Tibial External Rotator: Release and Lengthening

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Tibial External Rotator: Release and Lengthening (TFL, Biceps Femoris, Vastus Lateralis and Lateral Gastrocnemius)

Tibia External Rotator: Release and Lengthening

<p>This course describes tibial external rotator <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> and lengthening, commonly referred to as tibial external rotator foam rolling, tibial external rotator foam rolling, tibial external rotator <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> with ball, tibial external rotator stretching, or knee <a id="mobility" data-tip="1455" target="_blank" href="/glossary-term/mobility" class="glossary">mobility</a> techniques. Although terms like <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> tightness, tight hips, tight tibial external rotators, tensor fascia lata (TFL) tightness, a tight biceps femoris (hamstring) <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a>, etc., are commonly used, it may be more accurate to label these muscles as <a id="prone" data-tip="1561" target="_blank" href="/glossary-term/prone" class="glossary">prone</a> to over-activity (e.g. <a id="hypertonic" data-tip="1672" target="_blank" href="/glossary-term/hypertonic" class="glossary">hypertonic</a>, phasic). Performing tibial external rotator <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> and lengthening techniques to increase <a id="mobility" data-tip="1455" target="_blank" href="/glossary-term/mobility" class="glossary">mobility</a> prior to activation, <a id="integration" data-tip="1472" target="_blank" href="/glossary-term/integration" class="glossary">integration</a>, and strengthening techniques may significantly enhance rehabilitation and performance programs. In practice, the <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> of the tensor fascia latae (TFL), vastus lateralis, biceps femoris, and <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> gastrocnemius (calf), mobilizing the knee joint, and integrating a kneeling hip flexor stretch (TFL stretch), and modified calf stretch (gastrocnemius) is likely to improve knee <a id="mobility" data-tip="1455" target="_blank" href="/glossary-term/mobility" class="glossary">mobility</a> and improve the effectiveness of exercises like terminal knee extensions (TKE&apos;s), deadlift touchdowns, isolated tibial internal rotator activation, etc. Tibial external rotator over-activity has been correlated with altered lower extremity alignment, pronation distortion syndrome, knee bow in (knee valgus or functional valgus), an asymmetrical weight shift, loss of tibial internal rotator strength, and loss of vastus medialis obliquus (VMO), semitendinosus, and semimembranosus strength. Further, tibial external rotator over-activity has been correlated with knee pain, ankle pain, increased risk of future injury, and a loss of sports performance. Sports medicine professionals (personal trainers, fitness instructors, physical therapists, massage therapists, chiropractors, occupational therapists, athletic trainers, etc.) should consider adding these exercises to their repertoire to improve the outcomes of their <a id="integration" data-tip="1473" target="_blank" href="/glossary-term/integration" class="glossary">integrated</a> exercise programs and therapeutic (rehabilitation) interventions.</p>
<h4><strong>Release Techniques</strong></h4>
<ul>
  <li><a href="https://brookbushinstitute.com/videos/tensor-fascia-latae-tfl-self-administered-release">Tensor Fascia Latae Static Release</a></li>
  <li><a href="https://brookbushinstitute.com/videos/biceps-femoris-sa-static-release">Biceps Femoris Static Release</a></li>
  <li><a href="https://brookbushinstitute.com/videos/vastus-lateralis-sa-static-release">Vastus Lateralis Static Release</a></li>
  <li><a href="https://brookbushinstitute.com/videos/vastus-lateralis-self-administered-dynamic-release-a-k-a-pin-stretch">Vastus Lateralis Dynamic </a><a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">Release</a> (Pin and Stretch)</li>
  <li><a href="https://brookbushinstitute.com/videos/gastroc-and-soleus-calf-sa-static-release">Lateral Gastrocnemius Static Release</a></li>
  <li><a href="https://brookbushinstitute.com/videos/calf-and-fibularis-peroneal-active-release">Lateral Gastrocnemius Dynamic Release</a></li>
</ul>
<h4><strong>Joint Mobilization Techniques</strong></h4>
<p>Following <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> techniques, but before lengthening techniques, it may be beneficial to perform <a href="https://brookbushinstitute.com/courses/joint-mobilization-lower-body-self-administered">Self-administered Joint Mobilization Techniques: Lower Body</a></p>
<ul>
  <li><a href="https://brookbushinstitute.com/videos/knee-mobilization">Knee Mobilization</a></li>
</ul>
<h4><strong>Lengthening Techniques</strong></h4>
<ul>
  <li><a href="https://brookbushinstitute.com/videos/kneeling-hip-flexor-static-stretch">Hip Flexor Static Stretch</a></li>
  <li><a href="https://brookbushinstitute.com/videos/slant-board-calf-stretch">Slant Board Stretch (</a><a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">Lateral</a> Gastrocnemius Stretch)</li>
  <li><a href="https://brookbushinstitute.com/videos/biceps-femoris-active-stretch">Biceps Femoris Active Stretch</a></li>
</ul>
<p style="padding-left: 40px;"><img title="Dr. Brent Brookbush demonstrating release of the vastus lateralis using a pin and stretch technique on a foam roller" src="https://www.datocms-assets.com/25800/1650560124-tfl-release.png" alt="A vastus lateralis (pin and stretch) release technique with a foam roller"></p>

Course Description: Tibial External Rotator: Release and Lengthening

<h3><a href="https://brookbushinstitute.com/courses/lumbo-pelvic-hip-complex-dysfunction-lphcd" target="_blank" rel="noopener">Lumbo Pelvic Hip Complex Dysfunction (LPHCD)</a>, Sacroiliac Joint Dysfunction (SIJD), and <a href="https://brookbushinstitute.com/courses/lower-leg-dysfunction" target="_blank" rel="noopener">Lower Leg Dysfunction (LED)</a></h3>
<p>For a complete review of origin, insertion, innervation, action, <a id="integration" data-tip="1473" target="_blank" href="/glossary-term/integration" class="glossary">integrated</a> function, <a href="https://brookbushinstitute.com/glossary/arthrokinematics/" target="_blank" rel="noopener">arthrokinematics</a>, motor behavior, subsystem involvement, and <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a>, please check out the Functional Anatomy &amp; Human Movement Science of the:</p>
<ul>
  <li><a href="https://brookbushinstitute.com/courses/tensor-fascia-latae-tfl" target="_blank" rel="noopener">Tensor Fasciae Latae</a></li>
  <li><a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">Biceps Femoris</a></li>
  <li>Vastus Lateralis</li>
  <li><a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">Lateral</a> Gastrocnemius</li>
</ul>
<p><img src="https://www.datocms-assets.com/25800/1650560219-tfl.jpg" title="A cadaver dissection of the TFL muscle and IT band running along the lateral side of the leg " alt="The tensor fascia latae in a cadaver dissection"></p>

Introduction to Tibial External Rotator Release & Lengthening

<h4><span style="background-color: transparent; font-family: inherit; font-size: inherit; font-style: inherit; font-variant-ligatures: inherit; font-variant-caps: inherit; font-weight: inherit; letter-spacing: 0px;">T</span><a href="https://brookbushinstitute.com/courses/tensor-fascia-latae-tfl" target="_blank" style="letter-spacing: 0px;" rel="noopener">ensor fasciae latae (TFL)</a><span style="background-color: transparent; font-family: inherit; font-size: inherit; font-style: inherit; font-variant-ligatures: inherit; font-variant-caps: inherit; font-weight: inherit; letter-spacing: 0px;">, </span>vastus lateralis (VL)<span style="background-color: transparent; font-family: inherit; font-size: inherit; font-style: inherit; font-variant-ligatures: inherit; font-variant-caps: inherit; font-weight: inherit; letter-spacing: 0px;">, iliotibial band (ITB) Complex:</span></h4>
<p><span style="background-color: transparent; font-family: inherit; font-size: inherit; font-style: inherit; font-variant-ligatures: inherit; font-variant-caps: inherit; font-weight: inherit; letter-spacing: 0px;">The iliotibial band is an often misunderstood <a id="connective-tissue-cell" data-tip="1368" target="_blank" href="/glossary-term/connective-tissue-cell" class="glossary">connective tissue</a> (fascial) structure. Although this structure does not contract, develop <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> (a muscular phenomenon), and is unlikely to become &quot;tight&quot; or adaptively shortened, many practitioners prescribe techniques <a id="specificity" data-tip="1224" target="_blank" href="/glossary-term/specificity" class="glossary">specific</a> to the iliotibial band (ITB). A more sound approach to hypothesized ITB issues would be addressing the commonly over-active muscles that invest in this complex fascial sheath. The </span><a href="https://brookbushinstitute.com/courses/tensor-fascia-latae-tfl" target="_blank" style="letter-spacing: 0px;" rel="noopener">tensor fasciae latae (TFL)</a><span style="background-color: transparent; font-family: inherit; font-size: inherit; font-style: inherit; font-variant-ligatures: inherit; font-variant-caps: inherit; font-weight: inherit; letter-spacing: 0px;"> uses the iliotibial band as a tendon, and the </span>vastus lateralis (VL)<span style="background-color: transparent; font-family: inherit; font-size: inherit; font-style: inherit; font-variant-ligatures: inherit; font-variant-caps: inherit; font-weight: inherit; letter-spacing: 0px;"> has fascial slips that invest into the ITB. These fascial slips of the VL extend above the hip implying a role resisting adduction, and the <a id="distal" data-tip="1563" target="_blank" href="/glossary-term/distal" class="glossary">distal</a> slips create a fascial network that invests in several structures of the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> knee implying a role in resisting tibial internal rotation. Relative to <a id="movement-impairment" data-tip="1575" target="_blank" href="/glossary-term/movement-impairment" class="glossary">movement impairment</a>, the TFL/VL/ITB complex implies that VL <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> should be included when over-activity of the tibial external rotators (and potentially hip flexors) is suspected.</span></p>

Note on Integrated Functional Anatomy of Tight Tibial External Rotators and The IT Band

