius, plantaris,<a href="https://brookbushinstitute.com/courses/soleus" target="_blank" rel="noopener"> soleus</a>, <a href="https://brookbushinstitute.com/courses/tibialis-posterior" target="_blank" rel="noopener">tibialis posterior</a>, <a href="https://brookbushinstitute.com/courses/flexor-hallucis-longus-and-flexor-digitorum-longus" target="_blank" rel="noopener">flexor hallucis longus, flexor digitorum longus</a>, fibularis longus, fibularis brevis, <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> capsule, <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a> transverse ligament, calcaneofibular ligament (tibiotalar fibers), <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> tibiofibular ligament, interosseous ligament, deltoid ligament (tibiotalar fibers).</li>
 <li>Optimal Range of Motion (AAROM): 15-20&#xB0; (<a href="https://brookbushinstitute.com/video/dorsiflexion-goniometry" target="_blank" rel="noopener">Dorsiflexion Goniometry</a>)</li>
 </ul>
 </li>
 <li>Plantarflexion
 <ul>
 <li>Plantarflexors: Gastrocnemius, plantaris,<a href="https://brookbushinstitute.com/courses/soleus" target="_blank" rel="noopener"> soleus</a>, <a href="https://brookbushinstitute.com/courses/tibialis-posterior" target="_blank" rel="noopener">tibialis posterior</a>, <a href="https://brookbushinstitute.com/courses/flexor-hallucis-longus-and-flexor-digitorum-longus" target="_blank" rel="noopener">flexor hallucis longus, flexor digitorum longus</a>, fibularis longus, fibularis brevis</li>
 <li>Limited by: <a href="https://brookbushinstitute.com/courses/tibialis-anterior" target="_blank" rel="noopener">Tibialis anterior</a>, <a href="https://brookbushinstitute.com/courses/extensor-hallucis-longus-and-extensor-digitorum-longus-fibularis-tertius" target="_blank" rel="noopener">extensor digitorum longus, extensor hallucis longus, fibularis tertius</a>, <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> talofibular ligament, interosseous ligament, deltoid ligament (tibionavicular fibers).</li>
 <li>Optimal ROM: 40-50&#xB0;</li>
 </ul>
 </li>
</ul>
<ul>
 <li>Open Pack Position: Full Plantarflexion</li>
 <li>Close Pack Position: Full Dorsiflexion</li>
</ul>
<a href="https://www.datocms-assets.com/25800/1643058715-dorsiplantar-2.jpeg"><img src="https://www.datocms-assets.com/25800/1643058715-dorsiplantar-2.jpeg" width="549" height="785" title="Joint actions of the foot, including dorsiflexion and plantar flexion" alt="An example of dorsiflexion and plantar flexion of the foot"></a>
Dorsiflexion and Plantarflexion of the Tibiotalor (Talocrural) Joint By Connexions - http://cnx.org, CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=29624326
<h3>Talocalcaneal Joint Actions:</h3>
<ul>
 <li>Calcaneal Inversion
 <ul>
 <li>Invertors: <a href="https://brookbushinstitute.com/courses/tibialis-posterior" target="_blank" rel="noopener">Tibialis posterior</a>, <a href="https://brookbushinstitute.com/courses/tibialis-anterior" target="_blank" rel="noopener">tibialis </a><a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a>, <a href="https://brookbushinstitute.com/courses/flexor-hallucis-longus-and-flexor-digitorum-longus" target="_blank" rel="noopener">flexor hallucis longus, flexor digitorum longus</a>, <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> gastrocnemius</li>
 <li>Limited by: Fibularis longus, fibularis brevis, <a href="https://brookbushinstitute.com/courses/extensor-hallucis-longus-and-extensor-digitorum-longus-fibularis-tertius" target="_blank" rel="noopener">extensor digitorum longus, extensor hallucis longus, fibularis tertius</a>, <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> collateral ligaments (<a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> talofibular, <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> talofibular, calcaneal fibular ligaments), talocalcaneal ligaments (<a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a>, <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a>, <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a>), interosseous ligament and cervical ligament</li>
 <li>Optimal Range of Motion (ROM): About 5&#xB0;</li>
 </ul>
 </li>
 <li>Calcaneal Eversion
 <ul>
 <li>Evertors: Fibularis longus, fibularis brevis, <a href="https://brookbushinstitute.com/courses/extensor-hallucis-longus-and-extensor-digitorum-longus-fibularis-tertius" target="_blank" rel="noopener">extensor digitorum longus, extensor hallucis longus, fibularis tertius</a>, <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> gastrocnemius</li>
 <li>Limited by: <a href="https://brookbushinstitute.com/courses/tibialis-posterior" target="_blank" rel="noopener">Tibialis posterior</a>, <a href="https://brookbushinstitute.com/courses/tibialis-anterior" target="_blank" rel="noopener">tibialis </a><a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a>, <a href="https://brookbushinstitute.com/courses/flexor-hallucis-longus-and-flexor-digitorum-longus" target="_blank" rel="noopener">flexor hallucis longus, flexor digitorum longus</a><a href="https://brookbushinstitute.com/article/tibialis-anterior" target="_blank" rel="noopener">, </a>medial gastrocnemius, deltoid ligament (all fibers), talocalcaneal ligaments (<a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a>, <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a>, <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a>), interosseous ligament, cervical ligament</li>
 <li>Optimal ROM: About 5&#xB0;</li>
 </ul>
 </li>
 <li>Note: The <a href="https://brookbushinstitute.com/courses/soleus" target="_blank" rel="noopener">soleus</a> may be biased toward contributing to inversion; however, may also contribute to eversion when the attachment of the Achilles tendon on the calcaneus is <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> to the talocalcaneal axis of rotation (roughly the midline of the calcaneus) (25, 26)</li>
 <li>Further, the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> and <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> gastrocnemius may be biased toward eversion due to a 90&#xB0; rotation of the Achilles tendon that places the fibers that invest in the gastrocnemius muscles <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> to the center of the calcaneus (25, 27)</li>
</ul>
<img src="https://www.datocms-assets.com/25800/1643058762-subtalar-inversion-and-eversion.png" title="An example of subtalar inversion and eversion" alt="Illustration of talocalcaneal inversion and eversion">
Talocalcaneal (subtalor) Inversion and Eversion

Ankle Joint Actions

<ul>
 <li>Motion of the ankle is influenced by muscles, fascia, and the <a id="mobility" data-tip="1455" target="_blank" href="/glossary-term/mobility" class="glossary">mobility</a> of nerves that cross multiple joints, a concept often referred to as &quot;regional interdependence&quot;. Further, the motion of <a id="proximal" data-tip="1564" target="_blank" href="/glossary-term/proximal" class="glossary">proximal</a> joints may influence the position of bones, force vectors, moment arms, and the dissipation of force.
 <ul>
 <li>Joints:
 <ul>
 <li>Sacroiliac joint (SIJ) (32, 34)</li>
 <li>Hip Joint (28,29, 37)</li>
 <li>Knee (30, 31, 36, 38)</li>
 <li>Ankle/foot</li>
 </ul>
 </li>
 <li>Muscles:
 <ul>
 <li>A strong argument can be made that all muscles crossing the joints of the lower extremity (from the sacroiliac joint to phalanges) may affect ankle motion.</li>
 <li>Those with the largest influence likely include muscles that contribute to:
 <ul>
 <li>Dorsiflexion: <a href="https://brookbushinstitute.com/courses/tibialis-anterior" target="_blank" rel="noopener">Tibialis anterior</a>, <a href="https://brookbushinstitute.com/courses/extensor-hallucis-longus-and-extensor-digitorum-longus-fibularis-tertius" target="_blank" rel="noopener">extensor digitorum longus, extensor hallucis longus, fibularis tertius</a></li>
 <li>Platarflexion: Gastrocnemius, plantaris,<a href="https://brookbushinstitute.com/courses/soleus" target="_blank" rel="noopener"> soleus</a>, <a href="https://brookbushinstitute.com/courses/tibialis-posterior" target="_blank" rel="noopener">tibialis posterior</a>, <a href="https://brookbushinstitute.com/courses/flexor-hallucis-longus-and-flexor-digitorum-longus" target="_blank" rel="noopener">flexor hallucis longus, flexor digitorum longus</a>, fibularis longus, fibularis brevis</li>
 <li>Proximal Fibular <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> Glide: <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">Biceps femoris</a>, <a title="Tensor Fasciae Latae (TFL)" href="https://brookbushinstitute.com/courses/tensor-fascia-latae-tfl" target="_blank" rel="noopener">tensor fascia latae</a>, vastus lateralis (iliotibial band complex)
 <ul>
 <li>Note: All of the invertors and evertors of the talocalcaneal joint also either plantarflex or dorsiflex the ankle.</li>
 </ul>
 </li>
 </ul>
 </li>
 </ul>
 </li>
 <li>Fascial Structures (35):
 <ul>
 <li>Crural Fascia</li>
 <li>Iliotibial Band: by attachment to the fibular head and its influence on <a id="proximal" data-tip="1564" target="_blank" href="/glossary-term/proximal" class="glossary">proximal</a> tibiofibular joint motion.</li>
 </ul>
 </li>
 <li>Neural Structures:
 <ul>
 <li>Ankle (Tibiotalar) - Discussed above, the 5 major nerves of the lower leg both cross the ankle and innervate the joint capsules, saphenous <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a>, tibial <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a>, sural <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a> superficial fibular <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a>, and deep fibular <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a> (22, 23).</li>
 <li>Femoral and Sciatic Nerves - The saphenous <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a> departs from the femoral <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a>, the sciatic <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a> splits into the tibial nerves and the common fibular <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a>, the common fibular <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a> splits again into the superficial and deep fibular nerves and the sural is comprised of branches of the tibial and common fibular nerves (1 - 4).</li>
 <li>Common Fibular <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a> - The common fibular <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a> deserves an additional mention, as this <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a> may become irritated or trapped as a result of <a id="proximal" data-tip="1564" target="_blank" href="/glossary-term/proximal" class="glossary">proximal</a> tibiofibular joint dysfunction. Although this dysfunction is often treated as knee impairment, it is likely the ankle plays a significant role.</li>
 </ul>
 </li>
 </ul>
 </li>
</ul>

