Static Manual Release: Tibia External Rotators - TFL, Vastus Lateralis, Biceps Femoris and Lateral Gastrocnemius (for Lower Extremity Dysfunction)

This course describes static manual release techniques for lower extremity muscles 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 these terms. For example, the techniques described in this course could be considered refinements of remedial massage, massage therapy techniques, deep tissue massage, sports massage, trigger point therapy, static compression techniques, soft tissue mobilization, muscle inhibitory techniques, and 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, tight muscles, "locked" muscles, muscle strains, muscle spasm, etc. Part of the reason there are so many synonyms is the rich history of scientific inquiry, from multiple disciplines and cultures, that have contributed to our understanding of these techniques and the information in this course.

This course includes techniques for the tensor fascia latae, vastus lateralis, biceps femoris, gastrocnemius, and soleus. Release techniques for these muscles are commonly included in an integrated program designed to address lower extremity dysfunctions including feet turn out, knee valgus (knees bow in), pes planus (flat feet), or an excessive forward lean. It may also be beneficial to include these techniques for complaints of shin splint pain (e.g. shin splints, medial tibial stress syndrome, tibialis anterior muscle pain, and posterior shin splints). If a professional is attempting to develop a protocol for shin splint massage or a program to "prevent shin splints", the techniques in this course may have a significant effect on program efficacy and reliability. Safety note, shin splints are not generally correlated with compartment syndrome, anterior compartment syndrome, nerve pathology resulting in a change in sensation or tibialis anterior strength, connective tissue disorders, or scar tissue development. If signs of these potentially serious conditions are noted, a referral to a physician is recommended.

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.) with the intent of developing an evidence-based, systematic, integrated, patient-centered, and outcome-driven approach.

Techniques Covered in this Course:

• Tensor Fascia Latae Static Manual Release
• Vastus Lateralis Static Manual Release
• Biceps Femoris Static Manual Release
• Gastrocnemius and Soleus 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