<p><strong>Note:</strong> Although this course addresses muscles that &quot;externally rotate the tibia;&quot; excessive tibial external rotation may result in compensation at the hip and ankle.</p>
<h4>&quot;Rule #3 of Brent&apos;s Rules of Human Movement Science&quot;</h4>
<p><em>&quot;The motion of a bone is relative to the bones it approximates.&quot;</em></p>
<blockquote>
  <blockquote>
    <ul>
      <li>Tibial external rotation is relative femoral internal rotation</li>
      <li>Tibial external rotation, combined with femoral internal rotation approximates the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> knee (valgus force), resulting in &quot;<a href="http://videotree.brookbushinstitute.com/overhead-squat-assessment-6-knees-bow-in-breakdown/" target="_blank" rel="noopener">knees bow in</a>&quot; (functional valgus).</li>
    </ul>
  </blockquote>
</blockquote>
<p>If the foot remains fixed and the tibia cannot rotate enough to <a id="compensation-pattern" data-tip="1697" target="_blank" href="/glossary-term/compensation-pattern" class="glossary">compensate</a> for the restriction; the femur will internally rotate to pick up the slack. Further, the approximation of structures in the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> knee (the outside of the knee being pinched together by the biceps femoris and TFL/VL/ITB complex) will force the knee to deflect inward - aka. femoral internal rotation and adduction.</p>
<h3><a href="https://brookbushinstitute.com/courses/solutions-table-overhead-squat-assessment" target="_blank" style="letter-spacing: 0px;" rel="noopener">Overhead Squat Assessment:</a></h3>
<ul>
  <li><a href="http://videotree.brookbushinstitute.com/overhead-squat-assessment-5-feet-turn-out-breakdown/" target="_blank" rel="noopener">Feet Turn Out</a>: Short and Over-active Tibia External Rotators</li>
  <li><a href="http://videotree.brookbushinstitute.com/overhead-squat-assessment-6-knees-bow-in-breakdown/" target="_blank" rel="noopener">Knees Bow In</a>: Short and Over-active Tibia External Rotators</li>
  <li><a href="http://videotree.brookbushinstitute.com/asymmetrical-weight-shift-overhead-squat-assessment-15-sign-clusters/" target="_blank" rel="noopener">Asymmetrical Weight Shift</a>: Short and over-active Tibia External Rotators on the side opposite the shift</li>
</ul>
<p style="padding-left: 160px;"><img title="Dr. Brent Brookbush demonstrating feet turn out during an overhead squat assessment" src="https://www.datocms-assets.com/25800/1649862955-feet-turn-out.jpg" width="299" height="396" alt="An image of feet turn out during the overhead squat assessment"></p>
<h3>Goniometric Assessment:</h3>
<ul>
  <li><a href="http://videotree.brookbushinstitute.com/goniometry-hip-internal-rotation/" target="_blank" rel="noopener">Hip Internal Rotation in Prone</a>: &lt;35 - 45&#xB0; &#x2013; Short and Over-active Tibia External Rotators (via <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>)</li>
  <li><a href="http://videotree.brookbushinstitute.com/goniometry-hip-external-rotation-in-prone/" target="_blank" rel="noopener">Hip External Rotation in Prone</a>: &lt;35 - 45&#xB0; &#x2013; Short and Over-active Tibia External Rotators</li>
  <li><a href="http://videotree.brookbushinstitute.com/goniometric-assessment-hip-internal-rotation-at-90-degree-of-hip-flexion-9090-hip-ir/" target="_blank" rel="noopener">Hip Internal Rotation in </a><a id="supine" data-tip="1562" target="_blank" href="/glossary-term/supine" class="glossary">Supine</a> (with hip and knee at 90&#xB0;/90&#xB0;): &lt; 35 - 45&#xB0; &#x2013; Short and Over-active Tibia External Rotators (via <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>)</li>
  <li><a href="http://videotree.brookbushinstitute.com/goniometric-assessment-hip-external-rotation-at-90-degrees-of-hip-flexion-9090-hip-er/" target="_blank" rel="noopener">Hip External Rotation in </a><a id="supine" data-tip="1562" target="_blank" href="/glossary-term/supine" class="glossary">Supine</a> (with hip and knee at 90&#xB0;/90&#xB0;): &lt; 35 - 45&#xB0; &#x2013; Short and Over-active Tibia External Rotators</li>
  <li><a href="http://videotree.brookbushinstitute.com/hip-extension-goniometry/" target="_blank" rel="noopener">Hip Extension</a>: &lt; 0 - 10&#xBA; &#x2013; Short and Overactive <a href="https://brookbushinstitute.com/courses/tensor-fascia-latae-tfl" target="_blank" rel="noopener">Tensor Fasciae Latae</a> and potentially the <a href="https://brookbushinstitute.com/article/quadriceps-vastus-muscles" target="_blank" rel="noopener">Vastus Lateralis</a> via the Iliotibial Band</li>
  <li><a href="http://videotree.brookbushinstitute.com/knee-extension-with-hip-flexion-goniometry-hamstring-length-test/" target="_blank" rel="noopener">Knee Extension with Hip Flexion</a> (90&#xB0;/90&#xB0;) &gt; 0 - 20&#xB0; Short and Over-active <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">Biceps Femoris</a></li>
  <li>Note: Although tibial internal rotation would be the most direct method for assessing <a id="optimal" data-tip="1571" target="_blank" href="/glossary-term/optimal" class="glossary">optimal</a> ROM of these muscles, clinically I have found this <a id="goniometry" data-tip="1524" target="_blank" href="/glossary-term/goniometry" class="glossary">goniometric</a> <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">assessment</a> highly unreliable.</li>
</ul>
<h3>Muscle Length Tests:</h3>
<ul>
  <li>FADIR <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">Test</a> (video coming soon) - Indicative of Short and Overactive <a href="https://brookbushinstitute.com/courses/tensor-fascia-latae-tfl" target="_blank" rel="noopener">Tensor Fasciae Latae</a></li>
  <li><a href="http://videotree.brookbushinstitute.com/obers-test-tfl-flexibility-assessment/" target="_blank" rel="noopener">Ober&apos;s Test</a> - Short and Overactive <a href="https://brookbushinstitute.com/courses/tensor-fascia-latae-tfl" target="_blank" rel="noopener">Tensor Fasciae Latae</a> and potentially the Vastus Lateralis via the Iliotibial Band</li>
  <li>Hamstring Length <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">Test</a> (Identical to <a href="http://videotree.brookbushinstitute.com/knee-extension-with-hip-flexion-goniometry-hamstring-length-test/" target="_blank" rel="noopener">Knee Extension with Hip Flexion</a>) - Short and Over-active <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">Biceps Femoris</a></li>
  <li><a href="http://videotree.brookbushinstitute.com/gastrocnemius-and-soleus-muscle-length-test/" target="_blank" rel="noopener">Gastroc/Soleus </a><a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">Muscle</a> Length Test - Short and Over-active <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">Lateral</a> <a href="https://brookbushinstitute.com/article/gastrocnemius-plantaris" target="_blank" rel="noopener">Gastrocnemius</a></li>
</ul>

Signs of Over-Activity and Adaptive Shortening

<p>Maintaining <a id="optimal" data-tip="1571" target="_blank" href="/glossary-term/optimal" class="glossary">optimal</a> length and activity of the tibial external rotators is likely dependent on not only <a id="optimal" data-tip="1571" target="_blank" href="/glossary-term/optimal" class="glossary">optimal</a> soft tissue <a href="https://brookbushinstitute.com/glossary/extensibility/" target="_blank" rel="noopener">extensibility</a>&#xA0;but <a id="optimal" data-tip="1571" target="_blank" href="/glossary-term/optimal" class="glossary">optimal</a> <a id="arthrokinematics" data-tip="1701" target="_blank" href="/glossary-term/arthrokinematics" class="glossary">arthrokinematic motion</a> and activity of functional <a href="https://brookbushinstitute.com/glossary/antagonists/" target="_blank" rel="noopener">antagonists</a>.</p>
<ul>
  <li>Joint Mobilization:
    <ul>
      <li><a href="https://brookbushinstitute.com/video/knee-mobilization" target="_blank" rel="noopener">Knee Mobilization</a> (<a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">Posterior</a> to <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">Anterior</a> Mobilization of Tibia)</li>
      <li><a href="https://brookbushinstitute.com/video/self-administered-ankle-mobilization" target="_blank" rel="noopener">Ankle Mobilization</a> (<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> Talus Mobilization)</li>
    </ul>
  </li>
  <li>Activation:
    <ul>
      <li><a href="https://brookbushinstitute.com/video/gluteus-medius-isolated-activation" target="_blank" rel="noopener">Gluteus Medius Activation</a></li>
      <li><a href="https://brookbushinstitute.com/video/tibial-internal-rotator-activation" target="_blank" rel="noopener">Tibial Internal Rotator Activation</a></li>
    </ul>
  </li>
  <li><a id="kinesiology" data-tip="1692" target="_blank" href="/glossary-term/kinesiology" class="glossary">Kinesiology</a> Taping:
    <ul>
      <li><a href="https://brookbushinstitute.com/video/tibial-internal-rotator-activation-taping" target="_blank" rel="noopener">Tibial Internal Rotator Facilitation Taping</a></li>
    </ul>
  </li>
</ul>
<p><img src="https://www.datocms-assets.com/25800/1660275278-knee-mobilization-compressed.jpg" title="Dr. Brent Brookbush" alt="Demonstration of a self-administered knee mobilization"></p>

Optimizing Motion to Prevent Knee Pain

<p>Several texts have noted the propensity of the muscles addressed in this article to become over-active and short (1-5, 14). Further, many of these texts recommend techniques similar to those described in this article. Recently, more research has been done to investigate the relative activity of muscles as it relates to <a id="movement-impairment" data-tip="1575" target="_blank" href="/glossary-term/movement-impairment" class="glossary">movement impairment</a>, specifically knee valgus. In one study, functional knee valgus was found to be an indicator of relative over-activity of the <a href="https://brookbushinstitute.com/article/gastrocnemius-plantaris" target="_blank" rel="noopener">gastrocnemius</a>, unfortunately, the <a href="https://brookbushinstitute.com/article/tensor-fascia-latae-tfl" target="_blank" rel="noopener">TFL</a>, <a href="https://brookbushinstitute.com/article/quadriceps-vastus-muscles" target="_blank" rel="noopener">vastus lateralis</a>, and <a href="https://brookbushinstitute.com/article/biceps-femoris" target="_blank" rel="noopener">biceps femoris</a> were not examined in this study (7). However, in another study by Bell et al., an exercise intervention including <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> and lengthening of the <a href="https://brookbushinstitute.com/article/gastrocnemius-plantaris" target="_blank" rel="noopener">gastrocnemius</a>, <a href="https://brookbushinstitute.com/article/biceps-femoris" target="_blank" rel="noopener">biceps femoris</a>, and <a href="https://brookbushinstitute.com/article/adductors" target="_blank" rel="noopener">adductors</a> was found to be effective in reducing functional knee valgus (8)<em>. </em> In a study by Hasegawa et al. stretching the <a href="https://brookbushinstitute.com/article/biceps-femoris" target="_blank" rel="noopener">biceps femoris</a> also resulted in a relative increase in <a href="https://brookbushinstitute.com/video/vmo-activation" target="_blank" rel="noopener">vastus medialis activity</a> (15).</p>
<p>Two studies showed an increase in hamstring <a id="extensibility-2" data-tip="1308" target="_blank" href="/glossary-term/extensibility-2" class="glossary">extensibility</a> (<a href="https://brookbushinstitute.com/article/biceps-femoris" target="_blank" rel="noopener">biceps femoris</a>) when foam rolling was done prior to stretching (9, 11). Further, <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> and stretching of the calf complex (<a href="https://brookbushinstitute.com/article/gastrocnemius-plantaris" target="_blank" rel="noopener">gastrocnemius</a>) has been shown to be more effective than stretching alone for increasing range of motion, and potentially rehabilitation from plantar heel pain (12, 13). Although there are no studies specifically investigating the effect of self-administered <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> techniques on the <a href="https://brookbushinstitute.com/article/tensor-fascia-latae-tfl" target="_blank" rel="noopener">TFL</a> or <a href="https://brookbushinstitute.com/article/quadriceps-vastus-muscles" target="_blank" rel="noopener">vastus lateralis</a>, all of the research we are currently aware of shows self-administered <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> is effective for increasing range of motion, without reducing force output (9 - 13), and <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> and stretching is more effective for increasing ROM than either technique alone (11-13).</p>

