Name: Extensor Hallucis Longus and Extensor Digitorum Longus Static Manual Release (Soft Tissue Mobilization)
Uploaded: 2023-04-26T01:00:15.000Z
Duration: 14 min 32 s
Description: Learn how to perform a static manual release mobilization on Extensor Hallucis Longus and Extensor Digitorum Longus muscles. This video provides step-by-step instructions on the proper technique to mobilise soft tissue.

English captions

https://stream.mux.com/tdTfBxez9JGtnag2hbVcL5dfkIR1MqxdjpKNo7A01hSY.m3u8

Learn how to perform a static manual release mobilization on Extensor Hallucis Longus and Extensor Digitorum Longus muscles. This video provides step-by-step instructions on the proper technique to mobilise soft tissue.

Introduction to Extensor Muscle Release Techniques

Palpating the Extensor Muscles

Applying Static Manual Release Techniques

Recognizing Trigger Points and Their Impact

Situational Applications of the Techniques

Practice and Feedback for Effectiveness

Extensor Hallucis Longus and Extensor Digitorum Longus Static Manual Release (Soft Tissue Mobilization)

This is Brent of the Brookbush Institute and in this video we're going over static manual release of the extensor hallucis longus and extensor digitorum longus, also known as the long toe extensors. If you are doing this technique and you're watching this video, I'm assuming you're watching this video for educational purposes, and that you are a licensed manual practitioner following the laws determining your scope of practice in your state. If you're unsure on whether you're allowed to do manual release techniques, please check out those laws before you put your hands on a patient or client. I'm going to have my friend Melissa come out, she's going to help me demonstrate this technique. This is one of my favorite techniques the reason being, is that the extensor hallucis longus and extensor digitorum longus are muscles that are not easily addressed using self-administered techniques, so the responsibility falls on the manual therapists. This is one of the times we can really shine. The extensor hallucis longus and extensor digitorum longus also play a very interesting role in lower extremity dysfunction as they often become synergistically dominant for an inhibited tibialis anterior in those exhibiting lower extremity dysfunction. Whether that's a lack of dorsiflexion, excessive pronation, or we could get into pathologies like plantar fasciitis, shin splints, etc., this is a muscle that is often not addressed, and since it is often not addressed if you do address it and solve a problem, sometimes it's that missing link and you can look like a magician. Let's get into how to palpate this muscle, because that's probably the hardest part of this technique, just knowing how to palpate the extensor hallucis longus and extensor digitorum longus. If you see, I've got two marks right here. I know what some of you are thinking, 'that's the tibialis anterior'. Well, the tibialis anterior is here - dorsiflex for me Melissa - you can see her tibialis anterior all of a sudden pop up right here, kind of to the side, and behind the tibialis anterior, or, lateral and deep to the tibialis anterior, is your extensor digitorum longus, and your extensor hallucis longus. The easiest way to find these muscles is get really good at palpating the tibialis anterior. Once again, dorsiflex, and there you've got that crest of your tibia. That's the medial border of the tibialis interior, and if she dorsiflexes, especially if she dorsiflexes with toes down, so I know her extensors are not involved, I can feel her lateral border of her tibialis anterior, and then all I need to do to get to her extensors, is fall off that muscle mass. Here's her tibialis anterior, I'm just going to fall off the muscle mass this way. Once again,  I go down here -dorsiflex for me-  and then I fall off the muscle mass. Again, you'll also note that the tibialis anterior is a fairly broad, if you guys remember the term, 'multipennate' muscle, whereas these are very tubular, stringy muscles, so they're going to feel a little bit more like your fibularis muscle which is right there. If you're still having a hard time palpating what you can do is - wiggle your toes for me - don't be afraid to ask somebody to wiggle their toes and confirm your palpation. You can have them push their toes up against your hand, not your foot into my thigh, but - there you go - alright, and then relax. Do it again. Then just move your thumb perpendicularly until you feel the change in tissue density as she goes from contract to relax, contract to relax. "Wiggle your toes," is probably the easiest way I think. Once you figure out where those muscles are, we go back to the same technique or protocol that we've been using for our static manual release techniques. Knowing your trigger points does help, it will help you be more accurate faster. What you're really looking for is increased tissue density in fascicles, and the muscles you're looking for, and if I kind of run my fingers perpendicular across the guitar strings that are her fascicles, and notice right in here I have a very taut band. I'm then going to move proximal and distal to see if I can find a nodule in that top band, or a knot that's pulling my fascicle tight. Once I find it, nice broad finger strokes, apply some pressure to to help stabilize that trigger point. Once again, I'm not putting my finger tip on top of a marble. I can put some tension, stretch those fibers by pressing her toes down, and pressing her ankle into plantar flexion. The one big downside of this technique is, it's a bit tough on the hands, because rather than being able to use dummy thumb and bodyweight pressure, I more or less have to stabilize her lower leg, and stabilize my hand on one side, and then use my thumb to apply pressure in both a lateral to medial direction, and a little bit of an anterior to posterior direction, and use the other hand to stretch the fibers. It's really my grip strength getting this done. I understand for some of my smaller practitioners who work on large bodies, this is not going to be easy. You can do the dummy thumb approach, but I think you're just going to find that the tissue gives away a little bit, and it might be a little harder to get a release, there's a little give and take there. So all I'm going to do is, once again, stretch these tissues out with this hand, and hold this way. I can also come in, and do it this way, same thing, I find that tissue, find that nodule, apply pressure, and then I can use my other hand. Once I have that nodule compressed, I'm going to go ahead and wait about 30 seconds, until I feel the tissue start to melt under my fingertips. Sometimes it happens faster than 30 seconds. Sometimes you'll get releases really quickly in 5, 10, or 15 seconds. Once I get a good release, I can then