The ankle has a propensity toward a <a id="compensation-pattern" data-tip="1696" target="_blank" href="/glossary-term/compensation-pattern" class="glossary">compensation pattern</a> often described as &quot;flat feet,&quot; &quot;feet turn out,&quot; &quot;functional pes planus,&quot; or &quot;pronation distortion&quot;(1, 7-10). This <a id="movement-impairment" data-tip="1575" target="_blank" href="/glossary-term/movement-impairment" class="glossary">movement impairment</a> is a combination of joint restrictions and actions - inadequate dorsiflexion (excessive plantar flexion), excessive eversion, and potentially excessive tibial external rotation at the knee (which is discussed further in the article - <a href="https://brookbushinstitute.com/courses/knee" target="_blank" rel="noopener">Knee</a>). Several texts have noted that excessive <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> glide/inadequate <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> glide of the talus commonly accompanies this dysfunction (1, 7, 9, 10). Clinically, the Brookbush Institute has also noted stiffness and <a id="arthrokinematics" data-tip="1863" target="_blank" href="/glossary-term/arthrokinematics" class="glossary">arthrokinematic</a> <a id="dyskinesis" data-tip="1693" target="_blank" href="/glossary-term/dyskinesis" class="glossary">dyskinesis</a> of the talocalcaneal and <a id="proximal" data-tip="1564" target="_blank" href="/glossary-term/proximal" class="glossary">proximal</a> and <a id="distal" data-tip="1563" target="_blank" href="/glossary-term/distal" class="glossary">distal</a> tibiofibular joints that match the <a id="arthrokinematics" data-tip="1702" target="_blank" href="/glossary-term/arthrokinematics" class="glossary">arthrokinematic motions</a> that one would expect to find accompanying excessive plantarflexion, eversion, and talar <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a>.
That is, excessive <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a> of the calcaneus on the talus, excessive <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a> of the <a id="distal" data-tip="1563" target="_blank" href="/glossary-term/distal" class="glossary">distal</a> fibula, and excessive <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a> of the <a id="proximal" data-tip="1564" target="_blank" href="/glossary-term/proximal" class="glossary">proximal</a> tibiofibular joint. Again, this may be further accompanied by <a id="arthrokinematics" data-tip="1863" target="_blank" href="/glossary-term/arthrokinematics" class="glossary">arthrokinematic</a> <a id="dyskinesis" data-tip="1693" target="_blank" href="/glossary-term/dyskinesis" class="glossary">dyskinesis</a> of the <a href="https://brookbushinstitute.com/courses/knee" target="_blank" rel="noopener">knee</a>. These changes may result in, or be the result of altered length and activity of one, or many of the muscles crossing the ankle joint and/or <a id="proximal" data-tip="1564" target="_blank" href="/glossary-term/proximal" class="glossary">proximal</a> tibiofibular joint, and further, result in maladaptive changes in length and/or <a id="extensibility-2" data-tip="1308" target="_blank" href="/glossary-term/extensibility-2" class="glossary">extensibility</a> of passive soft tissues (capsule, ligaments and fascial structures). Although this section will describe dysfunction from the perspective of the ankle; the ankle could be viewed as the &quot;keystone&quot; of <a href="https://brookbushinstitute.com/courses/lower-leg-dysfunction" target="_blank" rel="noopener">Lower Extremity Dysfunction</a>. That is lower extremity alignment and <a id="optimal" data-tip="1571" target="_blank" href="/glossary-term/optimal" class="glossary">optimal</a> muscular recruitment are dependent on <a id="optimal" data-tip="1571" target="_blank" href="/glossary-term/optimal" class="glossary">optimal</a> function of the ankle during gait from heel strike to push off. Further, maladaptation of the structures associated with the <a href="https://brookbushinstitute.com/courses/hip-joint" target="_blank" rel="noopener">hip</a> and <a href="https://brookbushinstitute.com/courses/knee" target="_blank" rel="noopener">knee</a> may alter heel placement during heel strike and initiate compensatory patterns of motion during the gait cycle. Careful <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">assessment</a> of the <a href="https://brookbushinstitute.com/courses/hip-joint" target="_blank" rel="noopener">hip</a> and the <a href="https://brookbushinstitute.com/courses/knee" target="_blank" rel="noopener">knee</a> (and perhaps the sacroiliac joint) should be included for every patient/client exhibiting dysfunction of the ankle. It should also be noted that additional compensatory patterns exist and are <a id="relevance" data-tip="1505" target="_blank" href="/glossary-term/relevance" class="glossary">relevant</a> to practice; however, in this article, focus will be given to this pattern, which is presumed to be &quot;most common.&quot;
<ul>
 <li>Common <a id="osteokinematic-motion" data-tip="1881" target="_blank" href="/glossary-term/osteokinematic-motion" class="glossary">Osteokinematic</a> Dysfunction:
 <ul>
 <li>Inadequate dorsiflexion (excessive plantar flexion), excessive eversion, and potentially excessive tibial external rotation at the knee</li>
 </ul>
 </li>
 <li>Common <a id="arthrokinematics" data-tip="1863" target="_blank" href="/glossary-term/arthrokinematics" class="glossary">Arthrokinematic</a> Dysfunction:
 <ul>
 <li>Excessive <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a> of the talus on the tibia</li>
 <li>Excessive <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a> of the calcaneus on the talus</li>
 <li>Excessive <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a> of the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> malleolus</li>
 <li>Excessive <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a> of the fibular head on the tibia</li>
 </ul>
 </li>
</ul>
<h3>Ankle Compensatory Pattern Summary (<a href="https://brookbushinstitute.com/courses/lower-leg-dysfunction" target="_blank" rel="noopener">LLD</a>)</h3>
<ul>
 <li>Maladaptive Decrease In Length/Extensibility (Mobilize):
 <ul>
 <li>Restricts dorsiflexion and <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a> of talus on tibia - <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> capsule of tibiotalar joint, <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a> transverse ligament, calcaneofibular ligament (tibiotalar fibers), <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> tibiofibular ligament</li>
 <li>Restricts talocalcaneal inversion and <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a> of calcaneus on talus - <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> collateral ligaments (<a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> talofibular, <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> talofibular, calcaneal fibular ligaments), talocalcaneal ligaments (<a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a>, <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a>, <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a>), interosseous ligament and cervical ligament</li>
 </ul>
 </li>
</ul>
<ul>
 <li>Short/Over-active (<a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">Release</a> and Lengthen)
 <ul>
 <li>Gastrocnemius</li>
 <li><a href="https://brookbushinstitute.com/courses/soleus" target="_blank" rel="noopener">Soleus</a></li>
 <li><a href="https://brookbushinstitute.com/courses/fibularis-muscles" target="_blank" rel="noopener">Fibularis Muscles</a></li>
 <li><a href="https://brookbushinstitute.com/courses/flexor-hallucis-longus-and-flexor-digitorum-longus" target="_blank" rel="noopener">Flexor Hallucis Longus and Flexor Digitorum Longus</a></li>
 <li>Relative to <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a> of the <a id="proximal" data-tip="1564" target="_blank" href="/glossary-term/proximal" class="glossary">proximal</a> fibula (and potentially tibial external rotation)
 <ul>
 <li><a href="https://brookbushinstitute.com/courses/tensor-fascia-latae-tfl" target="_blank" rel="noopener">Tensor Fasciae Latae (TFL)</a></li>
 <li>Vastus Lateralis</li>
 </ul>
 </li>
 </ul>
 </li>
</ul>
<ul>
 <li>Long/Over-active (<a id="synergistic-dominance" data-tip="1649" target="_blank" href="/glossary-term/synergistic-dominance" class="glossary">Synergistically Dominant</a> - <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">Release</a> Only)
 <ul>
 <li><a href="https://brookbushinstitute.com/courses/extensor-hallucis-longus-and-extensor-digitorum-longus-fibularis-tertius" target="_blank" rel="noopener">Extensor Hallucis Longus and Extensor Digitorum Longus</a></li>
 <li>Relative to <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a> of the <a id="proximal" data-tip="1564" target="_blank" href="/glossary-term/proximal" class="glossary">proximal</a> fibula (and potentially tibial external rotation)
 <ul>
 <li><a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">Biceps Femoris</a></li>
 </ul>
 </li>
 </ul>
 </li>
</ul>
<ul>
 <li>Long/Under-active (Activate and <a id="integration" data-tip="1476" target="_blank" href="/glossary-term/integration" class="glossary">Integrate</a>)
 <ul>
 <li><a href="https://brookbushinstitute.com/courses/tibialis-anterior" target="_blank" rel="noopener">Tibialis Anterior</a></li>
 <li><a href="https://brookbushinstitute.com/courses/tibialis-posterior" target="_blank" rel="noopener">Tibialis Posterior</a></li>
 <li>Relative to <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">Posterior</a> <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a> of the <a id="proximal" data-tip="1564" target="_blank" href="/glossary-term/proximal" class="glossary">proximal</a> fibula (and potentially tibial external rotation)
 <ul>
 <li><a href="https://brookbushinstitute.com/courses/adductors" target="_blank" rel="noopener">Gracilis</a></li>
 <li><a href="https://brookbushinstitute.com/courses/popliteus" target="_blank" rel="noopener">Popliteus</a></li>
 <li>Semitendinosus and Semimembranosus</li>
 </ul>
 </li>
 </ul>
 </li>
</ul>

Postural Dysfunction and the Ankle Joint

<h3>Ankle Dysfunction relative to Predictive Models of Postural Dysfunction</h3>
<ul>
 <li>In <a title="UBD" href="https://brookbushinstitute.com/courses/upper-body-dysfunction-ubd" target="_blank" rel="noopener">Upper Body Dysfunction (UBD)</a> the ankle plays no significant role.</li>
</ul>
<ul>
 <li>In <a title="LLD" href="https://brookbushinstitute.com/courses/lower-leg-dysfunction" target="_blank" rel="noopener">Lower Leg Dysfunction (LLD)</a>, the ankle is most often the primary dysfunctional segment, exhibiting the common dysfunction noted above. Several texts and studies have noted a link between decreased dorsiflexion, and alterations in lower extremity alignment and <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> recruitment during functional tasks (7-10, 25, 28 - 31, 38). Although relatively few studies have considered the link between excessive eversion (pes planus) and a lack of dorsiflexion, there is anatomical studies to imply that the gastrocnemius and <a href="https://brookbushinstitute.com/courses/soleus" target="_blank" rel="noopener">soleus</a> may contribute to eversion once the Achilles tendon is <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> to the talocalcaneal axis of rotation (25 - 27). It is also worth noting that the primary evertors of the ankle are plantar flexors (the <a href="https://brookbushinstitute.com/courses/fibularis-muscles" target="_blank" rel="noopener">fibularis muscles</a>). Further, three studies have noted that a lack of dorsiflexion is correlated with an increase in functional knee valgus during squatting (30, 31, 38), which would displace the load of the lower extremities over the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> arch of the foot. One study showed a link between knee pain and increase in ankle eversion during a hopping task (36). Three studies have made interesting correlations between the hip and ankle, one showing a relationship between pronation and hip internal rotation, another between Achilles tendinopathy and a decrease in <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> and medius activity, and the third showing a decrease in eversion angle after hip abductor training (28, 29, 37). It is also worth noting that the behavior of the muscles that may contribute to the <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a> of the <a id="proximal" data-tip="1564" target="_blank" href="/glossary-term/proximal" class="glossary">proximal</a> fibula (over-activity) in <a title="LLD" href="https://brookbushinstitute.com/courses/lower-leg-dysfunction" target="_blank" rel="noopener">LLD</a>, is the same behavior noted in those muscles relative to <a href="https://brookbushinstitute.com/courses/hip-joint" target="_blank" rel="noopener">hip</a> and <a href="https://brookbushinstitute.com/courses/knee" target="_blank" rel="noopener">knee</a> dysfunction.</li>
 <li>In <a title="LPHCD" href="https://brookbushinstitute.com/courses/lumbo-pelvic-hip-complex-dysfunction-lphcd" target="_blank" rel="noopener">Lumbo Pelvic Hip Complex Dysfunction (LPHCD)</a> the ankle is not the primary dysfunctional segment; however, it cannot be ignored. As mentioned under <a title="LLD" href="https://brookbushinstitute.com/courses/lower-leg-dysfunction" target="_blank" rel="noopener">LLD</a>, studies have made interesting correlations between <a href="https://brookbushinstitute.com/courses/hip-joint" target="_blank" rel="noopener">hip</a> and ankle dysfunction including a link between pronation and hip internal rotation, Achilles tendinopathy and a decrease in <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> and medius activity, hip abductor strength and ankle eversion during gait, and similar behavior of the muscles that may contribute to <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a> of the <a id="proximal" data-tip="1564" target="_blank" href="/glossary-term/proximal" class="glossary">proximal</a> fibula (over-activity), in <a href="https://brookbushinstitute.com/courses/hip-joint" target="_blank" rel="noopener">hip</a> and ankle dysfunction (7 - 10, 28 - 31, 37, 38). It is worth noting that the Brookbush Institute has noted a relationship between ankle dysfunction and chronic low back pain that has proved clinically <a id="relevance" data-tip="1505" target="_blank" href="/glossary-term/relevance" class="glossary">relevant</a>. Often resolutions of low back symptoms may be seen from correcting ankle dysfunction without any <a id="specificity" data-tip="1224" target="_blank" href="/glossary-term/specificity" class="glossary">specific</a> intervention for the lumbar spine.</li>
 <li>In Sacroiliac Joint Dysfunction (SIJD), the ankle does not have a direct relationship to the sacroiliac joint (SIJ), but indirect relationships exist. Both relate to myofascial synergies that invest in the head of the fibula. First, Vleeming et. al. refers to a <a href="https://brookbushinstitute.com/courses/deep-longitudinal-subsystem" target="_blank" rel="noopener">Deep Longitudinal Subsystem (DLS)</a>, including the <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">biceps femoris</a> and fibularis muscles (33), which may become over-active resulting in increased <a id="tension" data-tip="1229" target="_blank" href="/glossary-term/tension" class="glossary">tension</a> of the sacrotuberous ligament, limiting <a id="nutation" data-tip="1213" target="_blank" href="/glossary-term/nutation" class="glossary">nutation</a> of the SIJ. Over time this could lead to adaptive shortening of soft tissues crossing the SIJ and joint stiffness. Second, there is a relationship between the <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a>, iliotibial band, and the fibular head (32). Sacroiliac joint pain may result in inhibition of the <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a>,(34) alterations to iliotibial band <a id="tension" data-tip="1229" target="_blank" href="/glossary-term/tension" class="glossary">tension</a>, the activity of other investing musculature (such as the <a href="https://brookbushinstitute.com/courses/tensor-fascia-latae-tfl" target="_blank" rel="noopener">tensor fascia latae</a>), and motion of the fibular head.</li>
</ul>
<img src="https://www.datocms-assets.com/25800/1643060124-screen-shot-2022-01-24-at-3-34-30-pm.png" title="The various arches of the foot, inlcuding normal, high arch, and flat foot" alt="Examples of arches of the foot">