Research Corner

<ul>
  <li>Tensor Fascia Latae Release: Static Only</li>
  <li>Vastus Lateralis Release: Static --&gt; Dynamic</li>
  <li>Biceps Femoris Release: Static --&gt; Dynamic</li>
  <li>Tensor Fasciae Latae Stretch: Static --&gt; Active --&gt; Dynamic</li>
  <li>Vastus Lateralis: No stretching techniques, presumed to be lengthened during Tensor Fasciae Latae Stretching</li>
  <li>Biceps Femoris: Active --&gt; Dynamic</li>
  <li>Manual Stretch for TFL: Thomas <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">Test</a> Stretch for Hip Flexors</li>
</ul>

Techniques and Progressions

Release Techniques

Tensor Fascia Latae

<p><iframe src="//player.vimeo.com/video/82875363" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p>
<h4>Tensor Fascia Latae (TFL) Self-administered Static Release:</h4>
<ol>
  <li>Explain to your patient/client where their TFL is, and if necessary palpate the TFL so they know where to exert pressure with the <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> tool. I have found the cue, &#x201C;It&apos;s the area just behind your front pocket&#x201D; helpful.</li>
  <li>Instruct your patient/client to assume a side-lying position, with a foam <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">roll</a>, softball, or <a href="https://brookbushinstitute.com/glossary/trigger-point/" target="_blank" rel="noopener">trigger point</a> tool underneath them, just <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a> to their iliac crest.</li>
  <li>Ask them to flex the hip and knee of the top leg, so they may rest that knee on the floor in front of them (this will aid in keeping your patient/client on their anterolateral pelvis and reduce some of the pressure exerted on the TFL)</li>
  <li>Have your patient/client <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">roll</a> <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>, and from the iliac crest to greater trochanter (stay off the greater trochanter), using the <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> tool to scan for <a id="latent-trigger-point" data-tip="1134" target="_blank" href="/glossary-term/latent-trigger-point" class="glossary">tender points</a>.</li>
  <li>When the most tender point is located have your patient hold still on that spot and attempt to relax.</li>
  <li>Wait for the discomfort to subside or for a &#x201C;release&#x201D; (generally 30 &#x2013; 120 seconds).</li>
  <li>Move on to another tender point or the next <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> to be <a id="release" data-tip="1253" target="_blank" href="/glossary-term/release" class="glossary">released</a>.
    <ul>
      <li>Common mistakes:
        <ul>
          <li>The amount of pressure exerted during this technique is significant, so finding the right <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> tool for the individual (i.e. sufficient surface area) is important. Too much pressure will result in guarding and is unlikely to result in any benefit.</li>
        </ul>
      </li>
      <li>Caution:
        <ul>
          <li>Patients/clients will often mistake the greater trochanter for a tender point. If this is not corrected, days and weeks of using this technique may result in inflammation and pain (trochanteric bursitis or contusion).</li>
        </ul>
      </li>
    </ul>
  </li>
</ol>

Tensor Fascia Latae (TFL) Self-administered Static Release

Vastus Lateralis

<p><iframe src="//player.vimeo.com/video/82877509" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p>
<h4>Vastus Lateralis Self-administered Static Release:</h4>
<p>Note: The body position used for this technique is identical to the Tensor Fasciae Latae <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> described above.</p>
<ol>
  <li>Explain to your patient/client where their vastus lateralis is, and if necessary palpate the vastus lateralis so they know where to exert pressure with the <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> tool.</li>
  <li>Instruct your patient/client to assume a side-lying position, with a foam <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">roll</a>, softball, or <a href="https://brookbushinstitute.com/glossary/trigger-point/" target="_blank" rel="noopener">trigger point</a> tool underneath their thigh</li>
  <li>Ask them to flex the hip and knee of the top leg, so they may rest that knee on or foot the floor in front of them (this will aid in reducing some of the pressure exerted on the vastus lateralis)</li>
  <li>Have your patient/client <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">roll</a> <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>, and from the greater trochanter to the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> knee (stay off the greater trochanter), using the <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> tool to scan for <a id="latent-trigger-point" data-tip="1134" target="_blank" href="/glossary-term/latent-trigger-point" class="glossary">tender points</a>.</li>
  <li>When the most tender point is located have your patient hold still on that spot and attempt to relax.</li>
  <li>Wait for the discomfort to subside or for a &#x201C;release&#x201D; (generally 30 &#x2013; 120 seconds).</li>
  <li>Move on to another tender point or the next <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> to be <a id="release" data-tip="1253" target="_blank" href="/glossary-term/release" class="glossary">released</a>.
    <ul>
      <li>Common mistakes:
        <ul>
          <li>The amount of pressure exerted during this technique is significant, so finding the right <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> tool for the individual (i.e. sufficient surface area) is important. Too much pressure will result in guarding and is unlikely to result in any benefit.</li>
        </ul>
      </li>
      <li>Caution:
        <ul>
          <li>Patients/clients will often mistake the greater trochanter for a tender point. If this is not corrected, days and weeks of using this technique may result in inflammation and pain (trochanteric bursitis or contusion).</li>
        </ul>
      </li>
    </ul>
  </li>
</ol>

Vastus Lateralis Self-administered Static Release

<p><iframe src="https://player.vimeo.com/video/138538554" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p>
<h4>Vastus Lateralis Self-administered Dynamic Release:</h4>
<p>Note: Like most dynamic <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> techniques, the body position used for this technique is similar to the static <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> technique described above.</p>
<ol>
  <li>Explain to your patient/client where their vastus lateralis is, and if necessary palpate the vastus lateralis so they know where to exert pressure with the <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> tool.</li>
  <li>Instruct your patient/client to assume a side-lying position, with a foam <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">roll</a> or <a href="https://brookbushinstitute.com/glossary/trigger-point/" target="_blank" rel="noopener">trigger point</a> tool underneath their thigh.</li>
  <li>Ask them to flex the hip and knee of the top leg, so they may rest that knee or foot on the floor in front of them (this will aid in reducing some of the pressure exerted on the vastus lateralis)</li>
  <li>Have your patient/client <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">roll</a> <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>, and from the greater trochanter to the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> knee (stay off the greater trochanter), using the <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> tool to scan for <a id="latent-trigger-point" data-tip="1134" target="_blank" href="/glossary-term/latent-trigger-point" class="glossary">tender points</a>.</li>
  <li>Once, the most tender point is located have your patient move the foam <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">roll</a> just <a id="distal" data-tip="1563" target="_blank" href="/glossary-term/distal" class="glossary">distal</a> to that point, so it abuts the tender point on the <a id="distal" data-tip="1563" target="_blank" href="/glossary-term/distal" class="glossary">distal</a> side.</li>
  <li>Instruct your patient/client to flex their knee, holding for 1 &#x2013; 2 seconds at end range. Perform 10 &#x2013; 15 repetitions.</li>
  <li>Move on to another tender point or the next <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> to be <a id="release" data-tip="1253" target="_blank" href="/glossary-term/release" class="glossary">released</a>.
    <ul>
      <li>Common mistakes:
        <ul>
          <li>Using the wrong size <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> tool - There is no shame in using a soft foam <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">roll</a> when the only result gained from a <a href="https://www.tptherapy.com/product/QuadBaller" target="_blank" rel="noopener">quadballer</a> is guarding. Remember, there is always time to progress.</li>
        </ul>
      </li>
    </ul>
  </li>
</ol>

Vastus Lateralis Self-administered Dynamic Release

Bicep Femoris

<p><iframe src="//player.vimeo.com/video/76677820" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p>
<h4>Biceps Femoris Self-Administered Static Release:</h4>
<ol>
  <li>Explain to your patient/client where their biceps femoris is (outside hamstring from the gluteal fold to knee), and if necessary palpate the biceps femoris so they know where to exert pressure with the <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> tool.</li>
  <li>This <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> is easiest to <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> while sitting on a bench, table, or platform, with the legs &#x201C;hanging&#x201D;.</li>
  <li>Have your client or patient place a softball or similar <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> tool under the &#x201C;mass&#x201D; of the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> thigh.</li>
  <li>Have your patient/client <a id="glide" data-tip="1815" target="_blank" href="/glossary-term/glide" class="glossary">slide</a> back and forth, using the <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> tool to scan the entire biceps femoris for <a id="latent-trigger-point" data-tip="1134" target="_blank" href="/glossary-term/latent-trigger-point" class="glossary">tender points</a> (gluteal fold to knee).</li>
  <li>Once, the most tender point is located have your patient hold still on that spot and relax.
    <ul>
      <li>Generally, you can find the <a href="https://brookbushinstitute.com/glossary/trigger-point/" target="_blank" rel="noopener">trigger point</a> for the long head of the biceps femoris about 1/3 the way from ischium to knee, and the short head just 4 &#x2013; 6 inches <a id="proximal" data-tip="1564" target="_blank" href="/glossary-term/proximal" class="glossary">proximal</a> to the knee.</li>
    </ul>
  </li>
  <li>Wait for the discomfort to subside or for a &#x201C;release&#x201D; (generally 30 &#x2013; 120 seconds).</li>
  <li>Move on to another tender point or the next <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> to be <a id="release" data-tip="1253" target="_blank" href="/glossary-term/release" class="glossary">released</a>.
    <ul>
      <li>Quick Tip:
        <ul>
          <li>Your long head of the biceps femoris is a hip extensor: Your patient or client can reduce or increase <a id="tension" data-tip="1229" target="_blank" href="/glossary-term/tension" class="glossary">tension</a> in the <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> by leaning back or bending forward over the knees (hip flexion and extension). This may aid in providing the <a id="optimal" data-tip="1571" target="_blank" href="/glossary-term/optimal" class="glossary">optimal</a> amount of <a id="tension" data-tip="1229" target="_blank" href="/glossary-term/tension" class="glossary">tension</a> for <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a>.</li>
        </ul>
      </li>
      <li>Common Mistakes:
        <ul>
          <li>Using a foam <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">roll</a> is generally ineffective for the biceps femoris. It is likely that the foal <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">roll</a> is simply too broad and cannot apply enough pressure to a small enough area to be effective.</li>
        </ul>
      </li>
    </ul>
  </li>
</ol>

