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Fibularis Muscles Static Manual Release
Fibularis Muscles Static Manual Release is a gentle, hands-on technique used to address chronic tension and pain in the lower leg muscles. This soft tissue release aids in restoring natural balance to the body and promotes circulation, flexibility and mobility of the affected area. It is a safe, easy and effective procedure that works by manually applying pressure to the specific regions of tension in the lower leg muscles, allowing for deep release of the fibularis muscles. This release is best done by
Transcript
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This is Brent of the Brookbush Institute.
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...blank
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In this video we're going over static
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manual release of the peroneals, or
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fibularis muscles. This is an
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educational video. I'm assuming that if
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you're watching this video, you're a
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licensed, manual practitioner, physical
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therapist, athletic trainer,
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chiropractor, or massage therapist, and
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that you are going to pay attention to
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the laws specific to your scope of
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practice in your state. If you don't know
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what those are, they might be worth
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looking up before you try this on a
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patient or client. I'm going to have my
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friend Melissa come out, she's going to help
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me demonstrate this technique. A
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little general rule, if you're going
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to put your hands on a patient or client,
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it is good practice to know, within
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80%, to have a good strong
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hypothesis, that where you're going to
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put your hands is involved in the
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dysfunction or pathology that you're
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treating. The only way to be able to do
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that is to do some level of assessment.
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If I'm thinking that the fibularis
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muscles are involved in Melissa's
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pathology or dysfunction, chances are
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I've done something like an overhead
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squat assessment, and maybe I've seen feet
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flat, which would be an indicator of
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fibularis muscles being overactive. Maybe
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I've done dorsiflexion goniometery.
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My fibularis muscles are plantar flexors,
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which means that could also be an
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indicator that they are overactive. If I did
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that gastroc-soleus muscle length test,
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if you go back to that video, you
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can see where I mess with eversion and
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inversion and, if you take up some slack
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in the fibularis muscles, pushing the
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ankle and the eversion, and that gives
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you more dorsiflexion, that's also an
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indication that the fibularis muscles
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might be involved. Keep in mind,
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before you get to this point with
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your patient or client on a table and
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you ready to put your hands down, you
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should probably have a good idea that
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those muscles are involved. In this
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particular technique, I'm going to have
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Melissa flip on her side.
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That way my fibularis muscles,
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which are on the lateral side of my
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lower leg, are now facing me. The first
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thing I need to know is how to palpate
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the fibularis muscles. Your fibularis
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muscles lie just anterior to your
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soleus. If I want, I could have
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Melissa go ahead and plantar flex, push
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down into my thigh so her soleus pops out
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right there, and then her fibularis
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muscles would be the divot right in
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front of it or just anterior to it.
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In fact, if I put my fingers here, and I
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kind of rub back and forth, you can
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almost feel the soleus does this,
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and then drops off, and then your
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fibularis is this little bump,
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this long half-circle right in
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front of the border of the soleus. You
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don't want to go any further anterior or
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you run into that anterior mass, that's
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your tibialis anterior and your long toe
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extensors. Alright, so we got this right
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here, the superior border, what I don't
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want to go higher than, is my fibular
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head, which if you rub your
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fingers up towards the knee in a broad
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fashion, eventually you're going to hit
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this hard bump. That hard bump is
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her fibular head. Right underneath that
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you can start to feel the fibularis
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fascicles. Anytime we find, or we are
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looking for, a point to release, it is
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helpful to know your trigger points. That
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will give you a good general indication
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of where you should be releasing. These
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trigger points are really consistent. The
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theory is that the dysfunction is
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happening around the neuromuscular
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junction, especially in these overactive
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muscles, and that right around the
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neuromuscular junction, we have this
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point of localized hyperactivity that
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releases with compression. So, knowing
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those points is definitely helpful and,
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I've actually put an X here on her
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trigger point for her fibularis longus,
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and a trigger point
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for her fibularis brevis. If I didn't
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have that memorized, I could still find
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them. What I'm going to do is
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strum across her fascicles, perpendicular
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to those fibers. Her fibularis muscle
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runs this way, I'm going to go ahead and
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strum with a nice broad pat of my thumb
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across those fibularis fibers, and what
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I'm looking for is fibers that feel
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more dense, that feel more
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resistant. Now, you're fibularis
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muscle isn't like your calf. If you've
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watched that previous video from us, it's
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not like your calf where you can compare
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fibers within the same muscle. It's a
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much narrower muscle. Chances are,
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we're going to have to palpate a fair
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number of fibularis muscles to
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determine what's normal, and then what's
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overactive. But, if I do this, I do feel a
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little bit of over activity, and,
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Melissa's fibularis longus here, and then
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what I'm going to do is
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start searching proximally and distally.