<h3>Signs of Changes in Range of Motion, Muscle Activity, and Length:</h3>
<ul>
 <li><a href="https://brookbushinstitute.com/courses/solutions-table-overhead-squat-assessment" target="_blank" rel="noopener">Overhead Squat Assessment</a>
 <ul>
 <li><a href="http://videotree.brookbushinstitute.com/overhead-squat-assessment-6-knees-bow-in-breakdown/" target="_blank" rel="noopener">Knees Bow In</a></li>
 <li><a href="http://videotree.brookbushinstitute.com/overhead-squat-assessment-7-knees-bow-out/" target="_blank" rel="noopener">Knees Bow Out</a> (tibia on foot eversion)</li>
 <li><a href="https://brookbushinstitute.com/video/overhead-squat-assessment-5-feet-turn-out-breakdown" target="_blank" rel="noopener">Feet Turn Out</a></li>
 <li><a href="https://brookbushinstitute.com/video/overhead-squat-assessment-15-sign-clusters-asymmetrical-weight-shift" target="_blank" rel="noopener">Asymmetrical Weight Shift</a></li>
 </ul>
 </li>
</ul>
<ul>
 <li>Goniometry:
 <ul>
 <li><a href="https://brookbushinstitute.com/video/knee-extension-with-hip-flexion-goniometry-hamstring-length-test" target="_blank" rel="noopener">Knee Extension with Hip Flexion Goniometry</a> &lt;110 - 135&#xB0;</li>
 <li><a href="https://brookbushinstitute.com/video/dorsiflexion-goniometry" target="_blank" rel="noopener">Dorsiflexion Goniometry</a> &lt; 15 - 20&#xB0;</li>
 </ul>
 </li>
</ul>
<ul>
 <li>Muscle Length Tests:
 <ul>
 <li><a href="http://videotree.brookbushinstitute.com/obers-test-tfl-flexibility-assessment/" target="_blank" rel="noopener">Ober&apos;s Test</a></li>
 <li><a href="https://brookbushinstitute.com/video/knee-extension-with-hip-flexion-goniometry-hamstring-length-test" target="_blank" rel="noopener">Hamstring Length Test</a></li>
 <li><a href="https://brookbushinstitute.com/video/gastrocnemius-and-soleus-muscle-length-test" target="_blank" rel="noopener">Gastroc/Soleus Length Test</a></li>
 </ul>
 </li>
</ul>
<ul>
 <li>Manual <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">Muscle</a> Testing:
 <ul>
 <li><a href="https://brookbushinstitute.com/video/tibialis-anterior-manual-muscle-testing-mmt-for-an-active-population" target="_blank" rel="noopener">Manual </a><a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">Muscle</a> Testing (MMT) of the Tibialis Anterior - Weak or With Compensation</li>
 <li><a href="https://brookbushinstitute.com/video/posterior-tibialis-manual-muscle-testing-mmt-for-an-active-population" target="_blank" rel="noopener">Manual </a><a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">Muscle</a> Testing (MMT) of the Tibialis Posterior - Weak or With Compensation</li>
 </ul>
 </li>
</ul>
<ul>
 <li>
 <h3>Clinical Issues:</h3>
 <ul>
 <li>Achilles Tendonitis</li>
 <li>Plantar Fasciitis</li>
 <li>Shin Splints/MTSS (<a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">Medial</a> Tibial Stress Syndrome)</li>
 <li>Ankle impingement</li>
 <li>Peroneal <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">Nerve</a> Entrapment</li>
 <li>Tarsal tunnel syndrome</li>
 <li>Noncontact injuries to the tibiofemoral ligaments</li>
 <li>Lateral knee bursitis (Runner&#x2019;s Knee)</li>
 <li>Patellar Tendonitis (Jumper&#x2019;s knee)</li>
 <li>Hip Impingement Syndrome</li>
 <li>Osteoarthritis of the:
 <ul>
 <li>Ankle Joint (relatively rare)</li>
 <li>Knee Joint (Tibiofemoral and patellofemoral)</li>
 <li>Hip Joint</li>
 <li>Iliosacral Joint</li>
 <li>DDD and DJD of the lumbar spine</li>
 </ul>
 </li>
 </ul>
 </li>
</ul>

Signs of Dyfunction

Videos

<h4><iframe src="https://player.vimeo.com/video/93046320?title=0&amp;byline=0&amp;portrait=0" width="500" height="281" frameborder="0" allowfullscreen="allowfullscreen"></iframe></h4>

<h4>Self-administered Ankle Joint Mobilization</h4>
<ol>
 <li>Affix a thick &quot;<a href="https://serioussteel.com/collections/41-individual-bands" target="_blank" rel="noopener">monster band</a>&quot; to a stable object about 0 - 6&quot; from the floor.</li>
 <li>Place the band over the talar neck, in an angle of the ankle (just <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a> to the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> and <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> malleolus).
 <ul>
 <li>This technique cannot be done with shoes on.</li>
 </ul>
 </li>
 <li>Face away from the stable object, creating an <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> to <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> pull.</li>
 <li>Place the affected leg on a step 12&quot; - 18&quot; high.
 <ul>
 <li>The low position of the band will help keep the band on the talus and prevent it from sliding proximally.</li>
 </ul>
 </li>
 <li>Internally rotate the foot of the mobilizing leg so that the 5th metatarsal (pinky toe) is pointing forward.</li>
 <li>With the affected foot maintaining flat on the step, move forward until the affected ankle is at end-range dorsiflexion.</li>
 <li>The unaffected leg should be <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> and just <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> to the ankle being mobilized, and nearly all bodyweight should be shifted onto the unaffected leg.
 <ul>
 <li>Weight-bearing on the ankle to be mobilized will add additional <a id="compression" data-tip="1595" target="_blank" href="/glossary-term/compression" class="glossary">compression</a> forces that may make mobilization more difficult.</li>
 </ul>
 </li>
 <li>Place extended arms on a wall, equipment, or dowel for added <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a>.</li>
 <li>Gently rock the hips back and forth, using the <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> of the unaffected side. Although the goal is to oscillate at end range dorsiflexion, it is helpful to cue &quot;thrusting the knee forward of the affected leg while keeping the foot flat&quot;.</li>
 <li>Continue oscillating 2 - 3&quot;, at a tempo of 1 - 2 oscillations per second, for 15 - 30 seconds.</li>
 <li>Reassess
 <ul>
 <li>Lateral Mobilization: This same technique can be done with the band over the inside of the talus (just <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a> to the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> malleolus), facing parallel to the stable object, perpendicular to the band, creating a <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> to <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">Lateral</a> force.</li>
 </ul>
 </li>
</ol>

Self-administered Ankle Joint Mobilization

<ol>
 <li>Donald A. Neumann, &ldquo;Kinesiology of the Musculoskeletal System: Foundations of Rehabilitation &ndash; 2nd Edition&rdquo; &copy; 2012 Mosby, Inc.</li>
 <li>David B. Jenkins, Hollinshead&rsquo;s Functional Anatomy of the Limbs and Back: Eighth Edition &copy; 2002 Saunders</li>
 <li>Cynthia C. Norkin, Pamela K. Levangie, Joint Structure and Function: A Comprehensive Analysis: Fifth Edition &copy; 2011 F.A. Davis Company</li>
 <li>Florence Peterson Kendall, Elizabeth Kendall McCreary, Patricia Geise Provance, Mary McIntyre Rodgers, William Anthony Romani, Muscles: Testing and Function with <span class="glossaryLink" data-tooltip="Posture refers to the optimal alignment of bones and joints both statically and dynamically. &ldquo;Good form&rdquo; could be defined as optimal posture during exercise.">Posture and Pain: Fifth Edition &copy; 2005 Lippincott Williams &amp; Wilkins</li>
 <li>Cynthia C. Norkin, D. Joyce White, Measurement of Joint Motion: A Guide to Goniometry &ndash; Third Edition. &copy; 2003 by F.A. Davis Company</li>
 <li>Phillip Page, Clare Frank, Robert Lardner, Assessment and Treatment of MuscleImbalance: The Janda Approach&copy; 2010 Benchmark Physical Therapy, Inc., Clare C. Frank, and Robert Lardner</li>
 <li>Dr. Mike Clark &amp; Scott Lucette, &ldquo;NASM Essentials of Corrective Exercise Training&rdquo; &copy; 2011Lippincott Williams &amp; Wilkins</li>
 <li>Leon Chaitow, Muscle Energy Techniques: Third Edition, &copy; Pearson Professional Limited 2007</li>
 <li>Shirley A Sahrmann, Movement Impairment Syndromes of the Extremities, Cervical and Thoracic Spine, &copy; 2011 Mosby Inc.</li>
 <li>Karel Lewit. Manipulative Therapy: Musuloskeletal Medicine &copy; 2007 Elsevier</li>
 <li>Carolyn Richardson, Paul Hodges, Julie Hides. Therapeutic Exercise for Lumbo Pelvic Stabilization &ndash; A Motor Control Approach for the Treatment and Prevention of Low Back Pain: 2nd Edition (c) Elsevier Limited, 2004</li>
 <li>Tom Myers, Anatomy Trains: Second Edition. &copy; Elsevier Limited 2009</li>
 <li>Andrew Biel, Trail Guide to the Human Body: 4th Edition, &copy; 2010
 <ul>
 <li>Studies on Specific Anatomy</li>
 </ul>
 
 </li>
 <li>Yoshioka, Y, Siu DW, Scudamore RA, Cooke TD: Tibial anatomy and functional axes, J Orthop Res 7:(1):132-7</li>
 <li>Soavi R, Girolami M, Loreti I, et al: The mobility of the proximal tibio-fibular joint. A Roentgen Stereophotogrammeteric Analysis on six cadaver specimens. Foot Ankle Int 21:336, 2000</li>
 <li>Takebe K, Nakagawa A, Minami H, Kanazawa H, Hirohata K. Role of the fibula in weight-bearing. ClinOrthop Relat Res 184:289, 1984.</li>
 <li>Wang CL, Cheng CK, Chen CW, Lu CM, Hang YS, Liu TK. Contact areas and pressure distributions in the subtalar joint. J Biomech 28:269, 1995</li>
 <li>Amitav S, Bhaskar B, and Bishwajeet S. Proximal tibiofibular joint: Rendezvous with a forgotten articulation. Indian J Orthop. 2015 Sep-Oct; 49(5): 489&ndash;495</li>
 <li>Safran MR, Benedetti RS, Bartolozzi AR 3rd, et Mandelbaum BR.: Lateral ankle sprains: A comprehensive review: Part 1: Etiology, pathoanatomy, histopathogenesis, and diagnosis. &lt;ed Sci Sports Exerc 31:S429, 1999</li>
 <li>Canoso JJ, Liu N, Traill MR, Runge VM. Physiology of the retrocalcaneal bursa. Ann Rheum Dis 1988; 47:910-912 doi:10.1136/ard.47.11.910</li>
 <li class="cit">de S&egrave;ze MP1, Rezzouk J, de S&egrave;ze M, Uzel M, Lavignolle B, Durandeau A, Casoli V, Midy D. Anterior innervation of the proximal tibiofibular joint. Surg Radiol Anat. 2005 Mar;27(1):30-2. Epub 2004 Nov 19.</li>
 <li class="cit">Mentzel M, Fleischmann W, Bauer G, Kinzl L. Ankle joint denervation. Part 1: Anatomy &ndash;the sensory innervation of the ankle joint. Foot and Ankle Surgery Volume 5, Issue 1, pages 15&ndash;20, March 1999</li>
 <li class="csl-right-inline">Clendenen SR, Whalen JL. Saphenous nerve innervation of the medial ankle. Local and Regional Anesthesia. 2013;6:13-16. doi:10.2147/LRA.S42603.</li>
 <li class="cit">Rab M, Ebmer J, Dellon AL.Innervation of the sinus tarsi and implications for treating anterolateral ankle pain. Ann Plast Surg. 2001 Nov;47(5):500-4.
 <ul>
 <li>Functional Anatomy</li>
 </ul>
 
