Static Manual Release: Lower Leg Muscles

This course describes static manual release techniques for muscles of the lower leg and calf, that are commonly assessed as over-active and prone to trigger point development. Unfortunately, it is easy to be confused by a large number of synonyms for the terms used for these techniques in this course. For example, they may be considered refinements of calf massage, massage therapy, therapeutic massage, deep tissue massage, sports massage, trigger point massage, static compression techniques, soft tissue mobilization, muscle inhibitory techniques, and/or manual therapy techniques. Even the term trigger point is referred to by a variety of synonyms including muscle knots, nodules, adhesions, over-active muscle fibers, hypertonic fascicles, spasms, and acute points of hyper-contractility, and the trigger point phenomenon is likely part of every reference to short muscles, muscle tightness, muscle spasm, muscle tension, and some references to scar tissue. The reason there may be so many synonyms is the rich history of scientific inquiry, from multiple disciplines and cultures, that have contributed to our understanding of the techniques described in this course.

This course includes techniques for the gastrocnemius, soleus, fibularis muscles (peroneal muscles), extensor hallucis longus (EHL), extensor digitorum longus (EDL), flexor hallucis longus (FHL), and flexor digitorum longus (FDL). Release techniques for these muscles are commonly included in an integrated program designed to address lower extremity dysfunctions including a loss of dorsiflexion range of motion, pes planus (feet flatten), feet turn out, knee valgus (knees bow in), an excessive forward lean, or an asymmetrical weight shift. Often lower extremity dysfunction results in patient complaints of tight calf muscles, calf pain, calf cramps, or calf spasm (often falsely attributed to circulation issues), and may be correlated with pathology including plantar fasciitis, calf muscle strain, and Achilles tendinopathy. More pronounced lower extremity dysfunction, in conjunction with physical stressors, can result in serious injuries including muscle tissue, tendon, or fascial ruptures.

The techniques in this course are recommended for all clinical human movement professionals (physical therapists, physical therapy assistants, athletic trainers, massage therapists, chiropractors, occupational therapists, etc.) to develop an evidence-based, systematic, integrated, patient-centered, patient-centered, and outcome-driven approach.

Techniques Covered in this Course:

• Gastrocnemius and Soleus Static Manual Release
• Fibularis Muscle Static Manual Release
• Extensor Hallucis Longus (EHL) and Extensor Digitorum Longus (EDL) Static Manual Release
• Flexor Hallucis Longus (FHL) and Flexor Digitorum Longus (FDL) Static Manual Release

Additional Static Manual Release Courses

• Static Manual Release: Upper Trapezius, Levator Scapulae and Splenii
• Static Manual Release: Suboccipitals, Sternocleidomastoid (SCM), Scalenes and Cervical Extensors
• Static Manual Release: Scapular Muscles
• Static Manual Release: Shoulder Muscles
• Static Manual Release: Trunk Muscles
• Static Manual Release: Hip Flexors
• Static Manual Release: Hip Internal Rotators
• Static Manual Release: Hip External Rotators
• Static Manual Release: Tibia External Rotators
• Static Manual Release: Lower Leg Muscles

For a review of muscle fiber dysfunction and trigger point etiology:

• Muscle Fiber Dysfunction and Trigger Points
• Trigger Point Assessment and Palpation

Pre-approved credits for:

• Integrated Manual Therapist (IMT) Certification

Pre-approved for Continuing Education Credits for:

• Athletic Trainers
• Chiropractors
• Massage Therapists
• Occupational Therapists - Advanced
• Physical Therapists
• Physical Therapy Assistants

This Course Includes:

• AI Tutor
• Study Guide
• Text and Illustrations
• Audio Voice-over
• Research Review
• Technique Videos
• Sample Routine
• Practice Exam
• Pre-approved Final Exam

