resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
An MD Who Understands the Opioid Epidemic
Doctors of chiropractic have an important role to play in ending the opioid epidemic and dealing with chronic pain by conservative means (see our top story in this issue) – but who's to blame for opioid dependence and abuse in the first place?
How to Stay Sane During the Elections: Understanding Through the Lens of Chinese Medicine
In Chinese Medicine philosophy, everything consists of Yin and Yang. The law of polar opposites – one cannot exist without its opposite.
What's New in Phytonutrition: Mangifera Indica, "The King of Fruits"
One hundred percent pure Indian green mango fruit (mangifera indica), harvested at a special degree of ripeness for efficacy and taste, can now be concentrated as a phytonutrient nutraceutical powder.
Sit or Stand? Analyzing a Mixed Message
I'm more than a bit confused. At my age, that seems to be a rather common occurrence. However, today more than ever, I'm getting a mixed message.
Acupuncture's Impact on the World
For several years, I have been hearing about the town of Rothenburg, Germany. It seemed just a dot on a map until I arrived. It is the home of the TCM Kongress which began in 1968. It has been held annually for 47 years and it has only missed one year.
Kansas Achieves Licensing Law
Kansas Governor Sam Brownback signed House Bill 2615 into law on Friday, May 13, 2016. HB2615 includes provisions for the licensure of acupuncturists in the state of Kansas.
Believe it or not, an estimated one-third of your patients have eaten some form of fast food within 24 hours of their appointment with you.
What You Say Isn't Always What Patients Hear
A few years ago, my aunt Edna (name changed for the purpose of this story) suffered a stroke. After a short hospital stay, she was transferred to a nursing home for rehabilitation. When she arrived at the nursing home, Edna requested a private room.
Insuring Quality Control in Herb Importation: An Interview with Wilson Lau
Wilson Lau is the vice president of Nuherbs, a Chinese herb importation company based in San Leandro, California. Before joining Nuherbs, he trained as a lawyer specializing in FDA law.
Adventures with the San Jiao
Those of us who have been in practice for several decades relish the way meridians and points reveal new diagnostic clues and new insights. I love to encourage my students to see this as an adventure that goes way beyond the textbooks.
Chronic Pain: Become Part of the Solution
I have lectured to more than 7,000 chiropractic physicians over the past five years regarding the chronic pain and opioid epidemic in this country.
The Pertinent Negative
We all have to perform evaluations on patients. Most of us don't like doing it – exams take time, and worse it takes even more time after the evaluation to put together a narrative summary of the findings. Sometimes, this process becomes downright tedious.
Acupuncture Muscle Trigger Point and Oriental Medicine Sports Therapy
It is difficult to ascertain the internal condition of professional basketball player Lebron James during game one of the 2014 NBA finals, in which he developed debilitating muscle cramps that led to his premature removal from the game.
AOM Hospital-Based Practice: A Future Reality?
The natural evolution of health care on the planet is integrative health. We may have some challenges ahead, but based on my research, all indicators are pointing in a positive direction. There seems to be an evolving consciousness among our patient population that is "getting it."
Tai Chi Documentary Premier
First Run Features recently announced the world theatrical premiere of Barry Strugatz's documentary The Professor: Tai Chi's Journey West, which premiered last month at the Laemmle Music Hall in Los Angeles.
Introducing the Acupuncture Today Digital Edition
In response to the changing habits of our readers, Acupuncture Today will introduce a digital edition of the publication (in addition to our print edition) beginning with the August 2016 issue.
Increasing the Value of Spine Care: CMS Approves New Low Back Pain Registry
The Centers for Medicare and Medicaid Services has approved the Spine IQ Low Back Pain Registry as a qualified clinical data registry for the Physician Quality Reporting System (PQRS) in 2016.
A Long-Overdue Win for Oregon Medicaid Patients - and the Implications for Other States
Beginning July 1, 2016, Oregon Medicaid patients with spinal pain (cervical, thoracic, lumbar, pelvic) who are determined to be low risk based on a biopsychosocial assessment tool (STarT Back – Keele University) can receive four chiropractic visits per episode.
Beating the Odds: Interview With Para-Powerlifter Adeline Dumapong-Ancheta
Since October 2015, the FICS Foundation, the charitable organization affiliated with the International Federation of Sports Chiropractic (FICS), has been supporting disabled athletes internationally.
Multivitamin Supplement May Reduce Breast Cancer Recurrence
There is a great deal of controversy regarding the value of multiple vitamin supplements in cancer prevention.
Treating Hip & Groin Pain With Abdominal Release of Upper Lumbar Nerve Impingements
Have you encountered patients with groin and hip pain you can't seem to solve? You know it's not a worn-out hip; you suspect the pain is somehow connected to the spine. But somehow, you just can't help them break through.
Three Tips to Help You Analyze the Acupuncture Case Studies of the NCCAOM Exam
Confirm the answer quickly by the elimination method. Case study:
After two treatments for back pain, a patient presents for a third
session complaining of rapid breathing and wheezing that is made worse
during cold weather.
An Emerging Partnership Model
Maryland University of Integrative Health (MUIH) has educated integrative health and wellness practitioners for the last 40 years, originally as an acupuncture clinic and school. The institution's transformative, relationship-centered programs integrate traditional wisdom with contemporary science
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.
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