 </li>
 <li>Michael RH, Holder LE: The soleus syndrome a cause of medial tibial stress (shin splints). Am J Sports Med 13:87-94 1985</li>
 <li>Klein P, Mattys S, Rooze M: Moment arm length variations of selected muscles acting on talocrural and subtalar joints during movement: An in vitro study. J Biomech 29:21, 1996</li>
 <li>Les SS, Piazza SJ: Inversion-eversion moment arms of gastrocnemius and tibialis anterior measured in vivo. J Biomech 41:3366, 2008
 <ul>
 <li>Regional Interdependence</li>
 </ul>
 
 </li>
 <li>Souza, T. R., Pinto, R. Z., Trede, R. G., Kirkwood, R. N., &amp; Fonseca, S. T. (2010). Temporal couplings between rearfoot&ndash;shank complex and hip <span class="glossaryLink " data-tooltip="Where two or more bones meet.&lt;br /&gt;Etymology: joint (n.) late 13c., &ldquo;a part of a body where two bones meet and move in contact with one another,&rdquo; from Old French joint &ldquo;joint of the body&rdquo; (12c.), from Latin iunctus &ldquo;united, connected, associated,&rdquo; past participle ofiungere &ldquo;join&rdquo; (see &lt;a href=&quot;http://www.etymonline.com/index.php?term=jugular&amp;allowed_in_frame=0&quot;&gt;jugular&lt;/a&gt;). (&lt;a href=&quot;http://www.etymonline.com/index.php?term=joint&quot;&gt;Etymology Online&lt;/a&gt;)" style="box-sizing: border-box; margin-top: 0px;">joint during walking. Clinical biomechanics, 25(7), 745-748&lsquo;</li>
 <li>Franettovich, S. M., Honeywill, C. O. N. O. R., Wyndow, N., Crossley, K. M., &amp; Creaby, M. W. (2014). Neuromotor control of gluteal muscles in runners with achilles tendinopathy. Medicine and science in sports and exercise, 46(3), 594-599.</li>
 <li>Padua, D. A., Bell, D. R., &amp; Clark, M. A. (2012). Neuromuscular characteristics of individuals displaying excessive medial knee displacement. Journal of athletic training, 47(5), 525.</li>
 <li>Macrum et al. Effect of limiting ankle-dorsiflexion range of motion on lower extremity kinematics and muscle-activation patterns during a squat. Journal of Sport Rehabilitation, 2012, 21, Pg 144-150.</li>
 <li>Stecco, A., Gilliar, W., Hill, R., Fullerton, B., Stecco, Carla. (2013). The anatomical and functional relation between gluteus maximus and fascia lata. Journal of Bodywork &amp; Movement Therapies. 17. 512-517</li>
 <li>Andry Vleeming, Vert Mooney, Rob Stoeckart. Movement, Stability &amp; Lumbopelvic Pain: Integration of Research and Therapy &copy; 2007 Elsevier Limited</li>
 <li>Hungerford, B., Gilleard, W., Hodges, P. (2003) Evidence of altered lumbopelvic muscle recruitment in the presence of sacroiliac joint pain. Spine 28(14), 1593-1600</li>
 <li>Schleip R, Findley T, Chaitow L, Huijing P. Fascia The Tensional Network of the Human Body &copy; 2012 Elsevier Limited</li>
 <li>Dos Reis, A. C., Correa, J. C. F., Bley, A. S., Rabelo, N. D. D. A., Fukuda, T. Y., &amp; Lucareli, P. R. G. (2015). Kinematic and Kinetic Analysis of the Single-Leg Triple Hop Test in Women With and Without Patellofemoral Pain. journal of orthopaedic &amp; sports physical therapy, 45(10), 799-807</li>
 <li>Snyder, K. R., Earl, J. E., O&rsquo;Connor, K. M., &amp; Ebersole, K. T. (2009). Resistance training is accompanied by increases in hip strength and changes in lower extremity biomechanics during running. Clinical Biomechanics, 24(1), 26-34</li>
 <li>Mauntel, T., Begalle, R., Cram, T., Frank, B., Hirth, C., Blackburn, T., &amp; Padua, D. (2013). The effects of lower extremity muscle activation and passive range of motion on single leg squat performance. Journal Of Strength And Conditioning Research / National Strength &amp; Conditioning Association, 27(7), 1813-1823</li>
</ol>

Bibliography

<html><head></head><body>© 2016 Brent Brookbush
Questions, comments and criticisms welcome and encouraged</body></html>

Copyright

A-Band - Refers to the part of the muscle cell that looks darker under a microscope.  This area of the cell is darker due to parallel arrangement of thicker filaments (myosin) and overlap with the thinner filaments (actin).
<ul>
 	<li>As a muscle contracts, the A-band is where actin and myosin interact.</li>
</ul>
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

Accuracy - the proportion of individuals correctly identified by the test results.
<ul>
 	<li>For example, a special test with perfect accuracy would imply a test has 100% specificity, 100% sensitivity, 100% positive predictive value and 100% negative predictive values.</li>
</ul>

Action Potential - A rapid change in voltage, resulting in a wave of excitation, that may result in stimulation of a nerve or muscle cell.
<ul>
 	<li>In order for an action potential to be initiated, the resting membrane voltage must exceed the excitation threshold, which then results in a cascade of depolarization and the "wave of excitation." Any stimulus below that threshold will not result in an action potential, and a stimulus greater than the threshold will not increase a single action potential, but may result in additional action potentials.  In this way, the action potential functions more like an on/off switch (all or none), and less like a dimmer switch.</li>
</ul>

A single-joint movement pattern (most often) designed to load a specific under-active muscle(s), while minimizing the contribution of over-active synergists via specific cues/joint motions.
<ul>
 	<li style="text-align: left;">Activation techniques/exercises are performed with the intent of addressing a muscle exhibiting a reduction in activity (tone) as a result of, or contributing to postural dysfunction.</li>
 	<li style="text-align: left;">Activation techniques/exercises cannot be multi-joint movement patterns due to relative flexibility, altered reciprocal inhibition, and synergistic dominance resulting in compensation patterns.</li>
</ul>
Example, <a href="https://brentbrookbush.com/articles/corrective-exercise-articles/activation/gluteus-medius-activation-progression/" target="_blank">gluteus medius activation</a> involves resisted hip abduction while minimizing the contribution of the TFL via hip extension.

Active stretching is a term used to describe a stretch that involves an active contraction of opposing musculature to lengthen a muscle to its end range. Generally these stretches are held for 2-5 seconds and repeated for 8-15 repetitions.

Adenosine triphosphatase (ATPase): is the enzyme responsible for catalyzing (initiating and accelerating) the decomposition of ATP to ADP.
<ul>
 	<li>This dephosphorylation (breakdown) reaction releases energy for processes like muscular contraction.</li>
</ul>

Adenosine triphosphate (ATP): The molecule that functions as a universal energy-transfer molecule, providing most of the energy associated with muscular contraction and human movement. ATP is composed of an adenine group, a ribose group, and three molecules of inorganic phosphates.
<ul>
 	<li>Energy is provided when hydrolysis results in the cleaving of a phophate group; resulting in adenosine diphosphate, an inorganigic phosphate group, and energy.</li>
</ul>

Algometry - measuring the amount of pressure to result in sensitivity or pain, using an algometer.
<ul>
 	<li>Generally, research uses algometry to establish a minimum pain pressure threshold (PPT), in which a lower PPT implies more sensitivity and pain, and a higher PPT implies less sensitivity and pain. PPT is a common outcome measure in trigger point research.</li>
</ul>
<a href="https://brentbrookbush.com/wp-content/uploads/2019/07/Algometer.jpg"><img class="aligncenter wp-image-140177" src="https://brentbrookbush.com/wp-content/uploads/2019/07/Algometer.jpg" alt="Image of an Algometer" width="500" height="333" /></a>

All-or-none principle - a nerve or muscle cell's response to a stimulus is independent of the strength of the stimulus. If that stimulus exceeds the threshold potential (threshold of an action potential), the nerve or muscle fiber will respond completely; otherwise, there is no response.

Example, when a motor unit in the biceps brachii is stimulated it contracts the same way whether a 10 lb or 50 lb dumbbell is lifted.  It is actually the number of muscle cells and the size of the motor unit that determines force output.

&nbsp;

The transition period between eccentric load and concentric contraction during a repetition of an exercise.  This term is most often used in reference to power/plyometric exercises, in which a shorter amortization phase is believed to be beneficial.  The shorter amortization phase may better use the stored energy from the elastic deformation of connective tissue and enhance synchronization of myotatic (stretch) reflex with maximum voluntary contraction.

Example, the athlete was cued to spend as little time as possible in the bottom of their squat stance (the amortization phase) during a set of box jumps.

Muscles that oppose the prime mover and synergists for a given joint action.

That is, all the muscles that can perform the opposing joint action.

Example: The triceps and anconeus are antagonists during elbow flexion.

An anatomical direction; toward the front

Example, the face is on the anterior aspect of the head

Appendicular Skeleton - referring to the bones the bones of the arms and legs, as well as the bones that support them. This includes the pelvis, clavicle and scapula. There are approximately 126 bones in the appendicular skeleton.
<ul>
 	<li>Etymology - Appendicular, as in appendage, "that which is appended to something as a proper part," 1640s, from <a class="crossreference" href="https://www.etymonline.com/word/append?ref=etymonline_crossreference">append</a> + <a class="crossreference" href="https://www.etymonline.com/word/-age?ref=etymonline_crossreference">-age</a>. - <a href="https://www.etymonline.com/word/appendage" target="_blank" rel="noopener">Etymology Online</a></li>
</ul>
"Appendicular skeleton" is a label referring to a set of bones whose function is distinct from the bones of the "<a href="https://brentbrookbush.com/glossary/axial-skeleton/" target="_blank" rel="noopener">axial skeleton</a>".

A reflexive decrease in muscle activity due to joint dyskinesis.
For example, a reduction in deep cervical flexor activity as a result of cervical spine dyskinesis.

Arthrokinematic Motion - Small amplitude motions between bone surfaces at a joint.  The arthrokinematic motions are roll, glide (slide or translation), spin, compression and distraction (traction). Arthrokinematic motions accompany osteokinematic motions to maintain joint congruence.
<ul>
 	<li>Example, arthrokinematic motion of the talus includes posterior glide on the tibia during ankle dorsiflexion.</li>
</ul>
Synonyms include: arthrokinematics, passive accessory motion, joint play and component motion

&nbsp;

Assessment - is the act of assessing, i.e. determining the importance, size, or value of -

In most cases, the results of an assessment are compared to normative data. If the individual exhibits values that are within normal parameters, it may be assumed that the aspect of health or motion assessed is not contributing to the patient's complaint, symptoms or movement impairment. If the results fall outside of normal parameters, it may indicate that the aspect of health or motion assessed is contributing to, or being affected by the patient/client's complaint, symptoms, or movement impairment. In some cases, the results of an assessment are compared to an "ideal model." In this case, deviations from the ideal are noted as potential issues. For example, deviations noted in the <a title="Introduction to the Overhead Squat Assessment" href="https://brentbrookbush.com/online-courses/articles/assessment/introduction-overhead-squat-assessment/" target="_blank">Overhead Squat Assessment</a> are compared to an "ideal model" of posture and motion.