Biceps Femoris Self-Administered Static Release

<p><iframe src="https://player.vimeo.com/video/153298162" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p>
<h4>Biceps Femoris Self-administered Dynamic Release:</h4>
<p>Note: Like many of the &#x201C;Dynamic <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">Release</a> Techniques&#x201D;, the position is very similar to the &#x201C;Static <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">Release</a> Technique&#x201D;</p>
<ol>
  <li>This <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> is easiest to <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> while sitting on a bench, table, or platform, with the legs &#x201C;hanging&#x201D;.</li>
  <li>Have your client or patient place a softball or similar <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> tool under the &#x201C;mass&#x201D; of the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> thigh (Note: for an active <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a>, smaller objects are not recommended).</li>
  <li>Have your patient/client <a id="glide" data-tip="1815" target="_blank" href="/glossary-term/glide" class="glossary">slide</a> back and forth, using the <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> tool to scan the entire biceps femoris for <a id="latent-trigger-point" data-tip="1134" target="_blank" href="/glossary-term/latent-trigger-point" class="glossary">tender points</a> (gluteal fold to knee).</li>
  <li>Once, the most tender point is located (generally midway between the sacrum and greater trochanter) have your patient move the foam <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">roll</a> just <a id="distal" data-tip="1563" target="_blank" href="/glossary-term/distal" class="glossary">distal</a> to that point, so it abuts the tender point on the <a id="distal" data-tip="1563" target="_blank" href="/glossary-term/distal" class="glossary">distal</a> side.</li>
  <li>Instruct your patient/client to extend their knee, holding for 1 &#x2013; 2 seconds at end range. Perform 10 &#x2013; 15 repetitions.</li>
  <li>Move on to another tender point or the next <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> to be <a id="release" data-tip="1253" target="_blank" href="/glossary-term/release" class="glossary">released</a>.
    <ul>
      <li>Progression:
        <ul>
          <li>Your long head of the biceps femoris is a hip extensor: Your patient or client can reduce or increase <a id="tension" data-tip="1229" target="_blank" href="/glossary-term/tension" class="glossary">tension</a> in the <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> by leaning back or bending forward over the knees (hip flexion and extension). This may aid in providing the <a id="optimal" data-tip="1571" target="_blank" href="/glossary-term/optimal" class="glossary">optimal</a> amount of <a id="tension" data-tip="1229" target="_blank" href="/glossary-term/tension" class="glossary">tension</a> for <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a>.</li>
        </ul>
      </li>
      <li>Common mistakes:
        <ul>
          <li>Using the wrong size <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> tool. A foam <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">roll</a> is too broad and large to apply the targeted pressure needed for biceps femoris release; however, if you use a tool smaller than a softball there will not be sufficient surface area to &#x201C;block&#x201D; the adhesive tissue.</li>
        </ul>
      </li>
    </ul>
  </li>
</ol>

Biceps Femoris Self-administered Dynamic Release

Lateral Gastrocnemius

<p><iframe src="//player.vimeo.com/video/76690427" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p>
<h4>Lateral Gastrocnemius Self-administered Static Release:</h4>
<ol>
  <li>Explain to your patient/client where their <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> gastrocnemius is, and if necessary palpate the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> gastroc so they know where to exert pressure with the <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> tool.</li>
  <li>Instruct your patient/client to assume a long sit position (sitting-up on their glutes with legs outstretched in front of them, propping themselves up with their hands behind them)</li>
  <li>Ask them to place a foam <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">roll</a>, softball, or <a href="https://brookbushinstitute.com/glossary/trigger-point/" target="_blank" rel="noopener">trigger point</a> tool underneath their lower leg, just <a id="distal" data-tip="1563" target="_blank" href="/glossary-term/distal" class="glossary">distal</a> to their knee.</li>
  <li>Have your patient/client <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">roll</a> side-to-side and <a id="distal" data-tip="1563" target="_blank" href="/glossary-term/distal" class="glossary">distal</a> to <a id="proximal" data-tip="1564" target="_blank" href="/glossary-term/proximal" class="glossary">proximal</a> using the <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> tool to scan for <a id="latent-trigger-point" data-tip="1134" target="_blank" href="/glossary-term/latent-trigger-point" class="glossary">tender points</a>. Keep in mind that if your intent is to reduce tibial external rotation you will want to keep your patient/client focused on the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> gastrocnemius, and not <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> that may exist in the soleus or <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> gastrocnemius.</li>
  <li>When the most tender point is located have your patient hold still on that spot and attempt to relax.</li>
  <li>If your patient/client requires more pressure, have them cross the leg not be <a id="release" data-tip="1253" target="_blank" href="/glossary-term/release" class="glossary">released</a> over the target leg.</li>
  <li>Wait for the discomfort to subside or for a &#x201C;release&#x201D; (generally 30 &#x2013; 120 seconds).</li>
  <li>Move on to another tender point or the next <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> to be <a id="release" data-tip="1253" target="_blank" href="/glossary-term/release" class="glossary">released</a>.
    <ul>
      <li>Common mistakes:
        <ul>
          <li>Lifting the butt off the floor using your hands (functional push-up) to increase pressure - Although this may be effective for increasing pressure, it also increases <a id="tension" data-tip="1229" target="_blank" href="/glossary-term/tension" class="glossary">tension</a> and <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity and may reduce the likelihood of achieving a <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a>.</li>
          <li>Using the wrong tool - As less of the body is contributing to the force exerted during this technique, it may be necessary to start with smaller, firmer tools. <a href="https://www.tptherapy.com/product/QuadBaller" target="_blank" rel="noopener">Quadballers</a> and softballs work well.</li>
        </ul>
      </li>
    </ul>
  </li>
</ol>

Lateral Gastrocnemius Self-administered Static Release

<p><iframe src="https://player.vimeo.com/video/148009927" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p>
<h4>Lateral Gastrocnemius Self-administered Active Release:</h4>
<p>Note: Like many of the &#x201C;Dynamic <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">Release</a> Techniques&#x201D;, the position is very similar to the &#x201C;Static <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">Release</a> Technique&#x201D;</p>
<ul>
  <li>Explain to your patient/client where their <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> gastrocnemius is, and if necessary palpate the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> gastroc so they know where to exert pressure with the <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> tool.</li>
  <li>Instruct your patient/client to assume a long sit position (sitting-up on their glutes with legs outstretched in front of them, propping themselves up with their hands behind them)</li>
  <li>Ask them to place a foam <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">roll</a> or <a href="https://brookbushinstitute.com/glossary/trigger-point/" target="_blank" rel="noopener">trigger point</a> tool underneath their lower leg, just <a id="distal" data-tip="1563" target="_blank" href="/glossary-term/distal" class="glossary">distal</a> to their knee.</li>
  <li>Have your patient/client <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">roll</a> side-to-side and <a id="distal" data-tip="1563" target="_blank" href="/glossary-term/distal" class="glossary">distal</a> to <a id="proximal" data-tip="1564" target="_blank" href="/glossary-term/proximal" class="glossary">proximal</a> using the <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> tool to scan for <a id="latent-trigger-point" data-tip="1134" target="_blank" href="/glossary-term/latent-trigger-point" class="glossary">tender points</a>. Keep in mind that if your intent is to reduce tibial external rotation you will want to keep your patient/client focused on the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> gastrocnemius, and not <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> that may exist in the soleus or <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> gastrocnemius.</li>
  <li>Once, the most tender point is located have your patient move the foam <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">roll</a> just <a id="distal" data-tip="1563" target="_blank" href="/glossary-term/distal" class="glossary">distal</a> to that point, so it abuts the tender point on the <a id="distal" data-tip="1563" target="_blank" href="/glossary-term/distal" class="glossary">distal</a> side.</li>
  <li>Instruct your patient/client to dorsiflex, holding for 1 &#x2013; 2 seconds at end range. Perform 10 &#x2013; 15 repetitions.</li>
  <li>Move on to another tender point or the next <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> to be <a id="release" data-tip="1253" target="_blank" href="/glossary-term/release" class="glossary">released</a>.
    <ul>
      <li>Common mistakes:
        <ul>
          <li>A Softball Will Not Work - For this technique to be effective, you need a surface that is broad. Trying to block an adhesion with a softball only results in the adhesion moving around the softball. Using a <a href="https://www.tptherapy.com/product/QuadBaller" target="_blank" rel="noopener">quadballer</a> or <a href="https://www.tptherapy.com/product/NANO_foot_roller" target="_blank" rel="noopener">footroller</a> from TriggerPoint is a much better way of progressing, and increasing pressure.</li>
        </ul>
      </li>
    </ul>
  </li>
</ul>

Lateral Gastrocnemius Self-administered Active Release

Lengthening Techniques

Hip Flexor Complex

<p><iframe src="//player.vimeo.com/video/82860782" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p>
<h4>Kneeling Hip Flexor Self-administered Static Stretch (TFL/VL/ITB Complex):</h4>
<ol>
  <li>Have your patient/client assume a half-kneeling position, with the knee on the side to be stretched directly under the hip. The other leg should be in line with the hip, with the hip and knee flexed to 90&#xB0; (foot directly under the knee).</li>
  <li>Have your patient/client assume an upright <a id="posture" data-tip="1658" target="_blank" href="/glossary-term/posture" class="glossary">posture</a> (normal curvature of the spine, shoulder back and down, head back and chin tucked).</li>
  <li>Cue your patient or client to posteriorly tilt their pelvis (I find the cue &quot;tuck the tail&quot; to be helpful).</li>
  <li>A stretch should be noted with a <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> pelvic tilt alone. This may take some practice but is more effective as a general hip flexor stretch than leaning forward.
    <ul>
      <li>Note: Leaning forward increases the lumbar curve reducing the length of the <a href="https://brookbushinstitute.com/article/psoas" target="_blank" rel="noopener">psoas</a>, which may lead to <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> pelvic tilt reducing the length of the <a href="https://brookbushinstitute.com/article/iliacus" target="_blank" rel="noopener">iliacus</a>&#xA0;and also reduces knee flexion reducing the length of the <a href="https://brookbushinstitute.com/article/rectus-femoris" target="_blank" rel="noopener">rectus femoris</a>.</li>
    </ul>
  </li>
  <li>Hold this stretch and wait for the discomfort to subside or for a &#x201C;release&#x201D; (generally 30 &#x2013; 120 seconds).</li>
  <li>Move deeper into the stretch or move on to the next <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> to be stretched.
    <ul>
      <li>Common Mistakes:
        <ul>
          <li>The most common mistakes are leaning forward and losing the <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> pelvic tilt, essentially trying to stretch around the muscles noted above.</li>
        </ul>
      </li>
      <li>Common Modification:
        <ul>
          <li>The kneeling position can be rough on the knee in contact with the floor. Use airex pads, folded yoga mats, or towels to provide as much comfort as needed.</li>
        </ul>
      </li>
    </ul>
  </li>
</ol>
<h4><strong>Modifications for preferential lengthening of the TFL:</strong></h4>
<ol>
  <li>Have your patient/client start in the upright, half-kneeling position described above.</li>
  <li>Add external rotation of the femur by having your patient/client line up the foot of the leg to be stretched with the opposite foot and hip (shift the back foot medially about 12&quot;).</li>
  <li>Have your patient/client add the <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> pelvic tilt, describe above.</li>
  <li><a id="glide" data-tip="1815" target="_blank" href="/glossary-term/glide" class="glossary">Slide</a> the hips (lean) toward the side to be stretched adding femoral adduction.</li>
  <li>Hold this stretch and wait for the discomfort to subside or for a &#x201C;release&#x201D; (generally 30 &#x2013; 120 seconds).</li>
  <li>Move deeper into the stretch or move on to the next <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> to be stretched.
    <ul>
      <li>Common Mistakes:
        <ul>
          <li>The most common mistakes are leaning forward and losing the <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> pelvic tilt. Do not be afraid to start over, attempting to teach and maintain the <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> pelvic tilt</li>
        </ul>
      </li>
      <li>Common Modification:
        <ul>
          <li>The kneeling position can be rough on the knee in contact with the floor. Use airex pads, folded yoga mats, or towels to provide as much comfort as needed.</li>
        </ul>
      </li>
    </ul>
  </li>
</ol>

