0:00 This is Brent coming at you with another manual stretching video. In this 0:03 video we're going to go after one of our most commonly overactive muscles, one of 0:07 those muscles that tends to be adaptively shortened in almost everybody, 0:11 definitely everybody with lower leg dysfunction, and that's the calf complex, 0:15 a very stubborn muscle that could use a good stretch in nine out of ten 0:21 individuals that I see. I'm going to have my friend, Leanne, come out and help me 0:24 demonstrate this exercise. Now, Leanne is going to set up so that she scoots 0:29 back on the table lying face up, with her heels just off the table. Now, if I was 0:35 doing this for me without the cameras here I'd want to concentrate on my 0:39 mechanics so I don't hurt myself if I'm going to be doing this all day. I would actually 0:43 have Leanne and go ahead and scoot as close to me and she possibly could, and I'm 0:46 blocking my hip out so I don't push her off the table. And then, I would have this 0:52 ankle nice and centered so that I don't have to lean over the table and 0:56 compromise my own low back. Now, for you for the camera, so that you can 1:00 see everything I'm doing with my hand placement, which is the more complicated 1:03 part, I'm going to move Leanne into a slightly different position. I'm going to 1:07 have Leanne go ahead and scoot back towards you, and then I'm going to 1:10 have her take this leg and move it out of our way. Now, we need to do a little 1:14 review of our anatomy of the ankle, and a little bit on the mechanics of the ankle, 1:17 so that we ensure that this stretch is effective for everybody that we do it on. 1:21 Now, we've got to remember that we've got two bones in the leg attached to our 1:26 ankle. We've got the tibia and the fibula which ends in our medial 1:31 malleoli and lateral malleoli. So those are the top bones of our ankle 1:36 complex, and then just below that we have our talis, which 1:40 we're going to palpate here in a second, and then we have our calcaneus which is 1:44 our heel bone. So, sandwiched between your tibia and fibula and your calcaneus, is 1:51 this often forgotten bone, the talis, which plays a huge role in making sure 1:57 that this stretch is as effective as possible. So, first things first, let's 2:01 find out how to palpate this little bone. I want you to slide your fingers 2:06 over the lateral and medial malleoli, then I want you to go just distal and 2:12 anterior into these little divots right here. If you push into inversion you 2:17 can actually see that divot a little bit, if you push into eversion you 2:21 can see the divot on the other side. If you put your fingers and those divots 2:25 you'll actually feel the bone pop into your hand. So, if I push her this way the 2:30 talis pops into my hand that way, if I go this way the talis pops into my hand this 2:35 way. So now I know where that talis is, I'm nice and comfortable. But 2:39 obviously you know where the heel bone is, so make sure you 2:43 have a good feel of what that calcaneus feels like. So, in individuals with 2:47 dysfunction, this bone has a tendency to move anteriorly, which we look at this 2:53 three bones set, if it moves anteriorly this bone in the middle blocks us 2:56 from getting into dorsiflexion, and we never get this stretch in the calf. I 3:00 know some of you have already felt felt this. You've gone to do a calf 3:03 stretch, either had your calf manually stretched or done it yourself with maybe 3:07 a slant board, and rather than feeling a stretch in your calf you feel nothing at 3:10 all or a pinch in the front of your ankle. So we need to figure out 3:13 how to reduce that. What you're going to do is you're going to wrap your hands 3:17 around the calcaneus like this. We're going to create just a little 3:21 distraction, just a little pull this way so we open up the ankle complex. 3:25 Don't yank on the ankle. I'm not trying to pull the foot off of the 3:29 leg, we're just going for a little distraction. So I'm going to use these 3:33 three fingers for me, wrapped nicely around Leanne's calcaneus, and then all I 3:38 did you saw is I just shifted my body weight over a 3:40 little bit, so that she feels just a little bit of downward pressure on that 3:44 calcaneus. That'll open the space here so that if I use my webspace, and I 3:52 stabilize that talis, as I pull into dorsiflexion this way, I get this nice - 3:59 this is my talis, this is my calcaneus, everything shifts like this. The talis 4:04 should move posteriorly as we go into dorsiflexion. So all I'm doing with all 4:09 of this crazy hand placement is ensuring that that happens. So we got calcaneus, a 4:15 little bit of distraction, talis, a little bit of posterior shift, so 4:22 stabilizing and pushing down a little bit with my webspace, and then I'm going to 4:27 pull up anteriorly on my calcaneus, while wrapping my forearm around this way, to 4:37 bring me into dorsiflexion. So let's review all that really quickly one more time. 4:43 Distraction, posterior shift, pull up on calcaneus, and now we're in the perfect 4:50 position to get a nice stretch on her calf. So I'm in position here, I 4:56 want to make sure that my fingers are wrapped around the front, but my forearm 5:00 is wrapped around behind like this. My arms I want to get nice and straight. 