Fibularis Muscles Static Manual Release

Differentiation

1. The fibularis muscles are superficial muscles that extend from the fibular head, down the lateral aspect of the lower leg, investing into tendons that course behind the lateral malleolus and insert into the bottom of the foot.
2. The belly of the fibularis muscles can be found just anterior to the lateral border of the soleus .
3. The fibularis muscles may be identified by palpating the lateral border of the soleus and "falling off" anteriorly. Having the patient press their foot (plantarflex) into your thigh, contracting the plantar flexors should make identifying the lateral border of the soleus easier.
4. The fibularis muscles should feel like a speed bump between the soleus and tibialis anterior . Note, the tibialis anterior may be identified by feeling for a contraction when asking the patient to dorsiflex and invert.
5. Further confirmation of your palpation can be achieved by placing a thumb or finger where you think the fibularis muscles are located. Then ask the patient to dorsiflex to inhibit the soleus and evert against your other hand to contract the fibularis muscles . Having your patient evert in an "on, off, on, off" fashion should make finding the muscle easier.

Potentially Sensitive Tissues

• Although rarely an issue, it is possible to compress or locally stretch the cutaneous branches of the common fibular nerve. If burning, tingling, or searing pain is felt; minor adjustments in any direction should be enough to address the same tissue and avoid this small nerve.

Trigger Points

• The common trigger points are in the center of the muscle bellies of the fibularis longus and fibularis brevis . However, the muscles themselves are relatively short, with long tendons making up a large portion of their length. The trigger point for the fibularis longus can generally be located approximately 2" distal the fibular head, and the fibularis brevis trigger point can be located near the mid-length of the fibula.

Release Technique

1. Start with the patient in side-lying with an affected leg up, standing at the foot of the table.
2. The patient's foot should be dangling off the end of the table so it may be pressed into end-range dorsiflexion without pressing the top of the foot into the table.
3. Ask the patient to bend the bottom leg, placing the mass of the calf of the bottom leg, under the muscle mass of the calf of the top leg. This will create a stable support for the top leg, without risk of pressing tender bony regions into one another.
4. Identify the fibularis muscles , use a broad thumb stroke and anterior to posterior strokes (perpendicular to the fiber direction) to identify taut bands in the tissue.
5. Once a taut band is located, the length of the band is explored for a dense nodule.
6. Consistent pressure is applied, adding a distal to proximal force to aid in pinning the dense nodule.
7. Tension may also be controlled by using your thigh to press into the patient's foot, controlling the amount of dorsiflexion.
8. Consistent pressure is held until the nodule softens under the practitioner's fingers, or tissue density/sensitivity is significantly reduced (generally 30 - 120 seconds).