1. Florence Peterson Kendall, Elizabeth Kendall McCreary, Patricia Geise Provance, Mary McIntyre Rodgers, William Anthony Romani, Muscles: Testing and Function with Posture and Pain: Fifth Edition © 2005 Lippincott Williams & Wilkins
2. Phillip Page, Clare Frank , Robert Lardner , Assessment and Treatment of Muscle Imbalance: The Janda Approach © 2010 Benchmark Physical Therapy, Inc., Clare C. Frank, and Robert Lardner
3. Shirley Sahrmann and Associates, Movement System Impairment Syndromes of the Extremities, Cervical and Thoracic Spine © 2011 Mosby, Inc, an affiliate of Elsevier Inc.
4. Simons, D. G., Travell, J. G., & Simons, L. S. (1983). Travell & Simons' myofascial pain and dysfunction: lower half of body (Vol. 2). Lippincott williams & wilkins.
   • Gastrocnemius and Soleus
5. Torres-Chica, B., Núñez-Samper-Pizarroso, C., Ortega-Santiago, R., Cleland, J. A., Salom-Moreno, J., Laguarta-Val, S., & Fernández-de-las-Peñas, C. (2015). Trigger points and pressure pain hypersensitivity in people with postmeniscectomy pain. The Clinical journal of pain, 31(3), 265-272.
6. Mayoral, O., Salvat, I., Martín, M. T., Martín, S., Santiago, J., Cotarelo, J., & Rodríguez, C. (2013). Efficacy of myofascial trigger point dry needling in the prevention of pain after total knee arthroplasty: a randomized, double-blinded, placebo-controlled trial. Evidence-Based Complementary and Alternative Medicine, 2013.
7. Yentür, E. A., Okçu, G., & Yegül, I. B. (2003). The role of trigger point therapy in knee osteoarthritis. The pain clinic, 15(4), 385-390.
8. Hsieh, C. Y. J., Hong, C. Z., Adams, A. H., Platt, K. J., Danielson, C. D., Hoehler, F. K., & Tobis, J. S. (2000). Interexaminer reliability of the palpation of trigger points in the trunk and lower limb muscles. Archives of physical medicine and rehabilitation, 81(3), 258-264.
9. Padua, D. A., Bell, D. R., & Clark, M. A. (2012). Neuromuscular characteristics of individuals displaying excessive medial knee displacement. Journal of athletic training, 47(5), 525.
10. 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, 27(7), 1813-1823
11. Bell, D. R., Vesci, B. J., DiStefano, L. J., Guskiewicz, K. M., Hirth, C. J., & Padua, D. A. (2012). Muscle activity and flexibility in individuals with medial knee displacement during the overhead squat. Athletic Training and Sports Health Care, 4(3), 117-125.
12. Bolgla, L. A., & Uhl, T. L. (2005). Electromyographic analysis of hip rehabilitation exercises in a group of healthy subjects. Journal of Orthopaedic & Sports Physical Therapy, 35(8), 487-494.
13. Vesci BJ, PAdua DA, Bell DR Strickland LJ, Guskiewicz KM, Hirth CJ. Influence of hip muscle strength, flexibility of hip and ankle musculature, and hip muscle activation on dynamic knee valgus motion during a double-legged squat. J Athl Train 2007; 42:S83
14. Gribble, P. A., & Robinson, R. H. (2009). Alterations in knee kinematics and dynamic stability associated with chronic ankle instability . Journal of Athletic Training, 44(4), 350-355.
15. Trimble, M. H., Bishop, M. D., Buckley, B. D., Fields, L. C., & Rozea, G. D. (2002). The relationship between clinical measurements of lower extremity posture and tibial translation. Clinical Biomechanics, 17(4), 286-290.
16. Bell, D. R., Padua, D. A., & Clark, M. A. (2008). Muscle strength and flexibility characteristics of people displaying excessive medial knee displacement. Archives of physical medicine and rehabilitation, 89(7), 1323-1328.
17. Michael RH, Holder LE: The soleus syndrome a cause of medial tibial stress (shin splints). Am J Sports Med 13:87-94 1985
18. 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. Clinical biomechanics, 25(7), 745-748 ‘
19. Padua, D. A., Bell, D. R., & Clark, M. A. (2012). Neuromuscular characteristics of individuals displaying excessive medial knee displacement. Journal of athletic training, 47(5), 525.
20. Macrum et al. Effect of limiting ankle-dorsiflexion range of motion on lower extremity kinematics and muscle-activation patterns during a squat. Journal of Sport Rehabilitation, 2012, 21, Pg 144-150 .
