resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
CRREW Rallies for Ongoing Acupuncture Relief Effort in the Philippines
On November 8, 2013, Typhoon Yolanda (Haiyan) made her way through the Philippine Islands, leaving in her wake at least 7,000 people dead, millions homeless and complete communities destroyed.
Don't Trust What a Patient Says
When a patient presents to the office for care, they typically have a specific complaint in mind – lower back pain, whiplash, sinus congestion, sciatica, etc.
Wellness: A New Buzzword at the Aging in America Conference
Aging in America is "the nation's largest gathering of a diverse, multidisciplinary community of professionals in healthcare, social service, government, business and philanthropy with expertise in providing services and products for older adults."
Employers Need Chiropractic First and Sooner
From the Journal of Occupational and Environmental Medicine comes a study that gives excellent direction to employers (and insurers) regarding the management of low back problems (LBP).
Low Melatonin Linked to Risk of Advanced Prostate Cancer
Epidemiological and experimental studies suggest the hormone melatonin, which plays a role in regulating the sleep-wake cycle, may play a role in the development of prostate cancer, as lower melatonin levels have been associated with an increased risk of prostate (and breast) cancer.
Deciphering the New CMS-1500 Claim Form
Q: I am confused about how and when to use the new 1500 form, particularly block 14 and block 15. What is required and how do I properly fill out these fields? And do I actually have to use this new form or may I continue using the old version?
Medical Qigong for the Heart: Part I
According to the Center for Disease Control and Prevention, heart disease is the leading cause of death in the United States, affecting people of all ages and backgrounds. Coronary heart disease, in just the United States alone, costs close to 109 billion dollars a year.
Medial Knee Pain: 11 Potential Causes (and Corrections)
We have all seen patients with medial knee pain that either has no traumatic origin or lasts well beyond when it should be resolved. How can we help these patients? Here is an overview of clinical scenarios and how we can provide conservative care.
Home Sweet Medical Home
While the Affordable Care Act (ACA) has received its fair share of praise and criticism since its adoption, few question the value of its emphasis on collaborative, patient-centered health care.
News in Brief
D'Youville Vet Program Gets High Praise; A Moment of Silence for Dr. Paul Reginald ("Reg") Hug.
The Search for the Origin of the Wiggle Technique
When Bob had adjusted me previously, most of the time I knew what he was doing. But this time, he had me lie on the treatment table in the usual side-posture position, and he "wiggled" my sacroiliac with the fingers of both hands, while stabilizing my pelvis with his forearm.
News In Brief
Pacific College of Oriental Medicine obtains grant funding from NIH; Yo San University of Traditional Chinese Medicine Announces New President; Kentucky Gets Licensed; PCOM Receives Approval from WASC to Offer FPD.
Replenishing and Restoring Jing
I learned an important principle from my great Taoist Master Sun Hak. He taught me that all people "leak" Jing, and that we can mitigate or stop this leaking, and as a result strengthen our life force, develop enhanced adaptability and lengthen our life.
New Leadership Era at the WFC
The World Federation of Chiropractic recently announced not only a new president, as is customary every two years, but also an incoming secretary-general, marking the first time since the WFC's inception in 1988 that someone other than David Chapman-Smith, Esq., will serve in that capacity.
Shared Mechanisms Between Computer-Assisted Mechanical Adjusting and Contemporary Acupuncture?
Can contemporary acupuncture provide clues to the mechanisms responsible for pain relief provided by computer-assisted mechanical adjusting instruments, and clarify whether certain mechanical frequency combinations are superior to others for modulation of acute peripheral pain?
Vibrational Medicine: Frequency Micro-Current and Color Acupuncture
Vibrational medicine involves the application of various forms of energy frequencies to the body for pain relief, healing and rejuvenation. Vibrational medicine will become a major growing trend in our medical systems for the following reasons:
Halt Allergies With Moxibustion Therapy
An allergy is an immune system disorder in which the body is hypersensitive to normally harmless substances in the environment.
The Boston Benevolent Chiropractic Clinic: Standing Up for the Needy
Our chiropractic assistant, Bridget, greeted an arriving patient at the Emmanuel Church in downtown Boston. She said, "Hi, Michael, good to see you. It's been awhile. Have a seat and Dr. Ken will see you soon."
"Doctor ... Always Do the Right Thing"
So says "Da Mayor" in the iconic Spike Lee movie. As a fresh grad questioning in-network versus out-of-network, it struck me that some doctors have explicitly skirted the issue, while others have argued adamantly for the latter and "sticking it to the man."
Changes in Herbal Medicines from Ancient Times to the Present
The classical literature of Chinese medicine remains highly relevant in the modern era, as many of the basic theories and herbal combinations emphasized in clinical practice were first established in texts that are nearly 2000 years old.
Working With The Yuan-Source Level: Resonance and the Extraordinary Vessels
How do we stay fresh with our medicine? As healers, how do we balance our medical selves with creative artistry? Chinese Medicine is not a fixed dogmatic entity, but a living system, reliant on a mysterious force called "resonance."
The Importance of Knowing Mainstream Lingo
There is a secret lingo within mainstream medicine of which the vast majority of acupuncturists and Chinese medical professionals are unaware.
We Get Letters & E-Mail
Imagine What More Could Be Achieved With Your Support; A Lesson in Hygiene: What Do You Do in Your Office? Open Letter to the Profession.
March, 2010, Vol. 10, Issue 03
Trigger Points in the Fibularis Tertius Muscle
By David Kent, LMT, NCTMB
Ankle and heel pain is a common complaint. Patients often are surprised to discover their pain is caused by trigger points in the fibularis tertius, a small and easily overlooked muscle in the front of the lower leg. This article will review the anatomy of the fibularis tertius muscle and discuss the trigger points that cause lateral ankle and heel pain, as well as treatment techniques and ways to educate your patients about the causes of their pain.