Assessments used by human movement professionals can be divided into three broad categories:
<ul>
 	<li>"Clear" the Patient/Client for Intervention - These are tests, assessments and evaluations used to determine if a patient/client's issue may improve given the assessing professional's scope, skills, abilities and willingness to treat that individual.
<ul>
 	<li>For example, many of the special tests used in orthopedic medicine assist in determining the level of pathology or likelihood of a particular diagnosis. Certain issues and diagnoses are beyond the scope of the human movement professional, and are better treated by diagnostic professionals in the medical community (physicians, podiatrists, surgeons, etc.). A Calf Squeeze (Thompson) Test is one example, in which a positive sign may indicate a rupture of the Achilles tendon that may be better treated via surgical intervention.</li>
</ul>
</li>
 	<li>Highlight Contraindications - Tests, assessments and evaluations used to stratify risk or preclude a professional from addressing certain tissues, motions or using a particular technique.
<ul>
 	<li>For example, the Vertebral Artery Test (VBI) is often used to determine if high velocity thrust mobilizations (manipulations) are safe for a patient with cervical dysfunction.</li>
</ul>
</li>
 	<li>Refine Exercise/Intervention Selection: Tests, assessments and evaluations used to assist the professional in determining which techniques, modalities and exercises will best address a patient/client's complaints or desired goals.
<ul>
 	<li>Most movement assessments fall into this category. For example, a positive <a href="https://brentbrookbush.com/vimeo_videos/elys-test-rectus-femoris-flexibility-assessment/" target="_blank">Ely's Test</a> may indicate a need to release and/or lengthen the <a href="https://brentbrookbush.com/articles/anatomy-articles/muscular-anatomy/rectus-femoris/" target="_blank">rectus femoris</a>.</li>
</ul>
</li>
</ul>
Note: An assessment, or assessment result, may fall into more than one category. For example, although goniometry is an assessment most often used to Refine Exercise/Intervention Selection, if a range of motion is significantly altered, with an abnormal end-feel, and/or causes the patient or client/pain, the individual may need to be referred to a physician for further testing and Clearance to resume rehab activities.  Further, that same patient may return to the human movement professional with a list of Contraindicated Activities from the physician. - "When in doubt, refer out!"

Axial Skeleton - referring to the bones of the head, neck, trunk and spinal column (does not include pelvis). There are approximately 80 bones in the axial skeleton.
<ul>
 	<li>Etymology - Axial, as in "axis", referring to "imaginary motionless straight line around which a body (such as the Earth) rotates," from Latin axis "axle, pivot, axis of the earth or sky" - <a href="https://www.etymonline.com/word/axis" target="_blank" rel="noopener">Etymology Online</a></li>
</ul>
"Axial skeleton" is a label referring to a set of bones whose function is distinct from the bones of the "<a href="https://brentbrookbush.com/glossary/appendicular-skeleton/" target="_blank" rel="noopener">appendicular skeleton</a>".

Balance - The ability to maintain a body’s center of mass over its base of support. Balance can be static or dynamic.
<ul>
 	<li>For example, maintaining balance is harder on one leg because the center of mass must stay over a much smaller base of support.</li>
</ul>

A ball and socket joint (also called a spheroid joint or spheroidal joint) is a synovial joint in which the rounded or spherical end of one bone fits into a cup-like depression of another bone. The distal bone is capable of motion around an indefinite number of axes, which have one common center. Examples include the hip and shoulder (glenohumeral joint)

Base of support (BoS) - refers to the area beneath an object or person, and the area within the perimeter created by every point of contact that the object or person makes with the supporting surface. This may include the <a href="https://brentbrookbush.com/articles/anatomy-articles/muscular-anatomy/gluteus-maximus/" target="_blank" rel="noopener">glutes</a> of someone sitting on a chair, or the back of someone leaning against a wall.
<ul>
 	<li>For example, during a single leg balance the BoS is the area of the foot in contact with the surface; however, when a person is standing on two feet, the BoS is the area of both feet and the surface between them.</li>
</ul>

Pertaining to both sides

Example, bilateral rows are performed with both arms at the same time.

Case-control Study - a particular form of retrospective study that samples a matched group of people who have, and do not have the outcome being studied. A case-control study is a quasi-experimental design, often used in medicine to aid in determining potential contributing factors (cannot determine causality). In this study type exposure is the dependent variable and outcome is independent.
<ul>
 	<li>Example, in this retrospective case-control, medical records were investigated for trends correlated with cervical pain (1).
<ol>
 	<li>Mäkela, M., Heliövaara, M., Sievers, K., Impivaara, O., Knekt, P., &amp; Aromaa, A. (1991). Prevalence, determinants, and consequences of chronic neck pain in Finland. American journal of epidemiology, 134(11), 1356-1367.</li>
</ol>
</li>
</ul>

An anatomical direction; toward the tail, relative to humans this term is often used to refer to "in the direction of the tale (toward the feet)".

Example, to release the trapezius muscle the therapist used a force directed caudally.

Center of mass (CoM) - an object's mean position of mass; that is, a point that is perfectly surrounded by an equal amount mass in all directions.

Center of gravity (CoG) - point where gravity appears to act. Since the human body is so small compared to the earth, we can assume gravity acts uniformly on the body, and that CoG and CoM are the same.
<ul>
 	<li>Example, the CoM of the human body while lying down or standing straight up is close to our navel. However, it is possible that during a resistance exercise, the combination of the body's weight and the weight of the resistance will place the combined CoM outside the body. For example, during the mid-portion of a <a href="https://brentbrookbush.com/vimeo_videos/back-squat/" target="_blank" rel="noopener">back squat</a> the CoM would be several anterior to the naval.</li>
</ul>

An anatomical direction; toward the head (synonym: cranial)

Example, hip pain was felt with any force directed cephalad.

Cohort Study - a particular form of longitudinal study that samples a cohort (a group of people who share a defining characteristic), performing a cross-section at intervals through-out a period of time. A cohort study is a quasi-experimental design often used in medicine to aid in determining etiology or a cause-and-effect relationship. In this study type exposure is the independent variable and outcome is dependent.
<ul>
 	<li>Example, the study by Cholewicki et al. (1) investigated Yale Varsity Athletes (the cohort) with 2 and 3 year follow up (longitudinal design) and found that trunk muscle response time to off-loading was predictive of future low back injury.</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/core/increased-trunk-muscle-latency-may-cause-rather-than-result-from-low-back-pain/" target="_blank" rel="noopener noreferrer">Cholewicki, J., Silfies, S., Shah, R., Greene, H., Reeves, N. Alvi, K., Goldberg, B. (2005). Delayed trunk muscle reflex responses increase the risk of low back injuries. Spine. 30(23), 2614-2620</a></li>
</ol>

Comparable Sign: A combination of pain, stiffness and/or spasm during examination that is comparable to the patients symptoms.
<ul>
 	<li>One common error made during evaluation with special tests is attention given to any discomfort or pain, rather than attempting to identify the pain/discomfort related to the patient's complaint (concordant/comparable sign). Many special tests purposefully test tissue limits and are at least mildly uncomfortable in every individual. Basing your assessment on positive tests that resulted in "concordant/comparable signs" will improve your chances of arriving at the correct diagnosis.</li>
</ul>

An alternative movement pattern that has been adopted to compensate for dysfunction/impairment in the human movement system.
Example: A lack of calf extensibility may limit dorsiflexion, leading to the knees bowing inward (functional valgus) and excessive forward lean of the torso during a squat.

An arthrokinematic motion - the approximation of joint surfaces; that is, a force that directs one bone surface into another resulting in a reduction in intra-articular volume. Although widely thought of as a "destructive force", it is likely best to consider compression as a naturally occurring, stabilizing force. Any arthrokinematic force in excess (spin, glide, roll, traction) may be viewed as potentially deleterious.

For example, during a squat the femoral head is compressed into the acetabulum by muscular forces, bodyweight and any additional external load.

Concave (Concavity) - Having an outline or surface curved like the interior surface of a bowl or sphere - to cave-in or curve inward.
<ul>
 	<li>Example, the internal surfaces of the pelvis is concave, holding some of the bodies viscera.</li>
</ul>

Concordant Sign - The patient's specific pain, symptom or complaint. 
<ul>
 	<li>One common error made during evaluation with special tests is attention given to any discomfort or pain, rather than attempting to identify the pain/discomfort related to the patient's complaint (concordant/comparable sign). Many special tests purposefully test tissue limits and are at least mildly uncomfortable in every individual. Basing your assessment on positive tests that resulted in "concordant/comparable signs" will improve your chances of arriving at the correct diagnosis.</li>
</ul>

Conductivity: Stimulation results in more than a local effect (1).
<ul>
 	<li>For example, in a muscle cell the stimulation of a motor endplate results in a change in cell membrane polarity that rapidly propagates (is conducted) along the entire length of the muscle cell, stimulating all sacromere.</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

A condyloid joint (also called condylar, bicondylar, ellipsoid, or ellipsoidal) is an ovoid articular surface, or condyle, that is received into an elliptical cavity.  These joints permit movement in two planes.  Examples include the knee, metacarpophalangeal joints and metatarsophalangeal joints.

Connective Tissue Cell - One of the four basic types of animal tissue, consisting mostly fibers and ground substance.  These cells are specialized to binds organs together, holds them in place, protect them from external forces, and may fill space in the body's cavities.

Example, the body's muscles are enclosed in durable connective tissue sheets known as the "epimysium", "perimysium", and "endomysium," which and in support and transmitting force.
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

Contractility: The ability to shorten (1).
<ul>
 	<li>Contractility: Muscle cells are unique in the amount they can shorten when stimulated; this is this largerly due to the highly organized and unique arrangement of myofilaments (actin and myosin).</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

Pertaining to the opposite side

Example, the external oblique muscle performs contralateral rotation; rotation to the opposite side.