21. 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, 27(7), 1813-1823
22. Lee, S. S., & Piazza, S. J. (2008). Inversion–eversion moment arms of gastrocnemius and tibialis anterior measured in vivo. Journal of biomechanics, 41(16), 3366-3370.
23. 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. Journal of biomechanics, 29(1), 21-30.
24. Michael RH, Holder LE: The soleus syndrome a cause of medial tibial stress (shin splints). Am J Sports Med 13:87-94 1985
25. 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
26. 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
27. Souza, R. B., Hatamiya, N., Martin, C., Aramaki, A., Martinelli, B., Wong, J., & Luke, A. (2015). Medial and lateral heel whips: prevalence and characteristics in recreational runners. PM&R, 7(8), 823-830.
28. Winslow, J., & Yoder, E. (1995). Patellofemoral pain in female ballet dancers: correlation with iliotibial band tightness and tibial external rotation. Journal of Orthopaedic & Sports Physical Therapy, 22(1), 18-21.
29. Andrews, M., Noyes, F. R., Hewett, T. E., & Andriacchi, T. P. (1996). Lower limb alignment and foot angle are related to stance phase knee adduction in normal subjects: a critical analysis of the reliability of gait analysis data. Journal of orthopaedic research, 14(2), 289-295.
30. Grieve, R., Barnett, S., Coghill, N., & Cramp, F. (2013). The prevalence of latent myofascial trigger points and diagnostic criteria of the triceps surae and upper trapezius: a cross sectional study. Physiotherapy, 99(4), 278-284.
31. Zuil-Escobar, J. C., Martínez-Cepa, C. B., Martín-Urrialde, J. A., & Gómez-Conesa, A. (2015). Prevalence of myofascial trigger points and diagnostic criteria of different muscles in function of the medial longitudinal arch. Archives of physical medicine and rehabilitation, 96(6), 1123-1130.
32. Ge, H. Y., Wang, Y., Fernandez-de-Las-Penas, C., Graven-Nielsen, T., Danneskiold-Samsøe, B., & Arendt-Nielsen, L. (2011). Reproduction of overall spontaneous pain pattern by manual stimulation of active myofascial trigger points in fibromyalgia patients. Arthritis research & therapy, 13(2), R48.
33. Prateepavanich, P., Kupniratsaikul, V., & Charoensak, T. (1999). The relationship between myofascial trigger points of gastrocnemius muscle and nocturnal calf cramps. Journal of the Medical Association of Thailand= Chotmaihet thangphaet, 82(5), 451-459.
34. Skorupska, E., Rychlik, M., Pawelec, W., & Samborski, W. (2015). Dry needling related short-term vasodilation in chronic sciatica under infrared thermovision. Evidence-Based Complementary and Alternative Medicine, 2015.
35. Gunn, C. C., Milbrandt, W. E., Little, A. S., & Mason, K. E. (1980). Dry needling of muscle motor points for chronic low-back pain. Spine, 5(3), 279-291.
36. Mason, J. S., Tansey, K. A., & Westrick, R. B. (2014). Treatment of subacute posterior knee pain in an adolescent ballet dancer utilizing trigger point dry needling: a case report. International journal of sports physical therapy, 9(1), 116.
37. Cotchett, M. P., Landorf, K. B., Munteanu, S. E., & Raspovic, A. (2011). Effectiveness of trigger point dry needling for plantar heel pain: study protocol for a randomised controlled trial. Journal of foot and ankle research, 4(1), 5.
38. Kim, D. H., Yoon, D. M., & Yoon, K. B. (2015). The effects of myofascial trigger point injections on nocturnal calf cramps. J Am Board Fam Med, 28(1), 21-27.
39. Devereux, F., O’Rourke, B., Byrne, P. J., Byrne, D., & Kinsella, S. (2018). The effects of myofascial trigger point release on the power and force production in the lower limb kinetic chain. J Strength Cond Res, 22.
40. Grieve, R., Clark, J., Pearson, E., Bullock, S., Boyer, C., & Jarrett, A. (2011). The immediate effect of soleus trigger point pressure release on restricted ankle joint dorsiflexion: a pilot randomized controlled trial. Journal of bodywork and movement therapies, 15(1), 42-49.
