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Plantar Flexor: Release and Lengthening Audio

Knowing ankle plantar flexion release and lengthening techniques can reduce ankle pain, Achille’s tendinitis, plantar fasciitis, etc., and improve fitness performance.

Plantar Flexor: Release and Lengthening

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I have almost completed my CPT certification and am half-way through the Human Movement certification to inform my massage practice. The different modalities of reading, watching audiovisual materials, and attending live or recorded webinars have been important to my learning style and for review.

Brookbush Institute has the most detailed, specific and effective tools for online learning for movement and/or bodywork professionals. I love the combination of the videos as well as the text available online.

I recently completed the CPT course. It was demanding yet practical. I would highly recommend it for anyone wanting an education about human movement.

I have my personal trainer certificate through here and am almost finished my human movement specialist certification. Overall, the education that Brookbush has packaged together for clinicians and trainers is invaluable. I am a physio assistant so coming from more of a rehab background I appreciate that this education has been beneficial both as a trainer and in a rehab setting. I love that I have been able to do all learning at my own pace and able to work around my schedule. Thank you for setting up this platform! Highly recommend :)

I have been a massage therapist for 10 yrs and I feel like all the “pieces” I’ve learned throughout the yrs have been put into place and can see the full picture. I am also a member to tons of great content since I love to learn! I plan to get my CPT through them as well.

I have been following Brent Brookbush for nearly a decade- back when I was a personal Trainer and now as a Physical Therapist. BBI is an incredible resource for any movement nerds and corrective exercise specialists! The information is thorough with multiple real world applications. I am looking forward to an in-person Manual Therapist course the second they do one a little bit closer to Virginia ;)

I have taken both the Human Movement Specialist and Certified Personal Trainer certificate programs and have found the value in understanding the how and ways the body moves and functions and from evidence, non-biased, outcome, conceptual, theoretical, and practical approach to helping my clients/patients look better, feel better, and move better.

Over the last years I've returned time and again to Brookbush Institute for stellar coursework as I've worked toward a Human Movement Specialist certification. (I'm currently ACE CPT, and in training with Anatomy Trains for Structural Integration Manual Therapy.) Every Brookbush Institute module is fantastic and each one includes detailed informational videos, written descriptions of how to-do, and, more importantly, why to-do!

I am a 70 yr old chiropractor and no other healthcare provider was able to come up with an exercise protocol particular to my structural and balances and muscle deficits and keep me in the game. And as for continuing education on human skeletal movement, the website is phenomenal full of great exercises for particular mechanical dysfunction.

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This course describes ankle plantar flexor release and lengthening. Unfortunately, these techniques have been referred to by a dizzying array of terms, including ankle mobility exercises, ankle flexibility exercises, ankle mobility techniques, plantar flexor foam rolling, myofascial release, self-myofascial release, calf foam rolling, plantar flexor release with a ball, crural fascia release, plantar flexor stretching, and/or calf stretching.

Although it is common to hear terms like tight muscles, muscle tightness, tight plantar fascia, Achilles tendon tightness, short Achilles tendon, calf muscle tightness, etc., fascia and tendons do not adaptively shorten in most individuals, and it is more accurate to label the muscles (not fascia) as prone to over-activity (e.g. hypertonic, phasic, increased muscle stiffness). Even pain resulting from plantar fasciitis is not due to a "tight plantar fascia", the term plantar fasciitis refers to inflammation of this fascial structure. However, it is often the case that reducing muscle stiffness with a nonsurgical intervention like plantar flexor release can have a positive influence by reducing the stress on the plantar fascia, and can significantly reduce the pain associated with plantar fasciitis.

Performing plantar flexor release and lengthening techniques to increase ankle mobility prior to activation, integration, and strengthening techniques may significantly enhance rehabilitation and performance programs. In practice, the release of the gastrocnemius, soleus, and fibularis muscles (peroneal muscles), mobilizing the ankle joint, and integrating a slant board calf stretch (gastrocnemius and soleus stretch), modified calf stretch (gastrocnemius, soleus, and fibularis stretch), and/or a dynamic calf and fibularis stretch, is likely to improve ankle mobility and improve the effectiveness of exercises like isolated 

, toe raises, heel walks, and other dorsiflexion exercises, in addition to squatting, step-ups, lunges, deadlifts, etc.

Plantar flexor over-activity has been correlated with altered lower extremity alignment, pronation distortion, lower extremity dysfunction, an asymmetrical weight shift, knee bow in, knee bow out, excessive forward lean, feet flatten (pes planus or functional flat foot), and feet turn out. Additionally, plantar flexor-over-activity and a loss of dorsiflexion range of motion have been correlated with a loss of plantar flexor strength, loss of dorsiflexion strength, chronic ankle sprains, chronic ankle instability, Achille’s tendinopathy, chronic plantar fasciitis, heel pain, knee pain, low back pain, an increased risk of future ankle and low back 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 integrated exercise programs and therapeutic (rehabilitation) interventions.