Kneeling Hip Flexor Self-administered Static Stretch (TFL/VL/ITB Complex)

<p><iframe src="//player.vimeo.com/video/82846750" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p>
<h4>Active Hip Flexor Stretch (TFL/VL/ITB Complex):</h4>
<p>As with many of the <a id="active-stretching" data-tip="1631" target="_blank" href="/glossary-term/active-stretching" class="glossary">active stretching</a> techniques, the position used is nearly identical to the static stretching technique for the same muscles.</p>
<h4><strong>Kneeling Hip Flexor Stretch:</strong></h4>
<ol>
  <li>Have your patient/client assume a half-kneeling position, with the knee on the side to be stretched directly under the hip. The other leg should be in line with the hip, with the hip and knee flexed to 90&#xB0; (foot directly under the knee).</li>
  <li>Have your patient/client assume an upright <a id="posture" data-tip="1658" target="_blank" href="/glossary-term/posture" class="glossary">posture</a> (normal curvature of the spine, shoulder back and down, head back and chin tucked).</li>
  <li>Cue your patient or client to posteriorly tilt their pelvis (I find the cue &quot;tuck the tail&quot; to be helpful), and squeeze their glute.</li>
  <li>Hold this stretched position and the glute contraction for 2 - 4 seconds and repeat 10 - 15 times.
    <ul>
      <li>Common Mistakes:
        <ul>
          <li>No need to lean forward - A stretch should be noted with a <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> pelvic tilt alone. This may take some practice but is more effective as a general hip flexor stretch than leaning forward. Leaning forward increases the lumbar curve reducing the length of the <a href="https://brookbushinstitute.com/article/psoas" target="_blank" rel="noopener">psoas</a>, may lead to <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> pelvic tilt reducing the length of the <a href="https://brookbushinstitute.com/article/iliacus" target="_blank" rel="noopener">iliacus</a>, and also reduces knee flexion reducing the length of the <a href="https://brookbushinstitute.com/article/rectus-femoris" target="_blank" rel="noopener">rectus femoris</a>.</li>
        </ul>
      </li>
      <li>Common Modification:
        <ul>
          <li>The kneeling position can be rough on the knee in contact with the floor. Use airex pads, folded yoga mats, or towels to provide as much comfort as needed.</li>
        </ul>
      </li>
    </ul>
  </li>
</ol>
<h4><strong>Modifications for preferential lengthening of the TFL:</strong></h4>
<ol>
  <li>Have your patient/client start in the upright, half-kneeling position described above.</li>
  <li>Add external rotation of the femur by having your patient/client line up the foot of the leg to be stretched with the opposite foot and hip (shift the back foot medially about 12&quot;).</li>
  <li><a id="glide" data-tip="1815" target="_blank" href="/glossary-term/glide" class="glossary">Slide</a> the hips (lean) toward the side to be stretched adding femoral adduction.
    <ul>
      <li>Common Mistakes:
        <ul>
          <li>No need to lean forward - A stretch should be noted with a <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> pelvic tilt alone. This may take some practice but is more effective as a general hip flexor stretch than leaning forward. Leaning forward increases the lumbar curve reducing the length of the <a href="https://brookbushinstitute.com/article/psoas" target="_blank" rel="noopener">psoas</a>, may lead to <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> pelvic tilt reducing the length of the <a href="https://brookbushinstitute.com/article/iliacus" target="_blank" rel="noopener">iliacus</a>, and also reduces knee flexion reducing the length of the <a href="https://brookbushinstitute.com/article/rectus-femoris" target="_blank" rel="noopener">rectus femoris</a>.</li>
        </ul>
      </li>
      <li>Common Modification:
        <ul>
          <li>The kneeling position can be rough on the knee in contact with the floor. Use airex pads, folded yoga mats, or towels to provide as much comfort as needed.</li>
        </ul>
      </li>
    </ul>
  </li>
</ol>

Active Hip Flexor Stretch (TFL/VL/ITB Complex)

<p><iframe src="//player.vimeo.com/video/76686148" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p>
<h4>Dynamic Hip Flexor Stretch (Upright Lunge Series):</h4>
<h4><strong>Upright Lunge Series:</strong></h4>
<ol>
  <li>It is helpful to have your patient/client practice the active stretch before attempting this exercise so they are aware of what they are trying to &quot;feel&quot;.</li>
  <li>Have your patient/client assume a half-kneeling position, with the knee on the side to be stretched directly under the hip on a yoga block or similar height object. The other leg should be in line with the hip, with the hip and knee flexed to 90&#xB0; (foot directly under the knee).
    <ul>
      <li>Note: The yoga block creates space between the floor and the knee, and mimicks the &quot;bottom&quot; position of the lunge. We do not want our patients/clients having to bounce their knee off the ground to &quot;feel&quot; the stretch.</li>
    </ul>
  </li>
  <li>Have your patient/client assume an upright <a id="posture" data-tip="1658" target="_blank" href="/glossary-term/posture" class="glossary">posture</a> (normal curvature of the spine, shoulder back and down, head back and chin tucked).</li>
  <li>Cue your patient or client to posteriorly tilt their pelvis (I find the cue &quot;tuck the tail&quot; to be helpful), and squeeze their glute.</li>
  <li>Have your client relax, and then rise from this position into an upright lunge (a staggered stance with back straight), using the glute of the front leg.</li>
  <li>As your patient/client descends back into the bottom position of the lunge they should feel the stretch as they did in the start position.</li>
  <li>Perform 10 &#x2013; 15 repetitions or until an increase in range of motion is noted.</li>
  <li>Increase speed as necessary for their sport, assuming <a id="optimal" data-tip="1571" target="_blank" href="/glossary-term/optimal" class="glossary">optimal</a> <a id="posture" data-tip="1660" target="_blank" href="/glossary-term/posture" class="glossary">form</a> is attained.
    <ul>
      <li>Common Mistakes:
        <ul>
          <li>Inability to achieve or maintain a <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> pelvic tilt - This <a id="exercise-progression" data-tip="1184" target="_blank" href="/glossary-term/exercise-progression" class="glossary">progression</a> is not effective if an <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> pelvic tilt is adopted in the bottom position. It is important to carefully progress individuals after mastering the active hip flexor stretch and not before.</li>
        </ul>
      </li>
      <li>Progressions:
        <ol>
          <li>Static Lunge with Psoas Modification - Same Side Arm Reach (abduction), <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">Lateral</a> Flexion and <a id="ipsilateral" data-tip="1550" target="_blank" href="/glossary-term/ipsilateral" class="glossary">Ipsilateral</a> Trunk Rotation (same side as being stretched)</li>
          <li>Static Lunge with TFL Modification - Trunk Rotation toward the front leg</li>
          <li>Reverse Lunge with Psoas Modification - Same Side Arm Reach (abduction), <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">Lateral</a> Flexion and <a id="ipsilateral" data-tip="1550" target="_blank" href="/glossary-term/ipsilateral" class="glossary">Ipsilateral</a> Trunk Rotation (same side as being stretched)</li>
          <li>Reverse Lunge with TFL Modification - Trunk Rotation toward the front leg</li>
          <li>Walking Lunge with Psoas Modification - Same Side Arm Reach (abduction), <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">Lateral</a> Flexion and <a id="ipsilateral" data-tip="1550" target="_blank" href="/glossary-term/ipsilateral" class="glossary">Ipsilateral</a> Trunk Rotation (same side as being stretched)</li>
          <li>Walking Lunge with TFL Modification - Trunk Rotation toward the front leg</li>
        </ol>
      </li>
    </ul>
  </li>
</ol>

Dynamic Hip Flexor Stretch (Upright Lunge Series)

Biceps Femoris

<p><strong>Note: Why no static biceps femoris stretch?:</strong> Often the biceps femoris is neurologically over-active, but in a lengthened position due to pelvic position (<a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> pelvic tilt). For this reason, we try to increase <a id="extensibility-2" data-tip="1308" target="_blank" href="/glossary-term/extensibility-2" class="glossary">extensibility</a> using <a id="active-stretching" data-tip="1631" target="_blank" href="/glossary-term/active-stretching" class="glossary">active stretching</a> and refrain from static stretching techniques that may promote an adaptive change in length. Further, the position used for stretching the biceps femoris may also stretch the sciatic <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a>. In general, nerves do not tolerate static stretching well, but the protocols used for enhancing neurodynamics resemble the protocol for <a id="active-stretching" data-tip="1631" target="_blank" href="/glossary-term/active-stretching" class="glossary">active stretching</a>.</p>
<p><iframe src="//player.vimeo.com/video/76673642" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p>
<h4>Biceps Femoris <strong>(Self-administered)</strong> Active Stretch:</h4>
<ol>
  <li>Have your patient/client assume a <a id="supine" data-tip="1562" target="_blank" href="/glossary-term/supine" class="glossary">supine</a> position.</li>
  <li>Flex the hip of the leg to be stretched to 90&#xBA;.</li>
  <li>Using the <a id="contralateral" data-tip="1549" target="_blank" href="/glossary-term/contralateral" class="glossary">contralateral</a> hand to wrap over the <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> portion of the thigh and hold the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> and <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> side of the knee (over the biceps femoris tendon).</li>
  <li>Use that hand to maintain hip flexion and pull the hip into slight adduction.</li>
  <li>Instruct your patient/client to extend their knee as if kicking over the <a id="contralateral" data-tip="1549" target="_blank" href="/glossary-term/contralateral" class="glossary">contralateral</a> shoulder. This should bias the stretch toward hip flexion, adduction and internal rotation, and tibial internal rotation.</li>
  <li>Have them hold their end range for 2-4 seconds. Be careful in maintaining hip position.</li>
  <li>Perform 10 &#x2013; 15 repetitions or until an increase in range of motion is noted.
    <ul>
      <li>Common Mistakes:
        <ul>
          <li>Not maintaining hip position &#x2013; be careful that your patient/client does not extend or abduct the hip to fully extend the knee.</li>
          <li>Dorsiflexion &#x2013; Your client/patient should maintain a relaxed ankle; adding dorsiflexion to this stretch will result in a lengthening of the sciatic <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a> which could be problematic.</li>
        </ul>
      </li>
    </ul>
  </li>
</ol>