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What I'm going to assume is
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that that fascicle is being pulled tight
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by a knot that is her trigger
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point, and if I palpate, and I can see
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right around here, all the
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sudden I feel a
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little nodule under my thumb. The way
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I'm going to release this is, I'm going
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to use a broad thumb this way.
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I'm going to use this entire thumb pad,
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other than trying to to poke at it, which
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is a little bit like trying to put your
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finger on top of a marble, it just
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doesn't work, it just keeps slipping
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either way. Let me use a nice broad thumb,
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this way, I'm then going to push her into
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a little bit of inversion and
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dorsiflexion, because that's going to
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help tighten up this muscle a little bit
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so that the trigger point
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stays centered. Between that
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broad thumb stroke, and the tension I put
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within the muscle, I now have a
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stable trigger point to put some static
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pressure against, which is going to
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increase the likelihood that I actually
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get a release. The way I get her into
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inversion and dorsiflexion is, I'm
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actually just going to use my thigh, I'm
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going to bring my leg up a little bit
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and then just drop it down. There's my
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inversion, and then I can just lean
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forward a little bit, and I have my
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dorsiflexion. Broad thumb here, this is
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going to be my dummy thumb, I'm then
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going to put this dummy thumb right
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in between my thenar eminences,
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right here, and then all I have to
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do is lean in until I feel that
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increase in tissue tension
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right there. I don't have to go to
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maximal tension. Usually what
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I'm feeling for is the
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tension within tissues, there's a linear
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increase, you get this slow
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increase, you just kind of push into the
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tissue, and then you reach a point where
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all of a sudden going any further,
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the tension increases very rapidly. I'm
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just going up to that point. It
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takes a little bit of practice because
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if you push too hard your patient or
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client will start guarding on you, the
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muscle will really start fighting back,
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and you'll never get a release. If
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you don't use enough tension, you also
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won't get a release. The thought
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process there is, you're probably not
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stimulating enough ruffini endings,
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enough of that golgi tendon organ, to get
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autogenic inhibition. I'm
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going to hold this for 30
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seconds. Usually what happens is, they get
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a decrease in discomfort. They might even
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ask you "did you let go, did you
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lighten up" and you're just keeping
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consistent pressure. What you'll feel
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underneath your thumb is the trigger
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point and the hypertonic fascicles, the
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overactive fascicles will actually kind
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of melt away underneath your thumb,
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and that was it for Melissa.
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Now I know she
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has a fibularis longus and brevis, so I
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could keep searching. Your fibularis
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brevis starts a little lower, a little
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lower than a the halfway mark of
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your tibia. If I start going
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across here, I feel some
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overactive fascicles. It's just
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finding where that nodule is, and
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again, I marked these X's over her
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trigger points, and I did that using of
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course, my knowledge of where the common
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trigger points are, and then I palpated
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before the video started. But, I'm going
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to do the same thing, I'm going to use a nice
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broad thumb, little inversion, little
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dorsiflexion, go ahead and put my hand
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over my dummy thumb, apply pressure until
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I feel that big increase in tissue
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resistance, and I'm going to hold.
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There is another protocol
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that uses four to six 5 second holds,
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and you can do that too, especially with
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trigger points that are really
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tender. We'll just push into that
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tissue barrier, 2 -3 - 4 - 5, and let up, but,
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I'm not moving my thumb. I want to keep
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that position, 1- 2- 3- 4- 5, and let up, and
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usually what you'll find is over
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several reps, the tissue density and
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activity will start to calm down.
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I do prefer static holds myself, but try
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them both. They're both effective
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methodologies, both are backed up by some
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pretty good theory, and supported by some
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very effective practitioners.
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This is
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our close up recap. Notice, I already have
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the fibularis longus and fibularis
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brevis trigger points mapped out for us.