Convex (Convexity) - Having an outline or surface curved like the exterior of a circle or sphere - to bulge or curve outward.
<ul>
 	<li>Example, the top of your head is shaped by the convex exterior surface of your skull.</li>
</ul>

Correlational Research - Non-experimental <a href="https://www.questionpro.com/blog/what-is-research/">research</a> method in which the statistical relationship between two variables is investigated.
<ul>
 	<li>In this research by Kwon et al., a correlation was noted between a decrease in extensibility during a hamstring length test (goniometry) and current knee pain (1).</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/knee/correlation-patellofemoral-pain-syndrome-pfps-hamstring-activity/" target="_blank" rel="noopener">Kwon O, Yun M, and Lee W. (2014). Correlation between intrinsic patellofemoral pain syndrome in young adults and lower extremity biomechanics. J. Phys. Ther. Sci. 26: 961-964</a></li>
</ol>

Counter-nutation - posterior rotation of sacrum relative to ilium, and/or anterior rotation of ilium relative to sacrum.
<ul>
 	<li>The pelvic floor muscles are examples of muscle that may counter-nutate the sacrum.</li>
</ul>
[caption id="attachment_126335" align="aligncenter" width="400"]<a href="https://brentbrookbush.com/wp-content/uploads/2018/10/Nutation.png"><img class=" wp-image-126335" src="https://brentbrookbush.com/wp-content/uploads/2018/10/Nutation.png" alt="Nutation and Counter-nutation of the Sacroiliac Joint" width="400" height="967" /></a> Nutation and Counter-nutation of the Sacroiliac Joint[/caption]

&nbsp;

Crossover (Study) Design - A type of longitudinal, repeated measures quasi-experimental design in which each group receives both treatments, but at different times. It is named "crossover" due to the patients "crossing-over" to the other treatment or sham group after a specified period of time.
<ul>
 	<li>This type of study has the advantage of every individual serving as their own control, which may reduce the influence of confounding variables.</li>
 	<li>Unfortunately, the design itself introduces the chances that anyone receiving the experimental variable in the first period will continue to be effected in the second period.</li>
</ul>
In a study by Senna et al., a cross-over design was used to investigate the difference load made on inter-set rest intervals (1).
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/strength-training-research-corner/heavy-vs-light-load-single-joint-exercise-performance-with-different-rest-periods/" target="_blank" rel="noopener">Senna, G.W., Rodrigues, B.M., Sandy, Scudese, Bianco, A, &amp; Dantas, E.H.M. (2017). Heavy vs light load single-joint exercise performance with different intervals. Journal of Human Kinetics, 58, 197-206. </a></li>
</ol>

Cross-sectional Study - a research design that involves gathering data from a population or representative subset at a specific point in time.
<ul>
 	<li>Example, the study by Karimi-Mobarake et al.(1) investigated the prevalence of genu varum and genu valgum among school children 7-11 years old in Iran.</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/knee/low-prevalence-of-genu-varum-and-valgum-among-elementary-school-children/" target="_blank" rel="noopener noreferrer">Karimi-Mobarake, M., Kashefipour, A., Yousfnejad, Z. The prevalence of genu varum and genu valgum in primary school children in Iran 2003-2004. (2005) Journal of Medical Science 5(1). 52-54</a></li>
</ol>

Cytokine - A broad and loose category of small proteins that act through receptors, and are especially important to immune function (inflammation).
<ul>
 	<li>Cytokines include substances such as interferon, interleukin, and growth factors, which are secreted by certain cells of the immune system and have an effect on other cells. Their definite distinction from hormones is a topic of continued research.</li>
</ul>
&nbsp;

Dependent variable - in research, this is the variable that is changed by the independent variable, most often this is the "outcome" of the study.
<ul>
 	<li>Example, in the study by Cleland et al. (1), the independent variable is "thoracic manipulation," and the dependent variable is "lower trapezius muscle strength."</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/short-term-effects-lower-thoracic-manipulation-lower-trapezius-muscle-strength/" target="_blank" rel="noopener noreferrer">Cleland J, Selleck B, Stowell T, Brown L, Alberini S, St. Cyr H, Caron T. Short-term Effects of Thoracic Manipulation on Lower Trapezius Muscle Strength.  Journal of Manual &amp; Manipulative Therapy. 2004; 12(2): 82-90</a></li>
</ol>

An anatomical direction; further from the trunk or center of the body

Example, the foot is at the distal end of the leg.

An arthrokinematic motion - a force applied to a body part that may result in the separation of joint surfaces, a reduction in intra-articular pressure, and/or an increase in intra-articlar space.

For example, to hang from one's hands (i.g. in preparation for a pull-up) results in a traction force on the glenohumeral joint (shoulder).

An anatomical term of location; back or upper surface

Example, shoe laces may compress tissues on the dorsal surface of the foot

The "drawing-in" maneuver is a common cue used during exercise and rehabilitation programs. A light contraction of the <a href="https://brentbrookbush.com/articles/muscular-anatomy/transverse-abdominis/" target="_blank" rel="noopener">transverse abominis</a> (and potentially the entire <a href="https://brentbrookbush.com/articles/corrective-exercise-articles/core-subsystems/intrinsic-stabilization-subsystem/" target="_blank" rel="noopener">intrinsic stabilization subsystem</a>) achieved by gently pulling the lower abdominal region away from one's waist band. This should have minimal effect on breathing, and should not be confused with a maximal contraction of the <a href="https://brentbrookbush.com/articles/muscular-anatomy/transverse-abdominis/" target="_blank" rel="noopener">transverse abdominis</a> resulting in a "vacuum pose".
<ul>
 	<li>Research often refers to this maneuver as the "abdominal drawing-in maneuver"; abbreviated ADIM.</li>
</ul>
Development and introduction of this cue into practice is based on the pivotal research and resulting text:
<ol>
 	<li>Carolyn Richardson, Paul Hodges, Julie Hides. Therapeutic Exercise for Lumbo Pelvic Stabilization – A Motor Control Approach for the Treatment and Prevention of Low Back Pain: 2nd Edition (c) Elsevier Limited, 2004</li>
</ol>

Faulty or abnormal movement; an alteration of normal kinematics.

For example, joint stiffness or a reduction in arthrokinematics motion that results in limited osteokinematic range of motion - inadequate inferior glide of the femoral head resulting in limited abduction of the hip.

The seeping into, or abnormal collection of fluid in a body cavity.

For example, knee effusion describes swelling within the knee joint.

Note: the word "effusion" is used differently in medicine than it is used in reference to the movement (seeping out) of liquids and gases, for example in chemistry.

&nbsp;

A trait of body tissues that allows a tissue to return to its resting length or state after deformation or stretch.
Example:  Muscle is elastic tissue; many muscles will return to their resting length after being stretched to 150% of that length without any appreciable change in tissue quality.

Elasticity: Elasticity refers to the ability of a cell to return to its resting length after being stretched/lengthened.
<ul>
 	<li>Note: this term is often confused with extensibility. Elasticity is not the ability to stretch; it is the ability to return to normal length after being stretched. Muscle tissue, connective tissue and even nerve tissue have varying levels of elasticity.</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

Epithelial cell - One of the four basic cell types, found lining the body's cavities, blood vessels, organs and constitutes most gland tissue.  These cells are specialized to aid with absorption, secretion, or act as a barrier from foreign objects.
<ol>
 	<li>Saladin, K. S., &amp; Miller, L. (1998). Anatomy &amp; physiology. New York (NY): WCB/McGraw-Hill.</li>
</ol>

Equilibrium - a state in which opposing forces or influences are balanced.
<ul>
 	<li>For example, to maintain a neutral trunk while pushing or pulling a weight in one hand, your core musculature must balance the force by creating an equal amount of force in the opposite direction.</li>
</ul>

The study of causation, or origination. The word is commonly used in the medical professions, where it may refer to the study of why things occur, or the reason behind why things act a certain way.

For example, the etiology of low back pain is a complex subject, with multiple contributing factors and various structures implicated.

<div class="gs_citr" tabindex="0">Evidence-based medicine (practice) is the integration of best research evidence with clinical expertise and patient(client) values (2)."</div>
<ul>
 	<li class="gs_citr" tabindex="0">...the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients (clients).  It involves the integration of at least (a) clinical expertise/expert opinion, (b) external scientific evidence, and (c) client/patient/caregiver perspectives to provide high-quality services reflecting the interests, values, needs, and choices of the individuals we serve (1).</li>
</ul>
&nbsp;
<ol>
 	<li id="gs_cit1" class="gs_citr" tabindex="0">Sackett, D. L., Rosenberg, W. M., Gray, J. M., Haynes, R. B., &amp; Richardson, W. S. (1996). Evidence based medicine: what it is and what it isn't. Bmj, 312(7023), 71-72.</li>
 	<li class="gs_citr" tabindex="0">Sackett D et al. Evidence-Based Medicine: How to Practice and Teach EBM, 2nd edition. Churchill Livingstone, Edinburgh, 2000, p.1</li>
</ol>

Excitability: The ability of a cell to change in membrane conductance as a response to stimulation.

<ul>
 	<li>For example, muscle cells are specialized to react to a change in membrane potential with contraction, where as nerve cells are specialized to propagate a change in membrane potential along there axons and communicate that message to other tissues via neurotransmitters.
</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

Excitation threshold: The level that a depolarization must reach for an action potential to occur.
<ul>
 	<li>The excitation threshold is a contributing factor to the "all-or-none" response of muscle and nerves cells to a stimulus.</li>
</ul>

Exercise Progression - Modification of an exercise with the intent of promoting adaptation by increasing demand. This can be accomplished by increasing reps, load, tempo, range of motion, complexity, and/or challenge to an individual's stability.
<ul>
 	<li>Because load, reps, tempo and complexity are often explicitly noted, the term "exercise progression" is most often used throughout Brookbush Institute (BI) content to refer to an exercise, or series of exercises that make it harder to maintain stability with good form.
<ul>
 	<li>Sample Exercise Progression: <a href="https://brentbrookbush.com/vimeo_videos/kneeling-chop-pattern/" target="_blank" rel="noopener">Kneeling Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/static-standing-chop-pattern/" target="_blank" rel="noopener">Standing Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/single-leg-chop-pattern/" target="_blank" rel="noopener">Single-leg Chop</a></li>
</ul>
</li>
</ul>

Exercise regression - The opposite of progression; that is, modification of an exercise with the intent of reducing demand. This can be accomplished by decreasing reps, load, tempo, range of motion, complexity, and/or challenge to an individual's stability. Generally, regressions are used to modify an exercise to the client's current level of ability, with the intent of improving form, motor learning and retention.
<ul>
 	<li>Because load, reps, tempo and complexity are often explicitly noted, the term "exercise regression" is most often used throughout Brookbush Institute (BI) content to refer to an exercise or series of exercises that make it easier to maintain stability with good form.
<ul>
 	<li>Sample Exercise Regression: <a href="https://brentbrookbush.com/vimeo_videos/single-leg-chop-pattern/" target="_blank" rel="noopener">Single-leg Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/static-standing-chop-pattern/" target="_blank" rel="noopener">Standing Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/kneeling-chop-pattern/" target="_blank" rel="noopener">Kneeling Chop</a></li>
</ul>
</li>
</ul>

Experimental Research - Studies in which the researchers introduce the variable to be studied, with the intent of observing the outcome. This is different than observational research which observes the effect of a variable already present. Many texts also assert that experimental research should include randomization and ideally a control group, as is seen in Randomized Control Trials. Studies in which the variable is introduced by the researchers, but participants are not randomized may be considered Quasi-experimental research.
<ul>
 	<li>In this study by Esformes, the experimental variable was squat depth and the outcome measures observed were various performance measures related to power (1).</li>
</ul>
<ol>
 	<li><a href="https://brookbushinstitute.com/article/back-squat-depth-lower-body-post-activation-potentiation/" target="_blank" rel="noopener">Esformes, J., &amp; Bampouras, T. (2013). Effect of back squat depth on lower-body postactivation potentiation. Journal of Strength and Conditioning Research, 27(11), 2997-3000.</a></li>
</ol>
&nbsp;

Extensibility: The ability of a cell to be stretched or lengthened without damage (1).
<ul>
 	<li>For example, most cells would rupture with even a modest stretch, but muscles can stretch up to 3 times their contracted length.</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

False Negative - the proportion of negatives in a group that were assessed incorrectly (assessed as negative when the patient was actually positive)
<ul>
 	<li>Test Results: Although most tests/assessments result in either a positive or negative, the accuracy of a test is dependent on the number  of positives and negatives that are correct. Therefore, when the accuracy of a test is determined, their are 4 possible results, because a positive or negative result could be right (true) or wrong (false).</li>
</ul>

False Positive - the proportion of positives in a group that were assessed incorrectly (assessed as positive when the patient was actually negative)
<ul>
 	<li>Test Results: Although most tests/assessments result in either a positive or negative, the accuracy of a test is dependent on the number  of positives and negatives that are correct. Therefore, when the accuracy of a test is determined, their are 4 possible results, because a positive or negative result could be right (true) or wrong (false).</li>
</ul>

The function of fascia is to transmit force, provide support, and protect tissues. Fascia can effect motion by:
Transmitting force from one or more muscles (example: the thoracolumbar fascia)
Restricting motion in cases of adaptive shortening and/or adhesion to proximal structures (example: iliotibial band in cases of lower-leg dysfunction)
Elastic recoil after stretching can contribute to force production (example: plyometric exercise)

Note: There is evidence that fascia may house more receptors related to human movement than other tissues. In this way fascia may act as a motherboard for the nervous system

The fascial system does not contract or develop trigger points, and its capacity to adapt to stretching and or strengthening exercise is limited, especially when compared to the adaptive capacity of muscle tissue.