5:05 Once you have your hand position down, you want to get nice and straight 5:08 this way so that I'm pulling her into dorsiflexion by simply taking a nice 5:13 wide step, going into a little lateral lunge, and using gravity and my body 5:17 weight to pull against her calf. Now, obviously I have a huge size advantage 5:22 on Leanne. That is not going to occur with every client or patient that you 5:27 have. So you need to ensure that you're using great body mechanics, and not 5:31 muscle, I see this every once in a while where people are using their 5:35 finger flexors and trying to use their biceps to get a good stretch. You're 5:38 going to wear out. This is a huge strong muscle that lifts somebody's entire body 5:42 weight with every step. So, good body mechanics, I'm going to go a little 5:48 distal, pull a little distraction, stabilize, arms straight, shift over. How 5:57 does that feel? -Great. If you wanted to use your PNF protocols with antagonist 6:02 and agonist contraction you absolutely could. If not, static stretching is very 6:06 effective for increasing the length of an adaptively shortened muscle. We would hold 6:10 this position for 30 seconds to 2 minutes until we felt a release. We'd 6:14 go a little further, and we'd do that for up to three repetitions. Now, just a 6:19 couple things to show you because I know you're probably curious what's 6:22 going on with my hand on the other side, let me see your other leg really 6:25 quickly. Just so you see, if you got all of the setup here, what happens with your 6:31 hand on the other side is actually it just kind of falls into place. 6:35 So I'm going to do my distraction. I'm going to brace down on my talis this way. 6:42 And you can kind of see my thumb just kind of ends up over the bottom of 6:45 my fingers, mostly because I have really large hands. Your fingers might 6:48 end up in slightly different places. I'm going to come this way, and 6:53 then I'm going to pull, and I know you see me blocking this out. So, once 6:57 again, this is my hand position on this side. A couple things that I don't like 7:01 to see on calf stretching which I do see in gyms a lot, as well as some therapy 7:06 studios and some ATCs, it's just a little bit of poor technique that we may 7:10 need to think about a little bit more. Every once in a while I'll see somebody bear 7:14 down on the forefoot this way. I understand the calves are big and strong 7:18 and we're trying to get some leverage, but there are a lot of other joints in 7:22 here, in the forefoot. These muscles that stabilize the bottom of the foot are not 7:27 particularly strong. If I push down on the forefoot I think I am probably just 7:34 as likely to stretch out those muscles that stabilize our medial longitudinal 7:37 arch as I am to stretch out the calf. Of course this has a postural, that is, a 7:43 movement impairment impact. If I continue to stretch out the medial stabilizers of 7:49 my foot, I could, over time, stretch somebody into flat-footedness. So we 7:53 definitely don't want that. The other thing I sometimes see, which really, 7:57 really worries me more than anything else, is every once in a while I'll see 8:01 somebody get up here and try to stretch down on the calf. Now, usually this is a 8:07 pretty intense feeling, and sometimes people end up feeling it all the way 8:11 into the back of their leg. Well, if we use a little logic we know that our 8:15 calves don't cross up into the back of our leg, they certainly don't cross our 8:19 hip, right. Our gastroc crosses the knee, I get it, but it certainly doesn't 8:24 go up this high. So if we have a sensation, we might need to think about 8:27 some of the other structures that we can affect. The only structure that crosses 8:31 behind our hip, behind our knee and behind our ankle, and would be stretched 8:37 by all three joints combined going into flexion, extension, and dorsiflexion, is 8:43 our sciatic nerve. So this becomes an awesome sciatic nerve 8:48 stretch, and there's not a reason to stretch a nerve. Stretching nerves, as we 8:54 know, reduces their blood supply, and could create damage, could create some 8:57 sort of at least short term damage. You could end up with a very upset patient 9:02 or client who has tingling for several weeks while that nerve has time to, I 9:07 guess, regenerate or recover from the stretch that you just did. We need to 9:12 make sure that when we do stretches we're in a nice neutral position at the 9:15 hip, nice neutral position of the knee, so that no matter how far we press into 9:20 dorsiflexion we're not going to end up stretching nerves and stretching 9:24 structures that we didn't intend to stretch. So, a really quick review here, 9:30 we're going to go a little bit of distraction, we're going to place our web 9:36 space just below our medial and lateral malleoli, we're going to press 9:42 distraction, press down posterior on the talis. We're going to wrap our forearm 9:48 around so it's just underneath the metatarsal head to the ball of the foot, 9:53 I'm going to get my arms up nice and straight and I'm going to shift over. I 9:57 hope you get great results from this stretch, I think with a little 10:01 practice you'll see some really big benefit that maybe you haven't seen in 10:05 the past. I'll talk with you soon.