move from extensor digitorum longus, to, let's say, below the halfway point in the tibia, and start looking for extensor hallucis longus. -Wiggle your toes- There it is, right there. Lie on the fibers that are expressing a little increased tissue density, find my nodule, removing proximal distal again, go ahead and compress, and stretch out, and maybe this one I could use that other protocol of several five-second repetitions. That several five-second repetitions protocol works really well for somebody who has very active trigger points and is super sensitive. In that protocol I could start with a really light touch for five seconds, and then back off, and then a little harder touch for five seconds, and then back off, until I got to that more standard resistance from the tissue. I've explained this in other videos where you have that nice linear increase in tissue density as you get deeper and deeper, and then all of a sudden it spikes. All of the sudden the tissue density gets a lot more resistant, you're just going to push right into that resistance. If you push too hard, the muscle starts pushing back, and you'll never get a release. If you don't push enough, you also won't get a release. -How do you feel? -Good. -Feeling it kind of melt away, the decrease in discomfort? Then I could retest a range of motion, or retest tibialis anterior activation. For a close-up recap, you can see here I got the two trigger points marked out for extensor digitorum longus and extensor hallucis longus. It is helpful to know, where those trigger points are located, they are fairly consistent. They tend to be related to the neuromuscular junction, which is a fairly consistent point within the middle of the muscle belly of most muscles. You can see her tibial crest right here, go ahead and dorsiflex for me, there we go, you can see her tibialis anterior pump up a little bit, and she goes that way. The easiest way to get to the extensor hallucis longus, and extensor digitorum longus, is just to fall off the muscle belly of the tibialis anterior. -Relax... good. If I fall off, I didn't feel these stringier muscles right here, but still in front of her fibularis muscles, and feel these stringer your muscles. If I need to double check my palpation, -wiggle your toes-  and feel their fibers kind of feels like fingers doing this, underneath my fingers. Then I can look for the most dense fascicles, assuming that there's a nodule within that fascicle that correlates with a trigger point, I can move proximal and distal, I can start using the other hand to push her toes down into flexion, as well as her ankle down in a plantar flexion, and then, unfortunately, with this one guys, I do kind of have to use my grip strength to get a release. It would be nice to be able to do dummy thumb and hand over thumb pressure, but if I do that, I lose my ability to lengthen tissue at the same time, increasing tension and stabilizing that trigger point for me to press against. Once I get a good release, maybe after a 20 to 30 second hold, I can then start moving down a little bit, seeing if I can find more tight fascicles in her extensor hallucis longus. You can see this little dot I have right here is where I found the trigger point earlier. I've got to make sure this time, I lengthen her big toe. I flex her big toe, and push her into plantar flexion. Again, I'm going to use my grip strength. You could use either this grip, which is kind of an underhand grip, or if it was more comfortable for you to go the other way, and I put my left hand here, right hand here, as opposed to right hand, and left hand here. You can experiment with which direction is more comfortable for you. I don't think it particularly matters. I do find that anterior to posterior, with a little bit this way, like I'm driving towards the table, with some medial to lateral force, helps pin down those trigger points. So find them with your perpendicular palpations. Find the most tight fascicle, find the nodule, a little bit of anterior to posterior as well as lateral to medial, along with some stretch in the tissues, and you should get a nice release in about 30 seconds. In closing, extensor hallucis longus, and extensor digitorum longus static manual release, is one of those techniques that individuals have to rely on manual therapists for. It can make you look like a magician, because that extensor hallucis longus and extensor digitorum longus plays this overactive synergist role to the tibialis anterior in lower extremity dysfunction. Sometimes you release this muscle and all of a sudden everything else starts to work better. You start getting better releases in the gastroc and soleus complex, you start getting better muscle activation from your tibialis anterior. Make sure, before you put your hands on somebody, you have good reason to believe that this synergistic dominance of extensor hallucis longus and extensor digitorum longus does exist. They're showing signs of lower extremity dysfunction, whether that's knees bow in, knees bow out, feet flat, feet turn out, excessive forward lean on the overhead squat assessment, you're looking at possibly a lack of dorsiflexion on goniometric assessment, and, of course, maybe failing that gastroc-soleus length test in the sense that they're lacking dorsiflexion regardless of whether you bend the knee or straighten the leg. All of these tests could be good indicators for trying this particular technique. As with all manual techniques and all palpation techniques, try to practice on colleagues first. Grab a few friends, grab a few fellow professionals, and start testing this technique out on each other, comparing pressure and handholds, and trying to really define what feels good, and then what feels not so good. Maybe what feels professional is getting effective releases, versus what feels inconsistent and not confident, which is not going to help your outcomes. I look forward to hearing how you guys do with this technique, I look forward to hearing your questions about this technique, and I look forward to hearing what type of outcomes you get by adding this technique to your arsenal. Thank you. 

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Manual release techniques for the commonly overactive muscles of the lower leg. Soft tissue release techniques for the gastrocnemius, fibularis longus/brevis, extensor hallicus longus, extensor digitorum longus, flexor hallicus longus, and flexor digitorum longus. Advanced soft tissue, massage, trigger point palpation, and mobilization techniques to inhibit antagonists. The reliability and validity of manual release techniques for excessive forward lean, asymmetrical weight shift, feet turn out, feet flatten, knees bow in, knees bow out, chronic ankle instability, and lower leg dysfunction.

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