Biceps Femoris (Self-administered) Active Stretch

<p><iframe src="//player.vimeo.com/video/82853520" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p>
<h4>Dynamic Biceps Femoris Stretch:</h4>
<h4><strong>Modified Single Leg Touchdown</strong></h4>
<ol>
  <li>Have your patient/client assume a position as if they were about to perform a <a href="http://videotree.brookbushinstitute.com/single-leg-deadlift-touchdown/" target="_blank" rel="noopener">single leg touchdown</a>.</li>
  <li>To reduce the <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a> component of this exercise so that focus may be placed on <a id="extensibility-2" data-tip="1308" target="_blank" href="/glossary-term/extensibility-2" class="glossary">extensibility</a>, have your patient/client place the <a id="contralateral" data-tip="1549" target="_blank" href="/glossary-term/contralateral" class="glossary">contralateral</a> ball of their foot on the floor, slightly behind them.</li>
  <li>Keeping a soft, but nearly fully extended knee on the side to be stretched, use the <a id="contralateral" data-tip="1549" target="_blank" href="/glossary-term/contralateral" class="glossary">contralateral</a> hand reach toward the toe. (Using the <a id="contralateral" data-tip="1549" target="_blank" href="/glossary-term/contralateral" class="glossary">contralateral</a> hand promotes adduction and internal rotation at the hip)</li>
  <li>Descend as far as necessary (via hip flexion with a neutral lumbar spine) to feel a moderate stretch.</li>
  <li>Instruct your patient, to &#x201C;thrust&#x201D; the hips forward and &#x201C;squeeze the glutes&#x201D; to return to an upright position.</li>
  <li>Perform 10 &#x2013; 15 repetitions or until an increase in range of motion is noted.</li>
  <li>Increase speed as necessary for their sport, assuming <a id="optimal" data-tip="1571" target="_blank" href="/glossary-term/optimal" class="glossary">optimal</a> <a id="posture" data-tip="1660" target="_blank" href="/glossary-term/posture" class="glossary">form</a> is attained.
    <ul>
      <li>Alternatives:
        <ul>
          <li>Using <a id="a-band" data-tip="1347" target="_blank" href="/glossary-term/a-band" class="glossary">a band</a> around the hips to create 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 may aid in teaching a hip <a href="https://brookbushinstitute.com/glossary/hinge/" target="_blank" rel="noopener">hinge</a>.</li>
        </ul>
      </li>
      <li>Common Mistakes:
        <ul>
          <li>Locking the knee: Locking the knee imposes stress on ligaments that may lead to pain and/or adaptive lengthening and <a id="stability" data-tip="1193" target="_blank" href="/glossary-term/stability" class="glossary">instability</a> overtime.</li>
          <li>Rounding the back: Just as you would not allow a rounded spine during a <a href="http://videotree.brookbushinstitute.com/deadlift-progressions-cueing-and-questionable-variations/" target="_blank" rel="noopener">deadlift</a>, allowing an individual to reinforce this pattern during stretching is not recommended.</li>
        </ul>
      </li>
    </ul>
  </li>
</ol>

Dynamic Biceps Femoris Stretch

Gastrocnemius

<p><iframe src="https://player.vimeo.com/video/82848760" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p>
<h4>Lateral Gastrocnemius Self-Administered Static Stretch:</h4>
<h4><strong>Wall Stretch</strong></h4>
<ol>
  <li>Have your patient/client assume a position with arms outstretched and hands on a wall or solid object in front of them.</li>
  <li>Have your patient/client take a small step back and out (hip extension and abduction) with the side they wish to stretch.</li>
  <li>Have them turn that foot inward so that the 5th metatarsal is pointing straight ahead.</li>
  <li>Have your patient/client squeeze their glute (extend their hip), squeeze their quad (extend their knee), and drive their heel into the floor (dorsiflex).
    <ul>
      <li>Note: The combination of turning the foot in and leaning away (tibia on foot inversion), with external rotation of the lower extremity (locking the knee and squeezing the glute), results in inversion of the ankle. This preferentially lengthens the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> gastrocnemius, fibularis muscles and <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> fibers of the <a href="https://brookbushinstitute.com/courses/soleus" target="_blank" rel="noopener">soleus</a>. Further, it reduces the likelihood that pronation and eversion will be reinforced during the stretch.</li>
    </ul>
  </li>
  <li>Have them lean forward and slightly away from the foot being stretched with their entire body until a stretch is felt. This often results in the patient/client assuming a position with elbows against the wall, like an upright plank. It may take a couple of attempts before the ideal distance from the wall is found. Note: If the patient/client only moves their hips this is likely to become a hip flexor stretch before the calf is sufficiently lengthened.</li>
  <li>Hold this stretch and wait for the discomfort to subside or for a &#x201C;release&#x201D; (generally 30 &#x2013; 120 seconds).</li>
  <li>Move deeper into the stretch or move on to the next <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> to be stretched.
    <ul>
      <li>Common Mistakes:
        <ul>
          <li>Pay careful attention to the position of the foot on the side being stretched. Often, the patient/client will start to turn the foot out and pronate as they lean into the wall.</li>
          <li>Do not allow the heel to rise off the floor. Trying to stretch the calf with the heel off the floor, not only reduces dorsiflexion but increases activity in the calf complex reducing the likelihood of getting a <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a>.</li>
        </ul>
      </li>
      <li>Common Sign implying a Need for Mobilization:
        <ul>
          <li>Patients/clients may complain that they cannot feel the stretch no matter how hard they try, or that this stretch results in a &quot;pinchy&quot; feeling in the front of the ankle. Clinically, this has been a strong indicator that <a href="https://brookbushinstitute.com/video/self-administered-ankle-mobilization" target="_blank" rel="noopener">ankle mobilization</a> may be beneficial prior to stretching</li>
        </ul>
      </li>
    </ul>
  </li>
</ol>

Lateral Gastrocnemius Self-Administered Static Stretch

<p><iframe src="https://player.vimeo.com/video/82873997" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p>
<h4>Lateral Gastrocnemius Slant Board Stretch (So Much Easier to Teach!):</h4>
<ol>
  <li>Have your patient/client place a slant board, flat side up half foam <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">roll</a>, or <a href="http://www.optp.com/Slant?cat_id=209#.VyuAXb7krQg" target="_blank" rel="noopener">OPTP slants</a> in front of a machine, railing or doorway that they can hold to keep from falling backward.</li>
  <li>Have your patient/client place both feet on the slant, with their feet turned inward so that their 5th metatarsal points straight ahead with a slightly wider than hip-width stance.</li>
  <li>Instruct your patient to hold onto the object in front of them and allow their heels to sink into the slant or floor. (Ensure that your patient or client keeps their heels firmly planted on the slant or slightly behind the slant on the ground through the duration of the stretch). This may require your patient/client to lean back a bit.</li>
  <li>Have your patient/client squeeze their glutes (extend their hip), squeeze their quads (extend their knee), and drive their heels into the floor (dorsiflex).
    <ul>
      <li>Note: The combination of turning the foot in and leaning away (tibia on foot inversion), with external rotation of the lower extremity (locking the knee and squeezing the glute), results in inversion of the ankle. This preferentially lengthens the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> <a href="https://brookbushinstitute.com/article/gastrocnemius-plantaris" target="_blank" rel="noopener">gastrocnemius</a>, <a href="https://brookbushinstitute.com/article/fibularis-muscles" target="_blank" rel="noopener">fibularis muscles</a>, and <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> fibers of the <a href="https://brookbushinstitute.com/article/soleus" target="_blank" rel="noopener">soleus</a>. Further, it reduces the likelihood that pronation and eversion will be reinforced during the stretch.</li>
    </ul>
  </li>
  <li>Your patient/client can lean forward if the above steps are not sufficient to feel mild discomfort.</li>
  <li>Hold this stretch and wait for the discomfort to subside or for a &#x201C;release&#x201D; (generally 30 &#x2013; 120 seconds).</li>
  <li>Move deeper into the stretch or move on to the next <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> to be stretched.
    <ul>
      <li>Common Mistakes:
        <ul>
          <li>Pay careful attention to the position of the feet. Often, the patient/client will start to turn the feet out and pronate as they lean into the wall.</li>
          <li>Do not allow the heel to rise off the floor. Trying to stretch the calf with the heel off the floor, not only reduces dorsiflexion but increases activity in the calf complex reducing the likelihood of getting a <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a>.</li>
        </ul>
      </li>
      <li>Common Sign implying a Need for Mobilization:
        <ul>
          <li>Patients/clients may complain that they cannot feel the stretch no matter how hard they try, or that this stretch results in a &quot;pinchy&quot; feeling in the front of the ankle. Clinically, this has been a strong indicator that <a href="https://brookbushinstitute.com/video/self-administered-ankle-mobilization" target="_blank" rel="noopener">ankle mobilization</a> may be beneficial prior to stretching.</li>
        </ul>
      </li>
    </ul>
  </li>
</ol>

Lateral Gastrocnemius Slant Board Stretch

<p><iframe src="//player.vimeo.com/video/76673901" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p>
<h4>Lateral Gastroc Active Stretch:</h4>
<p>As with many of the <a id="active-stretching" data-tip="1631" target="_blank" href="/glossary-term/active-stretching" class="glossary">active stretching</a> techniques, the position used is nearly identical to the static stretching technique for the same muscles.</p>
<ol>
  <li>Have your patient/client place a slant board set relatively low or an OPTP slant in front of a machine, railing, or doorway that they can hold to keep from falling backward.</li>
  <li>Have your patient/client place one foot on the slant, with their feet turned inward so that their 5th metatarsal points straight ahead.</li>
  <li>Instruct your patient to hold onto the object in front of them and allow their heels to sink into the slant or floor. (Ensure that your patient or client keeps their heels firmly planted on the slant or slightly behind the slant on the ground through the duration of the stretch).</li>
  <li>Have your patient/client bring the opposite knee to hip height.</li>
  <li>Have your patient/client squeeze their glutes (extend their hip), squeeze their quads (extend their knee), and drive their heels into the floor (dorsiflex), while trying to reach forward several inches with the raised knee. (Having a target distance, with a physical cue like your hand is helpful). We are using this forward motion to stimulate dorsiflexion and active stretch.</li>
  <li>Have them hold their end range for 2-4 seconds.</li>
  <li>Perform 10 &#x2013; 15 repetitions or until an increase in range of motion is noted.
    <ul>
      <li>Common Mistakes:
        <ul>
          <li>Pay careful attention to the position of the feet. Often, the patient/client will start to turn the feet out and pronate as they lean into the wall.</li>
          <li>Do not allow the heel to rise off the floor. Trying to stretch the calf with the heel off the floor, not only reduces dorsiflexion but increases activity in the calf complex reducing the likelihood of increasing <a id="extensibility-2" data-tip="1308" target="_blank" href="/glossary-term/extensibility-2" class="glossary">extensibility</a>.</li>
        </ul>
      </li>
      <li>Common Sign implying a Need for Mobilization:
        <ul>
          <li>Patients/clients may complain that they cannot feel the stretch no matter how hard they try, or that this stretch results in a &quot;pinchy&quot; feeling in the front of the ankle. Clinically, this has been a strong indicator that <a href="https://brookbushinstitute.com/video/self-administered-ankle-mobilization" target="_blank" rel="noopener">ankle mobilization</a> may be beneficial prior to stretching.</li>
        </ul>
      </li>
    </ul>
  </li>
</ol>