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It does help to know where those trigger
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points are at, but if I have Melissa go
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ahead and plantar flex into my thigh,
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you start to see this little
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shadow pop up, and the shadow is just
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anterior
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to the anterior border of the soleus, and
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it's caused by the contraction of the
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fibularis muscles pulling down on that
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crural fascia. If I palpate this way across
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the fascia, I can actually feel - go
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ahead and plantar flex again - I can feel
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the anterior border of the soleus, and
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then a little speed bump shape right here
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of muscle tissue, kind of like a half
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foam roll shape, and that is the
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fibularis longus right there. If I go any
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further anterior of course, I end up on
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the anterior tibialis, and the long toe
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extensors.
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Once I know where this trough is, I can
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start looking for hypertonic or
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increased tissue density, increased
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activity in this muscle, I can start by
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going as proximal as I possibly can, and
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I run right into her fibular head. That's bone that's not going anywhere.
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Start palpating across transversely here,
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and I feel a little increased tissue
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density right here, so now I'm going to
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start messing around, going distal, and
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see if I can find a nodule or knot
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contributing to the tautness in that band.
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Right here I feel something, so what
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I'm going to do is I'm going to help
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stabilize that trigger point by pulling
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these tissues a little tighter. The way
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I'm going to do that is use this thigh
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to push down into inversion, and then up
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into dorsiflexion, and I can feel,
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all of a sudden, it go "whoop",
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and almost center that trigger point
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for me, so that I can then use a nice
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broad thumb to just push right up
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against it. Then I can relax and use this
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hand, straight arms, put my shoulders up
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over my hands, press as hard as I need to
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to get to just when that tissue starts
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pushing back pretty good. I don't want to
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go past that, just up to the point where
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the tissue starts pushing back,
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and hold. If i push too hard, her muscle
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pushes back really hard, I'll feel it
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increase in tissue density, and I'll
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never get a release. If I don't push hard
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enough, I probably won't stimulate enough
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receptors to get autogenic inhibition
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and get a release, so it does take a
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little practice to know how much
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pressure you should use. Once I get
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that release, and I can feel the tissue
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density kind of melting under my finger,
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I can move on to my fibularis brevis,
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which for the most part is going to
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be on the lower half of the tibia.
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Once again, I start doing my little cross
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fiber palpation, oh there, that's
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that's a nice increase in tissue density
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right there, so now I start messing
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around, and sure enough, find a little
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nodule right there. Same thing, I'm going
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to push down into inversion, up into
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dorsiflexion, and then apply my pressure.
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I could use, if Melissa was getting
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really sensitive, that on-off
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sort of protocol which is 5
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seconds on, 2 to 3 seconds off. The only
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times I tend to use that protocol
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personally, is when somebody's so
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sensitive that I can't get to that
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increase in tissue resistance, so that I
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can get that mechanical release I'm
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looking for. I almost have to slowly
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desensitize the tissue until I can get
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deep enough. Last thing I want you
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to notice is how this bottom leg
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is positioned. Make sure that
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you don't get somebody like this, because
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you'll just put some lateral to medial
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sheer force through their knee, which is
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probably not going to feel very good. So
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I have her lower leg braced
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underneath this top leg.
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There you
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have it, that was static manual
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release of the peroneals, or fibularis
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muscles. Make sure that before you start
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implementing this technique, you've
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had a chance to
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practice on some of your friends and
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colleagues. You want to get your manual
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skills pretty solid, because there's
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nothing like a shaky hand to affect
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patient confidence, and that's not going
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to help your outcomes. Make sure that
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before you put your hands on somebody,
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that you're 80% sure
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that that muscle is involved in the
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dysfunction. You don't have to be
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100% sure. You're not going to
00:15:2100:15:24
get it right every time, but, one of my
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biggest pet peeves is a practitioner
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goes, 'okay lay on the table', as soon as
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the patient or client walks in. You need
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to assess. Whether it's the overhead
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squat assessment, ganiometry, some
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sort of special test, a muscle
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length test... you need to have a good
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working hypothesis before you start
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poking and palpating and trying to
00:15:4700:15:50
release some of these overactive
00:15:5000:15:52
structures. I look forward to hearing
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what type of outcomes you got from
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this technique. Talk with you soon.
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