Fibromyalgia - A loosely defined diagnosis that is associated with a combination of widespread pain in combination with 2) tenderness at 11 or more of the 18 specific tender point sites. Consideration may also be given to the presence of psychosocial stressors and inflammatory disease in the patients history. Newer research suggests that fibromyalgia may be at least in part due to central sensitization of myofascial pain, often associated with trigger points (1 - 4).
<ol>
 	<li>Wolfe, F. (2018). Fibromyalgia Syndrome and Fibromyalgia Syndrome Criteria: Problems in Definition and Validity. Fibromyalgia Syndrome and Widespread Pain: From Construction to Relevant Recognition.</li>
 	<li>Wolfe, F., Smythe, H. A., Yunus, M. B., Bennett, R. M., Bombardier, C., Goldenberg, D. L., ... &amp; Fam, A. G. (1990). The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Arthritis &amp; Rheumatism: Official Journal of the American College of Rheumatology, 33(2), 160-172.</li>
 	<li>Alonso-Blanco, C., Fernandez-de-las-Penas, C., Morales-Cabezas, M., Zarco-Moreno, P., Ge, H. Y., &amp; Florez-García, M. (2011). Multiple active myofascial trigger points reproduce the overall spontaneous pain pattern in women with fibromyalgia and are related to widespread mechanical hypersensitivity. The Clinical journal of pain, 27(5), 405-413.</li>
 	<li>Staud, R., Nagel, S., Robinson, M. E., &amp; Price, D. D. (2009). Enhanced central pain processing of fibromyalgia patients is maintained by muscle afferent input: a randomized, double-blind, placebo-controlled study. PAIN®, 145(1-2), 96-104.</li>
</ol>
&nbsp;

Muscles that act to reduce or prevent movement at proximal joints to improve force transmission.
Example: The muscles of the core are important fixators; reducing motion of the spine/trunk to enhance force transmission between the extremities and environment.

An increase in joint stability via compressive forces resulting from muscular contraction and increased tension in fascial structures (1,2).
<ul>
 	<li>This term is most often used in reference to core intrinsic stabilizers, the thoracolumbar fascia and the sacroiliac joint; however, force closure and form closure have been mentioned in the literature referring to other joints.</li>
 	<li>Related term: Form closure</li>
</ul>
<ol>
 	<li>Andry Vleeming, Vert Mooney, Rob Stoeckart. Movement, Stability &amp; Lumbopelvic Pain: <a class="glossaryLink " title="Glossary: Integration" href="https://brentbrookbush.com/glossary/integration/" target="_blank" rel="noopener noreferrer" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Integration&lt;/div&gt;&lt;div class=glossaryItemBody&gt;Making a whole of parts.&lt;br /&gt;&lt;br /&gt;Example, The Brookbush Institute uses an integrative approach to explaining and addressing human movement.&lt;/div&gt;">Integration</a> of Research and Therapy. (c) 2007 Elsevier Limited</li>
 	<li id="gs_cit1" class="gs_citr" tabindex="0">Vleeming, A., Pool-Goudzwaard, A. L., Stoeckart, R., van Wingerden, J. P., &amp; Snijders, C. J. (1995). The Posterior Layer of the Thoracolumbar Fascia| Its Function in Load Transfer From Spine to Legs. Spine, 20(7), 753-758.</li>
</ol>

The relative contribution of joint shape and structure to the stability of a joint (1,2).
<ul>
 	<li>This term is most often used in reference to the "rough" articulating surfaces of the sacroiliac joint and the wedge shape of the sacrum; however, force closure and form closure have been mentioned in the literature referring to other joints.</li>
 	<li>Related term: Force closure</li>
</ul>
<ol>
 	<li>Andry Vleeming, Vert Mooney, Rob Stoeckart. Movement, Stability &amp; Lumbopelvic Pain: <a class="glossaryLink " title="Glossary: Integration" href="https://brentbrookbush.com/glossary/integration/" target="_blank" rel="noopener noreferrer" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Integration&lt;/div&gt;&lt;div class=glossaryItemBody&gt;Making a whole of parts.&lt;br /&gt;&lt;br /&gt;Example, The Brookbush Institute uses an integrative approach to explaining and addressing human movement.&lt;/div&gt;">Integration</a> of Research and Therapy. (c) 2007 Elsevier Limited</li>
 	<li id="gs_cit1" class="gs_citr" tabindex="0">Vleeming, A., Pool-Goudzwaard, A. L., Stoeckart, R., van Wingerden, J. P., &amp; Snijders, C. J. (1995). The Posterior Layer of the Thoracolumbar Fascia| Its Function in Load Transfer From Spine to Legs. Spine, 20(7), 753-758.</li>
</ol>

An arthrokinematic motion - linear motion across a joint surface parallel to the plane of the adjacent joint surface, just as your posterior moves relative to a "slide" in a park.

For example, the glide of facet joint in the spine during spinal flexion and extension, or the posterior glide of the humeral head that must accompany anterior roll to maintain congruence with glenoid fossa during shoulder horizontal adduction.

A plane joint (also called an arthrodial joint, gliding joint or plane articulation) is a synovial joint which allows only gliding movement in the plane of the articular surfaces. The opposed surfaces of the bones are flat or almost flat, with movement generally limited by tight capsules and ligaments. Plane joints are numerous, are most often small, and allow very little motion.  Examples include the carpal joints of the wrist, the tarsal joints of the ankle, and the facet joints of the spine.

"...refers to the measurement of angles, in particular the measurement of angles created at human joints by the bones of the body (1).

&nbsp;
<ol>
 	<li>Cynthia C. Norkin, D. Joyce White. Measurement of Joint Motion: A Guide to Goniometry 3rd Edition. Copyright (C) 2003 by F.A. Davis Company</li>
</ol>

Ground reaction force (GRF) - The force exerted by the ground on the body in contact with it.

For example, when a runner's foot strikes the ground with a force equal to the mass of the individual times their acceleration due to gravity, momentum and muscular exertion, the ground exerts an equal and opposite force on the runner's foot.
<ul>
 	<li>GRF is often measured in research studies using force plates as a means of quantitatively measuring the force generated by an individual.</li>
</ul>

H-Band - Refers to the central zone of a sarcomere that looks lighter under a microscope.  This area of the sarcomere is a lighter portion of the A-band where there is no overlap between the thinner filaments (actin), and the thicker filaments (myosin).
<ul>
 	<li>Example, when a muscle contracts, actin and myosin cross-bridging occurs in the region of the A-band until the H-band is reached where no overlap occurs.</li>
</ul>
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

A hinge joint (also called a ginglymus) is a synovial joint in which the articular surfaces fit one another in a way that only permits motion in one plane. Examples include the elbow, the knee (unless considered a condyloid joint) and the interphalangeal joints.

Holism (holistic) (biological holism) - (from Greek holos "all, whole, entire") is the idea that systems and their properties should be viewed as wholes, not just as a collection of parts.
<ul>
 	<li>Summarized by Aristotle in his "Metaphysics": "The whole is more than the sum of its parts". However, the term "holism" was introduced into language by the South African statesman Jan Smuts as recently as 1926. (Smuts J. C. 1987 [1926]. Holism and evolution. Cape Town: N &amp; S Press.)</li>
</ul>
Example: The Brookbush Institute promotes a holistic approach to human movement science, in which the muscular, fascial, articular and neural systems are not viewed as separable and all proximal segments are considered.

Hormone: Chemical messengers produced by the endocrine system, transported via tissue fluids such as blood, to stimulate cells to "act."
<ul>
 	<li>Example: Growth hormone is secreted by the pituitary gland in the brain; stimulating growth, cell reproduction and cell regeneration in certain types of cells</li>
</ul>
The English physician E. H. Starling discovered in collaboration with the physiologist W. M. Bayliss secretin, the first hormone, in 1902. (1).
<ol>
 	<li>Henriksen, J. H., &amp; de Muckadell, O. S. (2000). Secretin, its discovery, and the introduction of the hormone concept. Scandinavian journal of clinical and laboratory investigation, 60(6), 463-472.</li>
</ol>

A range of motion achieved by the patient/client that is more than normal.
<ul>
 	<li>Note: Both hyper-mobility and hypo-mobility may adversely affect motion and may lead to deleterious effects on joints and soft tissue over time. There is no evidence to suggest that more or less flexibility than normal is beneficial.</li>
</ul>
Example: If an individual can place their forehead on their knees they are likely hypermobile at one, if not several joints

Example 2: 110° of shoulder external rotation would be considered hyper-mobile.

Hyperplasia is an increase in organic tissue size due to an adaptive increase in the number of cells per organ.
<ul>
 	<li>Although muscle hyperplasia has been noted in some animals, human muscle tissue does not seem to have this adaptive ability.</li>
</ul>

A condition of excessive tone of the skeletal muscles; increased resistance of muscle to passive stretching.  May be related to increased neural drive, synergistic dominance, trigger points, reflexive over-activity, and/or muscle length.
Example:  Individuals who exhibit ankle eversion and abduction during an overhead squat assessment likely have hypertonic fibularis (peroneal) muscles.

Muscular hypertrophy is an increase in muscle mass/size due to increase in the volume and cross-sectional area (CSA) of individual muscle cells. The increase in cross-sectional area can be attributed to an an increase in contractile proteins and structural elements (myofibrillar hypertophy), as well as an increase in glycogen storage and elements related to metabolism (sarcoplasmic hypertophy). Hypertrophy is an adaptation of both cardiac and skeletal muscle fibers in response to progressive increases in workload.
<ul>
 	<li>Note: Hypertrophy is not hyperplasia. Hyperplasia is an increase in muscle size due to an adaptive increase in the number of muscle fibers/cells per muscle. This type of adaptation does not occur in human muscle tissue.</li>
</ul>

A range of motion achieved by a patient/client that is less than normal.
<ul>
 	<li>Note: Both hyper-mobility and hypo-mobility may adversely affect motion and may lead to deleterious effects on joints and soft tissue over time. There is no evidence to suggest that more or less flexibility than normal is beneficial.</li>
</ul>
Example: If the end range of shoulder external rotation is reached and measured as 75° during goniometric assessment, the client/patient is exhibiting hypomobility of the glenohumeral joint (shoulder).

Hypothesis - a proposed explanation for a phenomenon; "scientific hypotheses" are generally constructed in a way that is testable or falsifiable.
<ul>
 	<li>Example: The hypothesis, "excessive knee valgus may be correlated with future knee pain and injury," has been the subject of several studies published over the last decade.</li>
</ul>

Diminished tone of skeletal muscles; diminished resistance of muscles to passive stretching.   May be related to inhibition, reciprocal inhibition, arthrokinematics inhibition and/or  increased resting length of muscle.
Example:  If your knees cave (hip adduction) during a squat or leg-press it is likely that your gluteus medius is hypotonic.

I-Band - Refers to the part of the muscle cell that looks lighter under a microscope.  This area of the cell is lighter due to parallel arrangement of thinner filaments (actin), and no overlap with the thicker filaments (myosin).
<ul>
 	<li>As a muscle contracts, the I-bands will decrease in width and move closer to one another.</li>
</ul>
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

Independent variable - in research, this is the variable or phenomenon being manipulated in the study.
<ul>
 	<li>Example, in the study by Ghanbari et al. (1), the independent variable is "knee joint mobilization", the dependent variable is "quadriceps muscle strength."</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/effect-knee-joint-mobilization-quadriceps-muscle-strength/" target="_blank" rel="noopener noreferrer">Ghanbari A. and Kamalgharibi S. (2013). Effect of knee joint mobilization on quadriceps muscle strength. International Journal of Health and Rehabilitation Sciences. 2(4): 186-191</a></li>
</ol>

An anatomical direction; toward the bottom (below)

Example, the mouth is inferior to the eyes

A reduction in neural drive, muscular activity, and or force output due to altered neuromuscular reflex.  Alterations in neuromuscular reflex may occur due to increases in muscle length (hypothesis: increased excitation threshold), altered reciprocal inhibition in response to increased antagonist tone, and or alterations in joint motion (arthrokinematics inhibition).