41. Grieve, R., Cranston, A., Henderson, A., John, R., Malone, G., & Mayall, C. (2013). The immediate effect of triceps surae myofascial trigger point therapy on restricted active ankle joint dorsiflexion in recreational runners: A crossover randomised controlled trial. Journal of bodywork and movement therapies, 17(4), 453-461.
42. Vijayakumar, M., Jaideep, A., Khankal, R., Gazbare, P., & Abraham, B. Effectiveness of Compressive Myofascial Release Vs Instrument Assisted Soft Tissue Mobilization in Subjects with Active Trigger Points of the Calf Muscle Limiting Ankle Dorsiflexion.
43. Grieve, R., Barnett, S., Coghill, N., & Cramp, F. (2013). Myofascial trigger point therapy for triceps surae dysfunction: A case series. Manual therapy, 18(6), 519-525.
44. Ajimsha, M. S., Binsu, D., & Chithra, S. (2014). Effectiveness of myofascial release in the management of plantar heel pain: a randomized controlled trial. The Foot, 24(2), 66-71.
45. Renan-Ordine, R., Alburquerque-SendÍn, F., Rodrigues De Souza, D. P., Cleland, J. A., & Fernández-de-las-Peñas, 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 physical therapy, 41(2), 43-50.
46. Saban, B., Deutscher, D., & Ziv, T. (2014). Deep massage to posterior calf muscles in combination with neural mobilization exercises as a treatment for heel pain: a pilot randomized clinical trial. Manual therapy, 19(2), 102-108.
47. Trampas, A., Kitsios, A., Sykaras, E., Symeonidis, S., & Lazarou, L. (2010). Clinical massage and modified Proprioceptive Neuromuscular Facilitation stretching in males with latent myofascial trigger points. Physical therapy in sport, 11(3), 91-98.
48. Hong, C. Z., Chen, Y. C., Pon, C. H., & Yu, J. (1993). Immediate effects of various physical medicine modalities on pain threshold of an active myofascial trigger point. Journal of musculoskeletal Pain, 1(2), 37-53.
49. Grieve, R. (2006). Proximal hamstring rupture, restoration of function without surgical intervention: a case study on myofascial trigger point pressure release. Journal of Bodywork and Movement Therapies, 10(2), 99-104.
50. Moghtaderi, A., Khosrawi, S., & Dehghan, F. (2014). Extracorporeal shock wave therapy of gastroc-soleus trigger points in patients with plantar fasciitis: A randomized, placebo-controlled trial. Advanced biomedical research, 3.
51. Kalichman, L., Levin, I., Bachar, I., & Vered, E. (2018). Short-term effects of kinesio taping on trigger points in upper trapezius and gastrocnemius muscles. Journal of bodywork and movement therapies, 22(3), 700-706.
52. Monteiro, E. R., Cavanaugh, M. T., Frost, D. M., & da Silva Novaes, J. (2017). Is self-massage an effective joint range-of-motion strategy? A pilot study. Journal of bodywork and movement therapies, 21(1), 223-226.
53. Phillips, J. (2017). The Effect of Foam Rolling Duration on Subsequent Power Performance.
54. Aune, A. A., Bishop, C., Turner, A. N., Papadopoulos, K., Budd, S., Richardson, M., & Maloney, S. J. (2019). Acute and chronic effects of foam rolling vs eccentric exercise on ROM and force output of the plantar flexors. Journal of sports sciences, 37(2), 138-145.
55. Aboodarda, S. J., Spence, A. J., & Button, D. C. (2015). Pain pressure threshold of a muscle tender spot increases following local and non-local rolling massage. BMC Musculoskeletal Disorders, 16(1), 265.
56. Cavanaugh, M. T., Döweling, A., Young, J. D., Quigley, P. J., Hodgson, D. D., Whitten, J. H., … & Behm, D. G. (2017). An acute session of roller massage prolongs voluntary torque development and diminishes evoked pain. European Journal of Applied Physiology, 117(1), 109-117.
57. Casanova, N., Reis, J. F., Vaz, J. R., Machado, R., Mendes, B., Button, D. C., … & Freitas, S. R. (2018). Effects of roller massager on muscle recovery after exercise-induced muscle damage. Journal of sports sciences, 36(1), 56-63.
58. Wilke, J., Vogt, L., & Banzer, W. (2018). Immediate effects of self-myofascial release on latent trigger point sensitivity: a randomized, placebo-controlled trial. Biology of sport, 35(4), 349.