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   • Tensor Fascia Lata and Gluteus Minimus
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34. Skorupska, E., Rychlik, M., & Samborski, W. (2015). Validation and test-retest reliability of new thermographic technique called thermovision technique of dry needling for gluteus minimus trigger points in sciatica subjects and TrPs-negative healthy volunteers. BioMed research international, 2015.
35. 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.
36. Cotchett, M. P., Munteanu, S. E., & Landorf, K. B. (2014). Effectiveness of trigger point dry needling for plantar heel pain: a randomized controlled trial. Physical therapy, 94(8), 1083-1094.
37. Brennan, K. L., Allen, B. C., & Maldonado, Y. M. (2017). Dry needling versus cortisone injection in the treatment of greater trochanteric pain syndrome: a noninferiority randomized clinical trial. journal of orthopaedic & sports physical therapy, 47(4), 232-239.
38. 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.
39. Mosler, A. B., Blanch, P. D., & Hiskins, B. C. (2006). The effect of manual therapy on hip joint range of motion, pain and eggbeater kick performance in water polo players. Physical Therapy in Sport, 7(3), 128-136.
    • Vastus Lateralis (4, 8, 17, 33)
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42. Souza, D. R., & Gross, M. T. (1991). Comparison of vastus medialis obliquus: vastus lateralis muscle integrated electromyographic ratios between healthy subjects and patients with patellofemoral pain. Physical therapy, 71(4), 310-6.
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44. Sanchis – Alfanos, V., Rosello Sastre, E. 2000. Immunohistochemical analysis for neural markers of the lateral retinaculum in patients with isolated symptomatic patellofemoral malalignment. A neuroanatomic basis for anterior knee pain in the active young patient. Am J. Sports Med. 28, 725 – 731
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46. Fredericson, M., & Wolf, C. (2005). Iliotibial band syndrome in runners. Sports Medicine, 35(5), 451-459.
47. 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.
48. Dippenaar, D. L., Korporaal, C., Jones, A., Brantingham, J. W., Globe, G., & Snyder, W. R. (2008). Myofascial Trigger Points in the Quadriceps Femoris Muscle of Patellofemoral Pain Syndrome Subjects Assessed and Correlated with NRS-101, Algometry, and Piloted Patellofemoral Pain Severity and Myofascial Diagnostic Scales. Journal of the American Chiropractic Association, 45(2).
49. Daly, G. (2005). The relationship between myofascial trigger points, total work and other recorded measurements of the vastus lateralis and vastus medialis, in long-distance runners with patellofermoral pain syndrome (Doctoral dissertation).
50. Weyer-Henderson, D. (2005). An investigation into the effectiveness of dry needling of myofascial trigger points on total work and other recorded measurements of the vastus lateralis and vastus medialis muscles in patellofermoral pain syndrome in long distance runners (Doctoral dissertation).
51. Aranda‐Villalobos, P., Fernández‐de‐las‐Peñas, C., Navarro‐Espigares, J. L., Hernández‐Torres, E., Villalobos, M., Arendt‐Nielsen, L., & Arroyo‐Morales, M. (2013). Normalization of widespread pressure pain hypersensitivity after total hip replacement in patients with hip osteoarthritis is associated with clinical and functional improvements. Arthritis & Rheumatism, 65(5), 1262-1270.
52. 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.
53. Rozenfeld, E., Finestone, A. S., Moran, U., Damri, E., & Kalichman, L. (2017). Test-retest reliability of myofascial trigger point detection in hip and thigh areas. Journal of bodywork and movement therapies, 21(4), 914-919.
54. Walsh, R., Kinsella, S., & McEvoy, J. (2017). The intra-rater reliability of locating and measuring the severity of latent trigger points in the quadriceps. Journal of bodywork and movement therapies, 21(4), 926-932.
55. Botter, A., Oprandi, G., Lanfranco, F., Allasia, S., Maffiuletti, N. A., & Minetto, M. A. (2011). Atlas of the muscle motor points for the lower limb: implications for electrical stimulation procedures and electrode positioning. European journal of applied physiology, 111(10), 2461.
56. Sutlive, T. G., Golden, A., King, K., Morris, W. B., Morrison, J. E., Moore, J. H., & Koppenhaver, S. (2018). Short-term effects of trigger point dry needling on pain and disability in subjects with patellofemoral pain syndrome. International journal of sports physical therapy, 13(3), 462.
57. Pavkovich, R. (2015). Effectiveness of dry needling, stretching, and strengthening to reduce pain and improve function in subjects with chronic lateral hip and thigh pain: A retrospective case series. International journal of sports physical therapy, 10(4), 540.
58. Hains, G., & Hains, F. (2010). Patellofemoral pain syndrome managed by ischemic compression to the trigger points located in the peri-patellar and retro-patellar areas: a randomized clinical trial. Clinical Chiropractic, 13(3), 201-209.
59. Pedrelli, A., Stecco, C., & Day, J. A. (2009). Treating patellar tendinopathy with Fascial Manipulation. Journal of bodywork and movement therapies, 13(1), 73-80.
60. Anaya-Terroba, L., Arroyo-Morales, M., Fernández-de-las-Peñas, C., Díaz-Rodríguez, L., & Cleland, J. A. (2010). Effects of ice massage on pressure pain thresholds and electromyography activity postexercise: a randomized controlled crossover study. Journal of manipulative and physiological therapeutics, 33(3), 212-219.
61. Peacock, C. A., Krein, D. D., Antonio, J., Sanders, G. J., Silver, T. A., & Colas, M. (2015). Comparing acute bouts of sagittal plane progression foam rolling vs. frontal plane progression foam rolling. The Journal of Strength & Conditioning Research, 29(8), 2310-2315.
62. 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.
63. Cavanaugh, M. T., Aboodarda, S. J., Hodgson, D. D., & Behm, D. G. (2017). Foam rolling of quadriceps decreases biceps femoris activation. The Journal of Strength & Conditioning Research, 31(8), 2238-2245.
64. Macgregor, L. J., Fairweather, M. M., Bennett, R. M., & Hunter, A. M. (2018). The effect of foam rolling for three consecutive days on muscular efficiency and range of motion. Sports medicine-open, 4(1), 26.