Making a whole of parts.

Example, The Brookbush Institute uses an integrative approach to explaining and addressing human movement.

Intermuscular Coordination - Optimal timing and motor unit recruitment of agonists, antagonists, synergists, neutralizers, stabilizers and fixators.

Example: Role of Muscles during Hip Extension
<ul>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Prime Mover" href="https://brentbrookbush.com/glossary/prime-mover/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Prime Mover&lt;/div&gt;The muscle most responsible for a joint action under load -&lt;br /&gt;&lt;br /&gt;That is, the muscle that can produce the most force for a given joint action. Often this term is used synonymously with the term agonist. The prime mover as defined above, may or may not be the most active muscle for a joint action during activities of daily living.&lt;br /&gt;&lt;br /&gt;Example: the gluteus maximus is the most powerful hip extensor and therefore the prime mover; however, the hamstrings are likely the most active hip extensors during low level activities like walking or standing.">Prime Mover</a>:  <a href="https://player.vimeo.com/external/82855344.hd.mp4?s=54c3e7d98fb9d4e0af8d282c85ba9b3e">Gluteus maximus</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Synergists" href="https://brentbrookbush.com/glossary/synergists/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Synergists&lt;/div&gt;Muscles that assist the prime mover in performing a joint action.&lt;br /&gt;&lt;br /&gt;That is, all muscles that can perform a joint action that are not the prime mover, are termed synergists.&lt;br /&gt;Example: The rectus abdominis is the prime mover of spinal flexion. All other muscles that can perform spinal flexion are synergists including – external obliques, internal obliques and psoas.">Synergists</a>: <a href="https://brentbrookbush.com/articles/muscular-anatomy/biceps-femoris/">Biceps femoris (long head)</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/semitendinosus-and-semimembranosus/">semitendinosus, semimembranosus</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/adductors/">posterior head of adductor magnus</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Antagonist" href="https://brentbrookbush.com/glossary/antagonists/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Antagonist&lt;/div&gt;Muscles that oppose the prime mover and synergists for a given joint action.&lt;br /&gt;&lt;br /&gt;That is, all the muscles that can perform the opposing joint action.&lt;br /&gt;&lt;br /&gt;Example: The triceps and anconeus are antagonists during elbow flexion.">Antagonists</a>: <a href="https://brentbrookbush.com/articles/muscular-anatomy/psoas/">Psoas</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/iliacus/">iliacus</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/tensor-fascia-latae-tfl/">tensor fascia latae</a> (TFL),<a href="https://brentbrookbush.com/articles/muscular-anatomy/rectus-femoris/"> rectus femoris</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/adductors/">anterior adductors (especially pectineus)</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/sartorius/">sartorius</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Neutralizer" href="https://brentbrookbush.com/glossary/neutralizers/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Neutralizer&lt;/div&gt;Muscles that oppose unwanted joint motions created by the prime mover and/or synergists, and/or muscles that prevent unwanted ancillary motion.&lt;br /&gt;Example: The teres minor and infraspinatus neutralize the internal rotation force created by the pectoralis major during horizontal adduction of the shoulder.">Neutralizers</a>: <a href="https://brentbrookbush.com/articles/muscular-anatomy/gluteus-minimus/">Gluteus minimus</a> and <a href="https://brentbrookbush.com/articles/muscular-anatomy/gluteus-medius/">anterior fibers of gluteus medius</a> neutralize external rotation force of <a href="https://brentbrookbush.com/articles/muscular-anatomy/gluteus-maximus/">gluteus maximus</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Stabilizer" href="https://brentbrookbush.com/glossary/stabilizers/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Stabilizer&lt;/div&gt;Muscles whose primary role is to improve arthrokinematics by maintaining optimal alignment of joint surfaces.&lt;br /&gt;&lt;br /&gt;Most often these muscles are the most intrinsic muscles of a joint, have a larger percentage of Type I muscle fibers and are rich in proprioceptors.&lt;br /&gt;Example: The muscles of the rotator cuff act as stabilizers for most shoulder motions.">Stabilizers</a>: <a href="https://brentbrookbush.com/articles/muscular-anatomy/deep-rotators-of-the-hip/">Deep rotators of hip</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Fixator" href="https://brentbrookbush.com/glossary/fixators/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Fixator&lt;/div&gt;Muscles that act to reduce or prevent movement at proximal joints to improve force transmission.&lt;br /&gt;Example: The muscles of the core are important fixators; reducing motion of the spine/trunk to enhance force transmission between the extremities and environment.">Fixators</a>: <a href="https://brentbrookbush.com/articles/core-subsystems/intrinsic-stabilization-subsystem/">Intrinsic stabilization subsystem</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/rectus-abdominis/">rectus abdominis</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/internal-obliques/">internal</a> and <a href="https://brentbrookbush.com/articles/muscular-anatomy/external-obliques/">external obliques</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/quadratus-lumborum/">quadratus lumborum</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/erector-spinae/">erector spinae</a></li>
</ul>
&nbsp;

Example from: <a href="https://brentbrookbush.com/articles/anatomy-articles/introduction-to-functional-anatomy/kinesiology-of-the-hip/" target="_blank" rel="noopener">Introduction to Functional Anatomy: Kinesiology of the Hip</a>

Intramuscular coordination refers to the coordinated recruitment of motor units within a single muscle. This concept is used to explain increases in maximal strength and power; however, the coordinated and sequential recruitment of motor units is also essential to strength endurance and smooth coordinated motion.  Related terminology may include; motor unit recruitment, preferential recruitment, rate coding, sequence, etc..

Example: It is hypothesized that the "shaking" noted during a novice exercisers attempt at an activity like the <a href="https://brentbrookbush.com/vimeo_videos/ball-crunch-and-progressions/" target="_blank">stability ball crunch</a> may be due to relatively poor intramuscular coordination. Rather than smooth, sequential firing of rectus abdominis motor units, groups of motor units turn on and off in an uncoordinated manner.

Pertaining to the same side

Example, the quadratus lumborum performs ipsilateral flexion; lateral flexion toward the same side as the muscle.

An isoform, or variant, is a member of a set of similar proteins, that originate from the same gene, or gene family.
<ul>
 	<li>Example, the variations in myosin heavy chain proteins (MHC I, MHC IIA, MHC IIB/X) that contribute to the characteristic differences between muscle fiber types.</li>
</ul>

“The Prime Assumption”
Everything crossing a joint will influence joint motion during every joint action.

A concept that has expanded over the past several decades to describe the integration of 4 body systems (muscle, joints, fascia and nerves), as well as, the coordinated function of various body segments (e.g. hip, knee and ankle) to produce motion. Kinetic referring to motion, and chain being an analogy for the interdependent link between systems.

Example, the posterior kinetic chain, refers to the integrated function of nerves, muscles, fascia and joints on the posterior side of the body.

The concept of the kinetic chain was originally adapted from the work of a mechanical engineer named Franz Reuleaux (Kinematics of Machinery (1875)) by Dr. Arthur Steindler in 1955 (Steindler A: Kinesiology of the Human Body. Springfield, IL, Charles C. Thomas Co.. 1955).

Latent Trigger Point - A myofascial trigger point that is not painful at rest, only painful when palpated, and may or may not exhibit a characteristic referral pain pattern when palpated.  Latent trigger points do result in an acute point of sensitivity, in a taut band of muscle, and may restrict range of motion (1).

Note: Based on the clinical experience, the Brookbush Institute suggests that latent trigger points (sometimes refereed to as Tender Points) are more common than active trigger points. Further, they are likely addressed more often than trigger points; being the intended target of many soft-tissue mobility techniques.
<ol>
 	<li>David G. Simons, Janet Travell, Lois S. Simons, Travell &amp; Simmons’ Myofascial Pain and Dysfunction, The Trigger Point Manual, Volume 1. Upper Half of Body: Second Edition,© 1999 Williams and Wilkens</li>
</ol>

An anatomical direction; further from the midline

Example, the anterior deltoid is lateral to the pectoralis major

Length/Tension Relationship - The amount of force generated by a muscle is dependent on sarcomere length.
<ul>
 	<li>The ability of sarcomere to maximally produce force occurs when sarcomere length results in optimal overlap between actin and myosin. Stretching a sarcomere decreases overlap between actin and myosin filaments and reduces force production (1-3). When length is less than optimal, actin from opposite ends overlap and interfere with cross-bridging, and myosin filament are compressed as they contact the the Z-disk also reducing force (4)</li>
</ul>
<ol>
 	<li>Gordon, A. M., Huxley, A. F., &amp; Julian, F. J. (1966). The variation in isometric tension with sarcomere length in vertebrate muscle fibres. The Journal of physiology, 184(1), 170-192.</li>
 	<li>Edman, K. A. P. (1966). The relation between sarcomere length and active tension in isolated semitendinosus fibres of the frog. The Journal of Physiology, 183(2), 407-417.</li>
 	<li>Lieber, R. L., Loren, G. J., &amp; Friden, J. (1994). In vivo measurement of human wrist extensor muscle sarcomere length changes. Journal of neurophysiology, 71(3), 874-881.</li>
 	<li>Lieber, R. L. (2002). Skeletal muscle structure, function, and plasticity. Lippincott Williams &amp; Wilkins.</li>
</ol>
&nbsp;

Levels of Evidence - Relative to evidence-based practice, levels of evidence are an attempt to describe the strength of the results measured in a clinical trial or research study.  Note: levels of evidence do not supersede the critical evaluation of an experienced professional, and should be viewed as guidelines - a meta-analysis may be poorly constructed (Level IA), and a comparative study (Level III) may employ new technologies and a strong methodology.


The Levels of Evidence used by the Brookbush Institute, as described by Shekelle et al.(1):
<ul>
 	<li class="p1">IA - Evidence from meta-analysis of randomized controlled trials</li>
 	<li class="p1">IB - Evidence from at least one randomized controlled trial</li>
 	<li class="p1">IIA - Evidence from at least one controlled study without randomization</li>
 	<li class="p1">IIB - Evidence from at least one other type of quasi-experimental study</li>
 	<li class="p1">III - Evidence from non-experimental descriptive studies, such as comparative studies, correlation studies, and case-control studies</li>
 	<li class="p1">IV - Evidence from expert committee reports or opinions or clinical experience of respected authorities, or both</li>
</ul>
<ol>
 	<li>Shekelle, P. G., Woolf, S. H., Eccles, M., &amp; Grimshaw, J. (1999). Developing clinical guidelines. Western Journal of Medicine, 170(6), 348.</li>
</ol>

Likelihood Ratios - Likilihood ratios are used for assessing the value of performing a diagnostic test. They use sensitivity and specificity to determine whether a test result usefully changes the practitioner's chance (probability) of reaching the correct assessment. Calculation of likelihood ratios is based on Baye's theorem.
<ul>
 	<li>Positive Likelihood Ratio (LR+) - The ratio of a positive test result in people with the pathology to a positive test result in people without the pathology.</li>
 	<li>Negative Likelihood Ratio (LR-) - The ratio of a negative test result in people with the pathology to a negative test result in people without the pathology.</li>
</ul>

Longitudinal Study - a research design that involves observing the same variables, several times over a period of time.
<ul>
 	<li>Example, the study by Hewett et al. (1) is a type of longitudinal study called a "cohort study." This study investigated whether excessive knee valgus during landing was a predictor of knee injury risk in adolescent females over the course of a season.</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/knee/research-review-increased-valgus-during-landing-predicts-acl-injury-in-adolescent-female-athletes/" target="_blank" rel="noopener noreferrer">Hewett, T. E., Myer, G. D., Ford, K. R., Heidt, R. S., Colosimo, A. J., McLean, S. G., &amp; Succop, P. (2005). Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes A prospective study. The American journal of sports medicine, 33(4), 492-501</a></li>
</ol>

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