The name of this muscle has changed over the years. Fibularis tertius has replaced the older term, peroneus tertius. Peroneal was derived from the Greek terminology meaning "a pin." Pointed objects like sewing needles were termed perone by the Greeks. The Latin word fibula also means "a pin or skewer." In some animals, the fibula often is very narrow and has sharp tips (styloid processes), thus it is probable that this bone was named for its resemblance to a pin, or sewing or knitting needle. Tertius is the Latin word for "third," or "concerning the third." This muscle attaches to the lower third of the fibula and is one of three muscles attaching to the fibula that everts the foot.
The lower leg contains two bones: the tibia and fibula. The tibia, the bone on the medial side, is the larger weight-bearing bone and forms the medial malleolus. The fibula, the smaller slender bone on the lateral side, is not a weight-bearing bone and forms the lateral malleolus.
The leg is divided into three fascial compartments: anterior, posterior and lateral. The fibularis tertius is located in the anterior compartment, whereas the lateral compartment contains the fibularis longus and brevis. The interosseous membrane that runs between the fibula and tibia divides the anterior and posterior compartments. The anterior intermuscular septum divides anterior and lateral compartments. The posterior intermuscular septum divides posterior and lateral compartments. (See Photo 1) Proximally, the fibularis tertius attaches to the distal third of the anterior surface of the fibula, the interosseous membrane and the adjacent intermuscular septum. In the foot, it attaches on the dorsum of the base of the fifth metatarsal. (See Photo 2)
The primary actions of the fibularis tertius are dorsiflexion of the ankle and eversion of the foot. The fibularis tertius dorsiflexes the ankle along with three other muscles: fibularis longus, fibularis brevis and tibialis anterior. It also acts to evert the foot, assisting fibularis longus and brevis.
It is important to assess, treat, lengthen and strengthen, as appropriate, the synergistic and antagonistic muscles that cross the joint. A muscle-movement chart is a quick reference tool that groups joints by body region and then lists the muscles that create each specific joint movement. A muscle movement chart also shows the degrees of normal range of motion (ROM) for each joint. This information provides a list of muscles to target and helps therapists develop a comprehensive treatment plan with goals that include improving ROM.
Patient complaints typically include weakness in the ankle and/or pain and tenderness in the ankle, behind and over the lateral malleolus. Whenever a patient reports a trigger point during treatment, take a moment to show them the specific referral pattern on a trigger point chart. Utilizing charts as visual aids to educate your patients about trigger point patterns is a powerful way to demonstrate your knowledge and understanding of the patient's pain. (See "Tools to Succeed for Massage Therapists," MT May 2009.)
Trigger points in the fibularis tertius muscle usually are palpated proximal and anterior to the lateral malleolus. The referral pattern for fibularis tertius trigger points is "pain and tenderness along the anterolateral aspect of the ankle with a spillover patterns projecting downward behind the lateral malleolus to the lateral aspect of the heel."1 (See Photo 3)
There are many reasons trigger points form in the fibularis tertuis. Sometimes they are caused by activities and/or events that occurred months, years or even decades before the onset of the chronic pain. A few examples include inversion sprains of the ankle, wearing too-tight running shoes, work boots or ski boots, direct trauma, a new activity requiring overuse of the muscle, and weakness from prolonged periods of immobility due to injury.
Postural analysis photos will reveal the stresses patients place on their muscles. (See "Getting Comfortable with Postural Analysis," MT July 2008) Intake forms, postural analysis, gait evaluation and orthopedic assessments will help you uncover a lot of information that will prepare you for the hands-on treatment.
Muscle Test: Palpation of the bony landmarks coupled with muscle testing will ensure you are specifically isolating and thoroughly treating the correct muscle. To muscle test the fibularis tertius, place the patient in a supine or sitting position. Support the patient's leg with one hand just above the ankle joint so your palm is cradling the Achilles tendon. With the other hand, apply pressure against the lateral side and dorsal surface of the foot with pressure in the direction of plantar flexion of the ankle and inversion of the foot. Instruct the patient to dorsiflex the ankle and evert the foot while you apply resistance.
Check for Sensitivity: Palpate along the belly and tendon of the muscle to check for sensitivity. Treatment should not cause pain.
Fifth Metatarsal: Treat the tendon attachment on the dorsal surface of the base of the fifth metatarsal. Apply static pressure and then integrate muscle-fiber and cross-fiber techniques. Start on the base of the fifth metatarsal and follow the tendon anterior to the lateral malleolus. (See Photo 4)
Tendon: Apply lubrication to the skin. Using distal to proximal gliding strips on the muscle, follow the tendon along the front of the lateral malleolus.
Belly: Glide distal to proximal on the belly of the muscle. Treat the attachment on the anterior lower third of the fibula. (See Photo 5)
Conclude your sessions with a brief explanation of the problems you identified and how ongoing massage therapy can help. Tell your patients you will design a customized treatment plan to address the soft-tissue components of their pain, and educate them on the use of ice, heat and other methods of self-care. Provide a stretching routine so patients can continue to improve and maintain themselves between visits. Show your patients proper home and work ergonomics (using computers and phones, lifting, etc.).
I wish you best in the treatment room. Please drop me a line to tell me about your results.
Click here for more information about David Kent, LMT, NCTMB.
Join the conversation
Comments are encouraged, but you must follow our User Agreementcomments powered by Disqus
Keep it civil and stay on topic. No profanity, vulgar, racist or hateful comments or personal attacks. Anyone who chooses to exercise poor judgement will be blocked. By posting your comment, you agree to allow MPA Media the right to republish your name and comment in additional MPA Media publications without any notification or payment.