Following release techniques, but before lengthening techniques, it may be beneficial to perform 

Self-administered Joint Mobilization Techniques: Lower Body

Active Calf Stretch with Modification for Fibularis Extensibility

Dr. Brent Brookbush demonstrating a static release technique for the gastrocnemius and soleus muscles

Course Description: Plantar Flexor and Evertor Release and Lengthening

Fibularis Static Self-Administered Release

Course Study Guide: Plantar Flexor: Release and Lengthening

 Location of the gastrocnemius muscle and achille's tendon

For Lower Extremity Dysfunction

Dr. Brent Brookbush demonstrating feet turn out during an overhead squat assessment

 Signs of Overactivity and Adaptive Shortening of the Plantar Flexor and Evertor Muscle Group

Optimizing Motion to Prevent Ankle Pain

Introduction: Plantar flexor and Evertor Release & Lengthening

Several texts have noted the propensity of the muscles addressed in this course to become over-active and short (1-5). 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 a result of movement impairment, and the regional interdependence between joints and body segments. Related to the techniques in this course, a lack of dorsiflexion has been associated with altered neuromuscular activity, including an increase in gastrocnemius activity, and an increase in frontal plane excursion of the knee (17), and excessive pronation (eversion) was linked to excessive hip internal rotation (18). 

Even Achilles tendinopathy was correlated with a decrease in 

 activity (19), which may be related to a lack of dorsiflexion, and result in an inability to decelerate hip internal rotation. In two studies, functional knee valgus was found to be an indicator of relative over-activity of the gastrocnemius (6, 7), and in another study by Bell et al., an exercise intervention including release and lengthening of the gastrocnemius and fibularis muscles was found to be effective in reducing functional knee valgus (8)

 to invert and evert the ankle deserves further explanation. The 

 has been found to have a bias toward inversion (15), which may be due to a 90° rotation of the Achilles tendon placing the soleus fibers medial to the midline of the posterior calcaneus (16). This 90° rotation of the Achilles tendon would also place the fibers of the gastrocnemius lateral to the midline of the calcaneus resulting in both the medial and lateral gastrocnemius having a bias toward eversion. 

Adding to the complexity of this relationship, the entire attachment of the Achilles tendon ends up lateral to the axis of rotation during ankle eversion, resulting in both the 

 and gastrocnemius contributing to inversion. That is, although the gastrocnemius may contribute to eversion and the 

' to inversion, both will contribute to "righting the calcaneus", or inversion if an individual has adopted a relatively everted position (

) as seen in those exhibiting LED (15). This may be why 

 is not strongly correlated with calcaneus valgus (21), and suggest that the majority of motion related to this impairment occurs at the transverse tarsal joint where the fibularis, 

Unfortunately, the fibularis muscles have not been as thoroughly studied. Based on their moment arm and size, these muscles are the strongest evertors (pronators) of the ankle/foot but are relatively weak plantar flexors (15, 22). This may imply that over-activity of the fibularis muscles are more likely to contribute to 

. Despite labeling the fibularis muscles over-active, it would seem that the excitation threshold actually increases, and reflex contraction in response to postural challenges is delayed (along with the 

) in those with chronic ankle sprains (23 - 27). It is clear that more research is needed not only in regard to the fibularis muscles but relative to our understanding of altered motor control.

Several studies on the self-myofascial release have specifically addressed the calf complex. Studies have shown that release of the calf complex (gastrocnemius) increased dorsiflexion with no decrease in performance, and that release and stretching are more effective than stretching alone for increasing dorsiflexion range of motion (10, 12). Further, self-myofascial release may decrease post-onset muscle soreness and enhance recovery, and release and stretching of the calf complex is likely more effective for rehabilitation from plantar heel pain when compared to stretching alone (13, 20).

The attachments of gastrocnemius and soleus muscle in the calf complex

Research Corner: Plantar Flexor and Evertor Release

Gastrocnemius and Soleus Self-administered Static Release

Gastrocnemius and Soleus Self-administered Dynamic Release a.k.a Pin and Stretch

Fibularis Self-administered Static Release

Release Techniques & Progressions for Plantar Flexor and Evertor Release

Calf and Fibularis Self-administered Static Stretch

Calf and Fibularis Slant Board Stretch

Calf and Fibularis Self-administered Active Stretch

Dynamic Calf and Fibularis Stretch

Manual Gastrocnemius and Soleus Stretch

Lengthening Techniques & Progressions for Plantar Flexor and Evertor Release

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

The sample circuit includes dynamic stretches for commonly over-active muscles in those exhibiting 

. This includes the dynamic stretch for the biceps femoris discussed above.