65. Heiss, R., Mayer, I., Huettel, M., Lutter, C., Forst, R., Hoppe, M., … & Hotfiel, T. (2019, April). Evaluation of Tissue Stiffness in Athletes with Different Experience in Foam Rolling Assessed by Acoustic Radiation Force Impulse Elastography. In Seminars in Musculoskeletal Radiology (Vol. 23, No. S 01, p. A011). Georg Thieme Verlag KG.
66. 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.
67. MacDonald, G. Z., Penney, M. D., Mullaley, M. E., Cuconato, A. L., Drake, C. D., Behm, D. G., & Button, D. C. (2013). An acute bout of self-myofascial release increases range of motion without a subsequent decrease in muscle activation or force. The Journal of Strength & Conditioning Research, 27(3), 812-821.
68. Grabow, L., Young, J. D., Alcock, L. R., Quigley, P. J., Byrne, J. M., Granacher, U., … & Behm, D. G. (2018). Higher Quadriceps Roller Massage Forces Do Not Amplify Range-of-Motion Increases nor Impair Strength and Jump Performance. The Journal of Strength & Conditioning Research, 32(11), 3059-3069.
69. Monteiro, E. R., Vigotsky, A. D., da Silva Novaes, J., & Škarabot, J. (2018). Acute effects of different anterior thigh self-massage on hip range-of-motion in trained men. International journal of sports physical therapy, 13(1), 104.
70. Zorko, N., Škarabot, J., García-Ramos, A., & Štirn, I. (2016). THE ACUTE EFFECT OF SELF-MASSAGE ON THE SHORT-TERM RECOVERY OF MUSCLE CONTRACTILE FUNCTION. Kinesiologia Slovenica, 22(3), 31.
71. 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
72. Pearcey, G. E., Bradbury-Squires, D. J., Kawamoto, J. E., Drinkwater, E. J., Behm, D. G., & Button, D. C. (2015). Foam rolling for delayed-onset muscle soreness and recovery of dynamic performance measures. Journal of athletic training, 50(1), 5-13.
73. Macdonald, G.Z., Button, D.C., Drinkwater, E.J., Behm, D.G. (2014) Foam rolling as a recovery tool after an intense bout of physical activity. Medicine & Science in Sports & Exercise 46(1): 131-142
74. Moore, T. (2014). Active release technique for iliotibial band syndrome: A case report (Doctoral dissertation, Florida Gulf Coast University).
75. Else, J. W. A. (2016). The effectiveness of foam rolling treatment versus chiropractic manipulative therapy in the management of iliotibial band friction syndrome in runners and cyclists (Doctoral dissertation, University of Johannesburg).
76. Jafarnezhadgero, A. A., Majlesi, M., Etemadi, H., & Robertson, D. G. E. (2018). Rehabilitation improves walking kinematics in children with a knee varus: Randomized controlled trial. Annals of physical and rehabilitation medicine, 61(3), 125-134.
77. Romero-Moraleda, B., González-García, J., Cuéllar-Rayo, Á., Balsalobre-Fernández, C., Muñoz-García, D., & Morencos, E. (2019). Effects of Vibration and Non-Vibration Foam Rolling on Recovery after Exercise with Induced Muscle Damage. Journal of sports science & medicine, 18(1), 172.
78. Enrique, D; Mauntel, T; Pietrosimone, B; Clark, M; Padua, D. The Influence of Local Muscle Vibration During Foam Rolling on Range of Motion and Pain. Submitted for publication to the Journal Strength and Conditioning Research in 2017
    • Biceps Femoris
79. 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.
80. Nourbakhsh, M. R., & Arab, A. M. (2002). Relationship between mechanical factors and incidence of low back pain. Journal of Orthopaedic & Sports Physical Therapy, 32(9), 447-460.
81. 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) Journal of Electromyography and Kinesiology 22 (3). 391-397
82. Hungerford, B., Gilleard, W., Hodges, P. (2003) Evidence of altered lumbopelvic muscle recruitment in the presence of sacroiliac joint pain. Spine 28(14), 1593-1600
83. Jung, H., Kang, S., Park, J., Cynn, H., & Jeon, H., (2015). EMG activity and force during prone hip extension in individuals with lumbar segmental instability. Manual Therapy, 20(3), 440-444
84. Botter, A., Oprandi, G., Lanfranco, F., Allasia, S., Maffiuletti, N. A., & Minetto, M. A. (2011). Atlas of the muscle motor points for the lower limb: implications for electrical stimulation procedures and electrode positioning. European journal of applied physiology, 111(10), 2461.
85. Alburquerque-García, A., Rodrigues-de-Souza, D. P., Fernández-de-las-Peñas, C., & Alburquerque-Sendín, F. (2015). Association between muscle trigger points, ongoing pain, function, and sleep quality in elderly women with bilateral painful knee osteoarthritis. Journal of manipulative and physiological therapeutics, 38(4), 262-268.
86. Itoh, K., & Kitakoji, H. (2010). Effects of acupuncture to treat fibromyalgia: a preliminary randomised controlled trial. Chinese Medicine, 5(1), 11.
87. Geist, K., Bradley, C., Hofman, A., Koester, R., Roche, F., Shields, A., … & Johanson, M. (2017). Clinical effects of dry needling among asymptomatic individuals with hamstring tightness: a randomized controlled trial. Journal of sport rehabilitation, 26(6), 507-517.
88. 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.
89. Dembowski, S. C., Westrick, R. B., Zylstra, E., & Johnson, M. R. (2013). Treatment of hamstring strain in a collegiate pole‐vaulter integrating dry needling with an eccentric training program: a resident's case report. International journal of sports physical therapy, 8(3), 328.
90. Mason, J. S., Crowell, M., Dolbeer, J., Morris, J., Terry, A., Koppenhaver, S., & Goss, D. L. (2016). The effectiveness of dry needling and stretching vs. stretching alone on hamstring flexibility in patients with knee pain: a randomized controlled trial. International journal of sports physical therapy, 11(5), 672.
91. 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.
92. 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 8(3) 228-236.
93. Morales‐Artacho, A. J., Lacourpaille, L., & Guilhem, G. (2017). Effects of warm‐up on hamstring muscles stiffness: Cycling vs foam rolling. Scandinavian journal of medicine & science in sports, 27(12), 1959-1969.
94. 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 8(3) 228-236.
95. Morales‐Artacho, A. J., Lacourpaille, L., & Guilhem, G. (2017). Effects of warm‐up on hamstring muscles stiffness: Cycling vs foam rolling. Scandinavian journal of medicine & science in sports, 27(12), 1959-1969.
96. 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.
    • Calf (Gastrocnemius and Soleus)
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