Lateral Gastroc Active Stretch

<p><iframe src="//player.vimeo.com/video/76685462" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p>
<h4>Dynamic Calve Stretch:</h4>
<p>This stretch uses the same mechanics as the &quot;Wall Stretch&quot;. Teaching the wall stretch first may be an effective means of introducing this exercise</p>
<ol>
  <li>Place <a id="a-band" data-tip="1347" target="_blank" href="/glossary-term/a-band" class="glossary">a band</a> around your patient/client&apos;s <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> iliac spine (ASIS) so that it creates 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>Have your patient/client take a small step forward and out, leaving the leg to be stretched behind.</li>
  <li>IMPORTANT: Your patient/client should take that step driving forward and out with the back leg - this is accomplished by squeezing their glute (extend their hip), squeezing their quad (extend their knee), and driving their heel into the floor (dorsiflex) against the band.
    <ul>
      <li>Note: The combination of stepping out (tibia on foot inversion), with external rotation of the lower extremity (locking the knee and squeezing the glute), results in inversion of the ankle. This preferentially lengthens the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> gastrocnemius, fibularis muscles, and <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> fibers of the <a href="https://brookbushinstitute.com/courses/soleus" target="_blank" rel="noopener">soleus</a>. Further, it reduces the likelihood that pronation and eversion will be reinforced during the stretch.</li>
    </ul>
  </li>
  <li>Return to the starting position. Your patient/client may need to adjust how far they step to induce a stretch.</li>
  <li>Perform 10 &#x2013; 15 repetitions or until an increase in range of motion is noted.</li>
  <li>Increase speed as necessary for their sport, assuming <a id="optimal" data-tip="1571" target="_blank" href="/glossary-term/optimal" class="glossary">optimal</a> <a id="posture" data-tip="1660" target="_blank" href="/glossary-term/posture" class="glossary">form</a> is attained.
    <ul>
      <li>Common Mistakes:
        <ul>
          <li>Pay careful attention to the position of the foot on the side being stretched. Often, the patient/client will start to turn the foot out and pronate.</li>
          <li>Do not allow the heel of the back foot to rise off the floor. Trying to stretch the calf with the heel off the floor, not only reduces dorsiflexion but increases activity in the calf complex reducing the likelihood of getting an increase in <a id="extensibility-2" data-tip="1308" target="_blank" href="/glossary-term/extensibility-2" class="glossary">extensibility</a>.</li>
        </ul>
      </li>
      <li>Common Sign implying a Need for Mobilization:
        <ul>
          <li>Patients/clients may complain that they cannot feel the stretch no matter how hard they try, or that this stretch results in a &quot;pinchy&quot; feeling in the front of the ankle. Clinically, this has been a strong indicator that <a href="https://brookbushinstitute.com/video/self-administered-ankle-mobilization" target="_blank" rel="noopener">ankle mobilization</a> may be beneficial prior to stretching.</li>
        </ul>
      </li>
    </ul>
  </li>
</ol>

Dynamic Calve Stretch

Additional Stretching Techniques

<p><iframe src="https://player.vimeo.com/video/82864269" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p>
<h4>Manual Hip Flexor Stretch/Thomas Test Position (Pectineus and Adductor Stretch):</h4>
<ol>
  <li>Have your client assume a position at the bottom of the table with their legs completely hanging off, but the sacrum supported by the table.</li>
  <li>It is easiest to achieve this position by having your patient stand up, walk to the bottom end of the table, sit their sacrum on the edge of the table, pull the knee opposite the side you wish to stretch to their chest, and then gently assist them rolling back onto their back.</li>
  <li>You will position yourself in front of the flexed leg with the hanging leg against your hip/thigh. You may use your chest to block the flexed leg so that your patient may relax. You can use the flexed leg to control the amount of pelvic tilt and or adjust the pelvic alignment in the frontal plane.</li>
  <li>Using your palm or webspace of the hand closest to the hanging leg; gently press the leg down into extension until you reach the first resistance barrier.</li>
  <li>You can then use your hand or hip to gently take up any &#x201C;slack&#x201D; into adduction and preferentially stretch the tensor fasciae latae</li>
  <li>Hold this position for 30-120 seconds or until a reduction in tension/release is felt.</li>
  <li>Move deeper into the stretch, or move on to the next <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> in your corrective intervention.
    <ul>
      <li>Common Mistakes:
        <ul>
          <li>More is not better: A mild sensation of stretch is plenty. Increasing <a id="tension" data-tip="1229" target="_blank" href="/glossary-term/tension" class="glossary">tension</a> to a point of moderate discomfort or pain will only result in <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> guarding, an increased risk of injury, and/or a less effective stretch.</li>
        </ul>
      </li>
    </ul>
  </li>
</ol>

Manual Hip Flexor Stretch/Thomas Test Position (Pectineus and Adductor Stretch)

<p><iframe src="https://player.vimeo.com/video/82863991" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p>
<h4>Manual Gastrocnemius and Soleus Stretch:</h4>
<ol>
  <li>Ask your patient/client to assume a <a id="prone" data-tip="1561" target="_blank" href="/glossary-term/prone" class="glossary">prone</a> position on the table with feet and heels hanging of the edge.</li>
  <li>Approach their ankle from the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> side.</li>
  <li>Reach over the foot with the hand closer to the plantar surface of their foot, and wrap your fingers over their heel with the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> surface in the palm of your hand.</li>
  <li>Place the webspace of your other hand in the angle of the ankle over the talar neck.</li>
  <li>Apply gentle downward pressure on the talus and upward pressure on the calcaneus as you brace the bottom of the foot with your forearm.</li>
  <li>This should put you in a position to tilt the talus, calcaneus, and foot in one unit into dorsiflexion as you lean toward the patient/client&apos;s head.</li>
  <li>Lean until you reach the first resistance barrier.</li>
  <li>Hold this position for 30-120 seconds or until a reduction in tension/release is felt.</li>
  <li>Move deeper into the stretch, or move on to the next <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> in your corrective intervention.
    <ul>
      <li>Common Mistakes:
        <ul>
          <li>More is not better: A mild sensation of stretch is plenty. Increasing <a id="tension" data-tip="1229" target="_blank" href="/glossary-term/tension" class="glossary">tension</a> to a point of moderate discomfort or pain will only result in <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> guarding, an increased risk of injury, and/or a less effective stretch.</li>
          <li>Use your body weight and not your arms - If you try to over-power the very strong and dense calf complex with your arm strength you will tire quickly. If you keep your arms locked, and you use your bodyweight you should be able to easily hold the end position.</li>
        </ul>
      </li>
    </ul>
  </li>
</ol>

Manual Gastrocnemius and Soleus Stretch

<p><iframe src="//player.vimeo.com/video/82862160" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p>
<h4>Dynamic Stretching Series for Lower Leg Dysfunction (TFL, Biceps Femoris, and Calves)</h4>
<p>The sample circuit includes dynamic stretches for commonly over-active muscles in those exhibiting <a href="https://brookbushinstitute.com/article/lower-leg-dysfunction" target="_blank" rel="noopener">Lower Leg Dysfunction (LLD)</a>. This includes the dynamic stretch for the biceps femoris discussed above.</p>

Dynamic Stretching Series for Lower Leg Dysfunction (TFL, Biceps Femoris, and Calves)

<p>Perform each technique with <a id="accuracy" data-tip="1218" target="_blank" href="/glossary-term/accuracy" class="glossary">accuracy</a> (ex. hold until <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> for static techniques, 10-15 repetitions for active techniques at a 2:2:2 count, etc.). Progress the flexibility routine as <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> are reduced, techniques are mastered, and <a id="optimal" data-tip="1571" target="_blank" href="/glossary-term/optimal" class="glossary">optimal</a> flexibility is attained (generally over the course of weeks). This can be accomplished by adding additional <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> techniques, and/or replacing static stretches with active and eventually dynamic stretches.</p>
<ol>
  <li><a href="http://videotree.brookbushinstitute.com/tfl-sa-static-release/" target="_blank" rel="noopener">TFL Static Release</a> (progress to TFL &amp; <a href="http://videotree.brookbushinstitute.com/vastus-lateralis-sa-static-release/" target="_blank" rel="noopener">VL</a>)</li>
  <li><a href="http://videotree.brookbushinstitute.com/biceps-femoris-sa-static-release/" target="_blank" rel="noopener">Biceps Femoris Static Release</a> (progress to <a href="http://videotree.brookbushinstitute.com/biceps-femoris-self-administered-dynamic-release-a-k-a-pin-stretch/" target="_blank" rel="noopener">dynamic release</a>)</li>
  <li><a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">Lateral</a> Gastroc Static <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">Release</a> (progress to <a href="http://videotree.brookbushinstitute.com/gastrocnemius-and-soleus-self-administered-dynamic-release-a-k-a-pin-stretch/" target="_blank" rel="noopener">dynamic release</a>)</li>
  <li><a href="http://videotree.brookbushinstitute.com/hip-mobilization/" target="_blank" rel="noopener">Hip Mobilization</a></li>
  <li><a href="https://brookbushinstitute.com/video/self-administered-ankle-mobilization" target="_blank" rel="noopener">Ankle Mobilization</a></li>
  <li><a href="http://videotree.brookbushinstitute.com/kneeling-hip-flexor-static-stretch/" target="_blank" rel="noopener">Static Hip Flexor Stretch</a> (Progress to <a href="http://videotree.brookbushinstitute.com/active-hip-flexor-stretch/" target="_blank" rel="noopener">Active Stretch</a> and then <a href="http://videotree.brookbushinstitute.com/dynamic-hip-flexor-stretch-upright-lunge-series/" target="_blank" rel="noopener">Dynamic Stretch</a>)</li>
  <li><a href="http://videotree.brookbushinstitute.com/slant-board-calf-stretch/" target="_blank" rel="noopener">Static Calve Stretch</a> (Progress to <a href="http://videotree.brookbushinstitute.com/active-calf-stretch-with-modifications-for-fibularis-peroneal-extensibility/" target="_blank" rel="noopener">Active Stretch</a> and then <a href="http://videotree.brookbushinstitute.com/dynamic-calf-stretch-gastrocnemius-soleus-peroneals/" target="_blank" rel="noopener">Dynamic Stretch</a>)</li>
  <li><a href="http://videotree.brookbushinstitute.com/biceps-femoris-active-stretch/" target="_blank" rel="noopener">Active Biceps Femoris Stretch</a> (Progress to <a href="http://videotree.brookbushinstitute.com/dynamic-biceps-femoris-lateral-hamstring-stretch/" target="_blank" rel="noopener">Dynamic Stretch</a>)
    <ul>
      <li>Activate and <a id="integration" data-tip="1476" target="_blank" href="/glossary-term/integration" class="glossary">Integrate</a> Under-active Structures specifically the <a href="http://videotree.brookbushinstitute.com/quick-glute-activation-circuit/" target="_blank" rel="noopener">Glute Complex</a> and the <a href="//player.vimeo.com/external/82876534.hd.mp4?s=38f1eca0dad0acaa3e79e38ed654a4e4" target="_blank" rel="noopener">Tibial Internal Rotator Activation</a></li>
    </ul>
  </li>
</ol>