59. Grieve, R., Goodwin, F., Alfaki, M., Bourton, A. J., Jeffries, C., & Scott, H. (2015). The immediate effect of bilateral self myofascial release on the plantar surface of the feet on hamstring and lumbar spine flexibility: A pilot randomised controlled trial. Journal of bodywork and movement therapies, 19(3), 544-552.
60. Linderoth, F. (2015). Foam rolling compared to dynamic stretch and 20 meter sprint time performance.
61. Suh, H. R., & Lee, S. Y. (2018). Effect of foam roller, kinesiotaping and dynamic stretching on gait parameters with induced ankle muscle fatigue. Physical Therapy Rehabilitation Science, 7(3), 127-133.
62. Junker, D., & Stöggl, T. (2019). The Training Effects of Foam Rolling on Core Strength Endurance, Balance, Muscle Performance and Range of Motion: A Randomized Controlled Trial. Journal of Sports Science and Medicine, 18(2), 229-238.
63. 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. 10(2): 203-212
64. Peacock, C. A., Krein, D. D., Silver, T. A., Sanders, G. J., & Von Carlowitz, K. P. A. (2014). An acute bout of self-myofascial release in the form of foam rolling improves performance testing. International journal of exercise science, 7(3), 202.
65. Yıldız, M., Bozdemir, M., & Akyıldız, Z. (2018). ACUTE EFFECTS OF PRE-EXERCISE FOAM ROLLING IN ADDITION TO DYNAMIC STRETCHING ON ANAEROBIC POWER. Journal of Physical Education & Sports Science/Beden Egitimi ve Spor Bilimleri Dergisi, 12(2).
66. Roylance, D. S., George, J. D., Hammer, A. M., Rencher, N., Fellingham, G. W., Hager, R. L., & Myrer, W. J. (2013). Evaluating acute changes in joint range-of-motion using self-myofascial release, postural alignment exercises, and static stretches. International Journal of Exercise Science, 6(4), 6.
67. Song, H. S., Woo, S. S., So, W. Y., Kim, K. J., Lee, J., & Kim, J. Y. (2014). Effects of 16-week functional movement screen training program on strength and flexibility of elite high school baseball players. Journal of exercise rehabilitation, 10(2), 124.
68. Fleckenstein, J., Wilke, J., Vogt, L., & Banzer, W. (2017). Preventive and regenerative foam rolling are equally effective in reducing fatigue-related impairments of muscle function following exercise. Journal of sports science & medicine, 16(4), 474.
69. Monteiro, E. R., & Neto, V. G. C. (2016). Effect of different foam rolling volumes on knee extension fatigue. International journal of sports physical therapy, 11(7), 1076.
70. Monteiro, E. R., Škarabot, J., Vigotsky, A. D., Brown, A. F., Gomes, T. M., & da Silva Novaes, J. (2017). MAXIMUM REPETITION PERFORMANCE AFTER DIFFERENT ANTAGONIST FOAM ROLLING VOLUMES IN THE INTER‐SET REST PERIOD. International journal of sports physical therapy, 12(1), 76.
71. Phillips, J. (2017). The Effect of Foam Rolling Duration on Subsequent Power Performance.
72. Baumgart, C., Freiwald, J., Kühnemann, M., Hotfiel, T., Hüttel, M., & Hoppe, M. W. (2019). Foam Rolling of the Calf and Anterior Thigh: Biomechanical Loads and Acute Effects on Vertical Jump Height and Muscle Stiffness. Sports, 7(1), 27.
73. Smith, J. C., Pridgeon, B., & Hall, M. C. (2018). Acute effect of foam rolling and dynamic stretching on flexibility and jump height. The Journal of Strength & Conditioning Research, 32(8), 2209-2215.
74. Miller, K. L., Costa, P. B., Coburn, J. W., & Brown, L. E. (2019). THE EFFECTS OF FOAM ROLLING ON MAXIMAL SPRINT PERFORMANCE AND RANGE OF MOTION. Journal of Australian Strength & Conditioning, 27(01), 15-26.
75. Hand, C., Holling, T., Klinkhammer, G., Locati, S., & Silvers, W. M. (2018). EFFECT OF FOAM ROLLING VOLUME ON ATHLETIC PERFORMANCE AND RANGE OF MOTION. In International Journal of Exercise Science: Conference Proceedings (Vol. 8, No. 6, p. 7).
76. Bradbury-Squires, D. J., Noftall, J. C., Sullivan, K. M., Behm, D. G., Power , K. E., & Button, D. C. (2015). Roller-massager application to the quadriceps and knee-joint range of motion and neuromuscular efficiency during a lunge. Journal of athletic training, 50(2), 133-140.