Dynamic Stretching Series for Lower Leg Dysfunction

Perform each technique with accuracy (ex. hold until release for static techniques, 10-15 repetitions for active techniques at a 2:2:2 count, etc.). Progress the flexibility routine as trigger points are reduced, techniques are mastered, and optimal flexibility is attained (generally over the course of weeks). This can be accomplished by adding additional release techniques, and/or replacing static stretches with active and eventually dynamic stretches.

Sample Flexibility Program and Progression

Phillip Page, Clare Frank, Robert Lardner, 

Assessment and Treatment of Muscle Imbalance: The Janda Approach

NASM Essentials of Corrective Exercise Training

Diagnoses and Treatment of Movement Impairment Syndromes,

Mauntel, T., Begalle, R., Cram, T., Frank, B., Hirth, C., Blackburn, T., & Padua, D. (2013). The effects of lower extremity muscle activation and passive range of motion on single leg squat performance. 

Journal Of Strength And Conditioning Research / National Strength & Conditioning Association

Padua, D. A., Bell, D. R., & Clark, M. A. (2012). Neuromuscular characteristics of individuals displaying excessive medial knee displacement. 

Bell, D. R., Oates, D. C., Clark, M. A., & Padua, D. A. (2013). Two-and 3-dimensional knee valgus are reduced after an exercise intervention in young adults with demonstrable valgus during squatting. 

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. 

International Journal of Sports Physical Therapy

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. 

The International Journal of Sports Physical Therapy. 9(1):

Mohr, A. R., Long, B. C., & Goad, C. L. (forthcoming 2014). Foam Rolling and Static Stretching on Passive Hip Flexion Range of Motion. 

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. 

International Journal of Sports Phyiscal Therapy.

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 & Sports Medicine

Lee, S. S., & Piazza, S. J. (2008). Inversion–eversion moment arms of gastrocnemius and tibialis anterior measured in vivo. 

[Klein, P., Mattys, S., & Rooze, M. (1996). Moment arm length variations of selected muscles acting on talocrural and subtalar joints during movement: An in vitro study. 

(1), 21-30.](http://Klein,%20P., Mattys, S., & Rooze, M. (1996). Moment arm length variations of selected muscles acting on talocrural and subtalar joints during movement: An in vitro study. Journal of biomechanics, 29(1), 21-30. ABSTRACT)

Michael RH, Holder LE: The soleus syndrome a cause of medial tibial stress (shin splints). 

Macrum et al. Effect of limiting ankle-dorsiflexion range of motion on lower extremity kinematics and muscle-activation patterns during a squat. 

Souza, T. R., Pinto, R. Z., Trede, R. G., Kirkwood, R. N., & Fonseca, S. T. (2010). Temporal couplings between rearfoot–shank complex and hip joint during walking. 

Franettovich, S. M., Honeywill, C. O. N. O. R., Wyndow, N., Crossley, K. M., & Creaby, M. W. (2014). Neuromotor control of gluteal muscles in runners with achilles tendinopathy. 

Medicine and science in sports and exercise

Healey, K.C., Hatfield, D.L., Blanpied, P., Dorfman, L.R., and Riebe, D. (2014). The effects of myofascial release with foam rolling on performance. Journal of Strength and Conditioning Research. 28(1). 61–68

Kulig K, Burnfeld JM, Reischl S, Requejo SM, Blanoc CE, Thordarson DB. Effect of foot orthoses on tibialis posterior activation in persons with pes planus. Medicine and Science in Sports and Exercise 2005, 37(1):24-29

Basmajian JV, Stecko G. The role of muscles in arch support of the foot. J Bone Joint Surg 1963;45A: 1184-90

Kim, K. M., Ingersoll, C. D., & Hertel, J. (2012). Altered postural modulation of Hoffmann reflex in the soleus and fibularis longus associated with chronic ankle instability. 

Journal of Electromyography and Kinesiology

Pietrosimone, B. G., & Gribble, P. A. (2012). Chronic ankle instability and corticomotor excitability of the fibularis longus muscle. 

Palmieri-Smith, R. M., Ty Hopkins, J., & Brown, T. N. (2009). Peroneal activation deficits in persons with functional ankle instability. 

Konradsen, L., & Ravn, J. B. (1991). Prolonged peroneal reaction time in ankle instability. 

Nawoczenski, D. A., Owen, M. G., Ecker, M. L., Altman, B., & Epler, M. (1985). Objective evaluation of peroneal response to sudden inversion stress. 

Journal of Orthopaedic & Sports Physical Therapy

Bibliography

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Plantar Flexor: Release and Lengthening

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