Sample Mobility Program and Progressions

<ol>
  <li>Phillip Page, Clare Frank, Robert Lardner, <em>Assessment and Treatment of Muscle Imbalance: The Janda Approach</em> &copy; 2010 Benchmark Physical Therapy, Inc., Clare C. Frank, and Robert Lardner</li>
  <li>Dr. Mike Clark &amp; Scott Lucette, &ldquo;<em>NASM Essentials of Corrective Exercise Training</em>&rdquo; &copy; 2011 Lippincott Williams &amp; Wilkins</li>
  <li>Leon Chaitow, <em>Muscle Energy Techniques: Third Edition</em>, &copy; Pearson Professional Limited 2007</li>
  <li>Shirley A Sahrmann, <em>Diagnoses and Treatment of Movement Impairment Syndromes,</em> &copy; 2002 Mosby Inc.</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>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. <em>Journal Of Strength And Conditioning Research / National Strength &amp; Conditioning Association</em>, <em>27</em>(7), 1813-1823.</li>
  <li>Padua, D. A., Bell, D. R., &amp; Clark, M. A. (2012). Neuromuscular characteristics of individuals displaying excessive medial knee displacement. <em>Journal of athletic training</em>, <em>47</em>(5), 525.</li>
  <li>Bell, D. R., Oates, D. C., Clark, M. A., &amp; Padua, D. A. (2013). Two-and 3-dimensional knee valgus are reduced after an exercise intervention in young adults with demonstrable valgus during squatting. <em>Journal of athletic training</em>,<em>48</em>(4), 442-449.</li>
  <li>Sullivan, K.M., Silvey, D.B.J., Button, D.C., Behm, D.G. (2013). Roller-massager application to the hamstrings increases sit-and-reach range of motion within five to ten seconds without performance impairments. <em>International Journal of Sports Physical Therapy</em> 8(3) 228-236.</li>
  <li>Halperin, I., Aboodarda, S.J., Button, D.C., Andersen, L.L., Behm, D.G. (2014). Roller massager improves range of motion of plantar flexor muscles without subsequent decreases in force parameters. <em>The International Journal of Sports Physical Therapy. 9(1):</em> 92 -102</li>
  <li>Mohr, A. R., Long, B. C., &amp; Goad, C. L. (forthcoming 2014). Foam Rolling and Static Stretching on Passive Hip Flexion Range of Motion. <em>Journal of sport rehabilitation</em>. Currently in press.</li>
  <li>Skarabot, J., Beardsley, B., Stim, I. (2015). Comparing the effects of self-myofascial release with static stretching on ankle range of motion in adolescent athletes. <em>International Journal of Sports Phyiscal Therapy.</em> 10(2): 203-212</li>
  <li>Renan-Ordine, R., Alburquerque-Sedin, F., De Souza, E.P.R., Cleland, J.A., Fernandez-De-La-Penas, C. (2011) Effectiveness of myofascial trigger point manual therapy combined with a self-stretching protocol for the management of plantar heel pain: A randomized controlled trial. Journal of Orthopaedic &amp; Sports Medicine</li>
  <li>Tateuchi, H., Taniguchi, M., Mori, N., Ichihashi, N. Balance of hip and trunk muscle activity is associated with increased anterior pelvic tilt during prone hip extension (2013) <em>Journal of Electromyography and Kinesiology</em> 22 (3). 391-397</li>
  <li>Hasegawa, K. T., Hori, S., Tsujita, J., &amp; Dawson, M. L. (2001). Effects of Stretching Exercises on Vastus Medialis and Vastus Lateralis.Medicine &amp; Science in Sports &amp; Exercise, 33(5), S10.</li>
</ol>

Bibliography

<p>© 2016 Brent Brookbush</p>
<p>Questions, comments, and criticisms are welcomed and encouraged</p>

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>

<strong>Accuracy</strong> - 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.

<strong>Adenosine triphosphatase (ATPase):</strong> 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>

<b>Adenosine triphosphate (ATP): </b>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>

<strong>Algometry</strong> - 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>

<span class="_Tgc"><b>All-or-none</b> <b>principle</b> - 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.</span>

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 <em>anterior</em> aspect of the head

<strong>Appendicular Skeleton</strong> - 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.

<strong>Arthrokinematic Motion</strong> - 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;

<strong>Assessment</strong><em> -</em> 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><strong>"Clear" the Patient/Client for Intervention</strong> - 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 <em>Calf Squeeze (Thompson) Test</em> 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><strong>Highlight Contraindications - </strong>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><strong>Refine Exercise/Intervention Selection</strong>: 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 <em>Refine Exercise/Intervention Selection</em>, 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 <em>Clearance</em> to resume rehab activities.  Further, that same patient may return to the human movement professional with a list of <em>Contraindicated Activities</em> from the physician. - <em>"When in doubt, refer out!"</em>

<strong>Axial Skeleton</strong> - 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 <span class="foreign">axis</span> "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>".

<strong>Balance</strong> - 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)

<strong>Base of support (BoS)</strong> - 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.

<strong>Case-control Study</strong> - 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. <i>American journal of epidemiology</i>, <i>134</i>(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<em> caudally</em>.

<strong>Center of mass (CoM)</strong> - an object's mean position of mass; that is, a point that is perfectly surrounded by an equal amount mass in all directions.

<b>Center of gravity (CoG)</b> - point where <b>gravity</b> 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 <em>cephalad</em>.

<strong>Cohort Study</strong> - 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>

<strong>Comparable Sign:</strong> 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.

<strong>Concave (Concavity)</strong> - 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>

<strong>Concordant Sign</strong> - The patient's specific pain, symptom or complaint.<span style="color: #ff0000;"> </span>
<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>

<strong>Conductivity</strong>: 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>

<strong>Contractility: </strong>The ability to shorten (1).
<ul>
 	<li><strong>Contractility</strong>: 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.

<strong>Convex (Convexity)</strong> - 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>

<strong>Correlational Research</strong> - 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. <em>J. Phys. Ther. Sci. </em>26: 961-964</a></li>
</ol>

<strong>Counter-nutation</strong> - 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;

<strong>Crossover (Study) Design</strong> - 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. <em>Journal of Human Kinetics, 58, 197-206.</em> </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) <em>Journal of Medical Science</em> 5(1). 52-54</a></li>
</ol>

<strong>Cytokine</strong> - 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. <em> Journal of Manual &amp; Manipulative Therapy</em>. 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 <em>distal</em> end of the leg.

An arthrokinematic motion - a <span class="_Tgc">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.</span>

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 <em>dorsal</em> 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<span class="_Tgc"> alteration of normal kinematics.</span>

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.

<strong>Elasticity</strong>: 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). <i>Anatomy &amp; physiology</i>. New York (NY): WCB/McGraw-Hill.</li>
</ol>

<strong>Equilibrium</strong> - 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"><strong>Evidence-based medicine (practice)</strong> 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. <i>Bmj</i>, <i>312</i>(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>

<strong>Excitability:</strong> The ability of a cell to <span class="hvr">change</span> in <span class="hvr">membrane</span> <span class="hvr">conductance</span> as a <span class="hvr">response</span> to <span class="hvr">stimulation.
</span>
<ul>
 	<li><span class="hvr">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.
</span></li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

<strong>Excitation threshold:</strong> 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>

<strong>Exercise Progression</strong> - 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>

<strong>Exercise regression</strong> - 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>

<strong>Experimental Research</strong> - 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. <em>Journal of Strength and Conditioning Research, 27</em>(11), 2997-3000.</a></li>
</ol>
&nbsp;

<strong>Extensibility</strong>: 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>

<strong>False Negative </strong>- 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>

<strong>False Positive </strong>- 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.

<strong>Fibromyalgia</strong> - A loosely defined diagnosis that is associated with a combination of widespread pain <i>in combination with</i> 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. <i>Fibromyalgia Syndrome and Widespread Pain: From Construction to Relevant Recognition</i>.</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. <i>Arthritis &amp; Rheumatism: Official Journal of the American College of Rheumatology</i>, <i>33</i>(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. <i>The Clinical journal of pain</i>, <i>27</i>(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. <i>PAIN®</i>, <i>145</i>(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. <i>Spine</i>, <i>20</i>(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. <i>Spine</i>, <i>20</i>(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>

<strong>H-Band</strong> - 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) (<em>biological holism</em>) - (from Greek <i>holos</i> "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]. <em class="EmphasisTypeItalic ">Holism and evolution</em>. 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.

<strong>Hormone: </strong>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. <i>Scandinavian journal of clinical and laboratory investigation</i>, <i>60</i>(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.

<strong>Hyperplasia</strong> 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.

<strong>Muscular hypertrophy</strong> 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.

<strong>I-Band</strong> - 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. <em>International Journal of Health and Rehabilitation Sciences</em>. 2(4): 186-191</a></li>
</ol>

An anatomical direction; toward the bottom (below)

Example, the mouth is <em>inferior</em> 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.

<strong>Intermuscular Coordination</strong> - Optimal timing and motor unit recruitment of agonists, antagonists, synergists, neutralizers, stabilizers and fixators.

<strong>Example: Role of Muscles during Hip Extension</strong>
<ul>
 	<li><strong><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>:</strong>  <a href="https://player.vimeo.com/external/82855344.hd.mp4?s=54c3e7d98fb9d4e0af8d282c85ba9b3e">Gluteus maximus</a></li>
 	<li><strong><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>:</strong> <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><strong><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>:</strong> <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><strong><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>:</strong> <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><strong><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>:</strong> <a href="https://brentbrookbush.com/articles/muscular-anatomy/deep-rotators-of-the-hip/">Deep rotators of hip</a></li>
 	<li><strong><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>: </strong><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 <strong>isoform</strong>, or variant, is a member of a set of similar proteins, that originate from the same gene, or gene family.<sup id="cite_ref-2" class="reference"></sup>
<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 <em>kinetic chain</em>, 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).

<strong>Latent Trigger Point</strong> - 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, <em>Travell &amp; Simmons’ Myofascial Pain and Dysfunction, The Trigger Point Manual, Volume 1. Upper Half of Body: Second Edition</em>,© 1999 Williams and Wilkens</li>
</ol>

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

<strong>Length/Tension Relationship</strong> - 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. <i>The Journal of physiology</i>, <i>184</i>(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. <i>The Journal of Physiology</i>, <i>183</i>(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. <i>Journal of neurophysiology</i>, <i>71</i>(3), 874-881.</li>
 	<li>Lieber, R. L. (2002). <i>Skeletal muscle structure, function, and plasticity</i>. Lippincott Williams &amp; Wilkins.</li>
</ol>
&nbsp;

<span class="_Tgc"><strong>Levels of Evidence</strong> - 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.
</span>

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. <i>Western Journal of Medicine</i>, <i>170</i>(6), 348.</li>
</ol>

<strong>Likelihood Ratios</strong> - 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><strong>Positive Likelihood Ratio (LR+)</strong> - The ratio of a positive test result in people with the pathology to a positive test result in people without the pathology.</li>
 	<li><strong>Negative Likelihood Ratio (LR-)</strong> - 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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