77. Bushell, J. E., Dawson, S. M., & Webster, M. M. (2015). Clinical relevance of foam rolling on hip extension angle in a functional lunge position. The Journal of Strength & Conditioning Research, 29(9), 2397-2403.
78. Yoshimura, A., Inami, T., Schleip, R., Mineta, S., Shudo, K., & Hirose, N. Study on Mechanism of the Increase of Range of Motion by Foam Rolling.
79. Fleisher, T. M. (2014). The acute effects of two different self-myofascial release products on the calf muscle pump and plantar flexion ankle range of motion (Doctoral dissertation).
80. Kim, K., Park, S., Goo, B. O., & Choi, S. C. (2014). Effect of self-myofascial release on reduction of physical stress: a pilot study. Journal of physical therapy science, 26(11), 1779-1781.
81. Garcia-Gutiérrez, M. T., Guillén-Rogel, P., Cochrane, D. J., & Marin, P. J. (2018). Cross transfer acute effects of foam rolling with vibration on ankle dorsiflexion range of motion. Journal of musculoskeletal & neuronal interactions, 18(2), 262.
82. Lee, C. L., Chu, I. H., Lyu, B. J., Chang, W. D., & Chang, N. J. (2018). Comparison of vibration rolling, nonvibration rolling, and static stretching as a warm-up exercise on flexibility, joint proprioception, muscle strength, and balance in young adults. Journal of sports sciences, 36(22), 2575-2582.
    • Fibularis Muscles
83. Basmajian JV, Stecko G. The role of muscles in arch support of the foot. J Bone Joint Surg 1963;45A: 1184-90
84. (71) 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 , 22(6), 997-1002.
85. (72) Pietrosimone, B. G., & Gribble, P. A. (2012). Chronic ankle instability and corticomotor excitability of the fibularis longus muscle . Journal of athletic training, 47(6), 621-626.
86. (73) Palmieri-Smith, R. M., Ty Hopkins, J., & Brown, T. N. (2009). Peroneal activation deficits in persons with functional ankle instability . The American journal of sports medicine, 37(5), 982-988.
87. (74) Konradsen, L., & Ravn, J. B. (1991). Prolonged peroneal reaction time in ankle instability . International journal of sports medicine, 12(03), 290-292.
88. ( 75) 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, 7(3), 107-109.
89. Palmieri, R. M., Ingersoll, C. D., Hoffman, M. A., Cordova, M. L., Porter, D. A., Edwards, J. E., … & Stone, M. B. (2004). Arthrogenic muscle response to a simulated ankle joint effusion . British journal of sports medicine, 38(1), 26-30.
90. Murley, G. S., Tan, J. M., Edwards, R. M., De Luca, J., Munteanu, S. E., & Cook, J. L. (2014). Foot posture is associated with morphometry of the peroneus longus muscle, tibialis anterior tendon, and A chilles tendon. Scandinavian journal of medicine & science in sports, 24(3), 535-541.
91. Wilke, J., Engeroff, T., Nürnberger, F., Vogt, L., & Banzer, W. (2016). Anatomical study of the morphological continuity between iliotibial tract and the fibularis longus fascia. Surgical and Radiologic Anatomy, 38(3), 349-352.
92. Zuil-Escobar, J. C., Martínez-Cepa, C. B., Martín-Urrialde, J. A., & Gómez-Conesa, A. (2016). The prevalence of latent trigger points in lower limb muscles in asymptomatic subjects. PM&R, 8(11), 1055-1064.
93. Zuil-Escobar, J. C., Martínez-Cepa, C. B., Martín-Urrialde, J. A., & Gómez-Conesa, A. (2015). Prevalence of myofascial trigger points and diagnostic criteria of different muscles in function of the medial longitudinal arch. Archives of physical medicine and rehabilitation, 96(6), 1123-1130.
94. Bajaj, P., Bajaj, P., Graven-Nielsen, T., & Arendt-Nielsen, L. (2001). Trigger points in patients with lower limb osteoarthritis. Journal of Musculoskeletal Pain, 9(3), 17-33.
95. Andrzejewski, W., Kassolik, K., Brzozowski, M., & Cymer, K. (2010). The influence of age and physical activity on the pressure sensitivity of soft tissues of the musculoskeletal system. Journal of bodywork and movement therapies, 14(4), 382-390.
96. Sanz, D. R., Lobo, C. C., López, D. L., Morales, C. R., Marín, C. S., & Corbalán, I. S. (2016). Interrater reliability in the clinical evaluation of myofascial trigger points in three ankle muscles. Journal of manipulative and physiological therapeutics, 39(9), 623-634.
97. Zale, K. E., Klatt, M., Volz, K. R., Kanner, C., & Evans, K. D. (2015). A mixed-method approach to evaluating the association between myofascial trigger points and ankle/foot pain using handheld sonography equipment: a pilot study. Journal of Diagnostic Medical Sonography, 31(4), 210-220.
98. Cotchett, M. P., Landorf, K. B., & Munteanu, S. E. (2010). Effectiveness of dry needling and injections of myofascial trigger points associated with plantar heel pain: a systematic review. Journal of foot and ankle research, 3(1), 18.
99. Rossi, A., Blaustein, S., Brown, J., Dieffenderfer, K., Ervin, E., Griffin, S., … & Johanson, M. (2017). Spinal and peripheral dry needling versus peripheral dry needling alone among individuals with a history of lateral ankle sprain: a randomized controlled trial. International journal of sports physical therapy, 12(7), 1034.
100. Salom-Moreno, J., Ayuso-Casado, B., Tamaral-Costa, B., Sánchez-Milá, Z., Fernández-de-las-Peñas, C., & Alburquerque-Sendín, F. (2015). Trigger point dry needling and proprioceptive exercises for the management of chronic ankle instability: a randomized clinical trial. Evidence-Based Complementary and Alternative Medicine, 2015.
101. Chou, L. W., Hong, J. Y., & Hong, C. Z. (2008). A new technique for acupuncture therapy and its effectiveness in treating fibromyalgia syndrome: a case report. Journal of Musculoskeletal Pain, 16(3), 193-198.
102. Truyols-Domínguez, S., Salom-Moreno, J., Abian-Vicen, J., Cleland, J. A., & Fernández-De-Las-Peñas, C. (2013). Efficacy of thrust and nonthrust manipulation and exercise with or without the addition of myofascial therapy for the management of acute inversion ankle sprain: a randomized clinical trial. journal of orthopaedic & sports physical therapy, 43(5), 300-309.
103. Kahere, M. (2017). The effectiveness of a myofascial treatment protocol combined with cryotherapy compared to cryotherapy alone in the treatment of acute and subacute ankle sprains (Doctoral dissertation).
104. Costa, I. A., & Dyson, A. (2007). The integration of acetic acid iontophoresis, orthotic therapy and physical rehabilitation for chronic plantar fasciitis: a case study. The Journal of the Canadian Chiropractic Association, 51(3), 166.
105. Majlesi, J., & Ünalan, H. (2004). High-power pain threshold ultrasound technique in the treatment of active myofascial trigger points: a randomized, double-blind, case-control study. Archives of physical medicine and rehabilitation, 85(5), 833-836.
106. Dorsher, P. T. (2010). Clinical equivalence of laser needle to metal acupuncture needle in treating musculoskeletal pain: a pilot study. Medical acupuncture, 22(1), 11-17.
107. Saggini, R., Giamberardino, M. A., Gatteschi, L., & Vecchiet, L. (1996). Myofascial pain syndrome of the peroneus longus: biomechanical approach. The Clinical journal of pain, 12(1), 30-37.
     • FHL, FDL, EHL and EDL
108. Wei, S. Y., Kneeland, J. B., & Okereke, E. (1998). Complete atraumatic rupture of the flexor hallucis longus tendon: a case report and review of the literature. Foot & ankle international, 19(7), 472-474.
109. Sanhudo, J. A. V. (2002). Stenosing tenosynovitis of the flexor hallucis longus tendon at the sesamoid area. Foot & ankle international, 23(9), 801-803.
110. Nachazel, K. M. (2002). Mechanism and treatment of tendinitis of the flexor hallucis longus in classical ballet dancers. Athletic Therapy Today, 7(2), 13-15.
111. Kirane, Y. M., Michelson, J. D., & Sharkey, N. A. (2008). Contribution of the flexor hallucis longus to loading of the first metatarsal and first metatarsophalangeal joint. Foot & ankle international, 29(4), 367-377.
112. Kwak, J. M., Kim, D. H., Lee, Y. G., & Choi, Y. H. (2019). Optimal needle placement for extensor hallucis longus muscle using ultrasound verification. Muscle & nerve, 59(3), 331-336.