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News In Brief
A "Modern" Business Model. Acupuncturists may have a new professional atmosphere to consider, as a new concept is on the horizon - at least for one business.
Insomnia Treatment Based on the Yu Theory
In recent years, acupuncture has risen in popularity as a form of alternative or supplemental medicine for the treatment of many different types of disorders.
Chiropractic: A Great Fit for the White House
Dr. Eric Kaplan is a New York Chiropractic College alumnus; a No. 1 best-selling author whose books include Awaken the Wellness Within and The 5 Minute Motivator; a chiropractor for professional sports teams and elite athletes; and even served as an advisor under the Clinton Administration to the President's Council on Sports & Physical Fitness.
Good Works at the Canandaigua VA
Faculty and students of the Finger Lakes School of Acupuncture and Oriental Medicine (FLSAOM) of the New York Chiropractic College have provided acupuncture to veterans at the Veterans' Administration Medical Center (VAMC) in Canandaigua, New York since September of 2007.
What's Bugging You? Probiotics and Your Health
An estimated 100 trillion microorganisms representing more than 500 different species inhabit every normal, healthy bowel. Gut-dwelling bacteria keep pathogens in check, aid digestion and nutrient absorption, and contribute to immune function.
How to Correct a Cuboid Subluxation
Cuboid subluxation is a poorly recognized condition, even though it is not uncommon. It has been described in the literature under various names: cuboid subluxation, cuboid syndrome, locked cuboid, dropped cuboid, cuboid fault syndrome or peroneal cuboid syndrome.
Making Sense of Liver Regulation
In Chinese medicine, the liver has the function of moving and storing qi and blood. In its moving function, the liver smoothly distributes qi and blood to the tendons, muscles and flesh through microcirculation.
Shedding Light on the Benefits of Heliotherapy
I can't imagine anyone not feeling good strolling in the sun on a beautiful spring day. The sun is responsible for all life on earth and is best illustrated along the equator touting the richest biodiversity on the planet, in stark contrast to the Arctic Circle and South Pole.
Treating the Terrain of Chronic Sinus Infections
Chronic sinus infections can be stubborn to treat, but the therapeutic path forward can be simplified when utilizing three distinct treatment principles which take into account the terrain of the body, and the way in which microbes grow.
Help Save an Important Chiropractic Landmark
The chiropractic profession has a splendid and varied history. Sadly, many landmarks have been lost to bulldozers and wrecking crews, such as the Ryan Building, Little-Bit-O-Heaven, Spears Chiropractic Hospital, and Clearview Sanitarium.
Waist Circumference: A Conversation Starter (Part 2)
Now let's discuss the clinical approach to reducing WC and implementation in today's chiropractic practice. The primary intervention centers around dietary modification and lifestyle habits aimed to reduce adiposity, improve insulin sensitivity and ultimately, diminish systemic metabolic dysfunction.
Give Your Patients the Ergonomic Advantage
Prolonged sitting contributes to low back pain and is a health risk. When I discuss my POLITE technique practice recommendations with patients, ergonomics may be last, but not least!
Caring for Refugees in Greece
At the beginning of 2016 I had no idea what was in store for me, but I was looking forward to a personal retreat on the Greek island of Paros; a graduation gift to myself after 22 years of motherhood, and four-plus years of Chinese medicine school.
Treating LBP the Right Way: Think Natural
An updated clinical practice guideline from the American College of Physicians (ACP) recommends spinal manipulation and other non-invasive, non-drug therapies as first options for acute, subacute and chronic low back pain, rather than pain medications, as stipulated in the original 2007 guideline.
The Chiropractor's Guide to CRISPR
Science magazine's "Breakthrough of the Year" award for 2015 was described as "the gene-editing tool called CRISPR." CRISPR stands for "clustered regularly interspaced short palindromic repeats."
5 Ways to Enhance Your Family Practice
Every practice has a personality style. A practice that caters to athletes, PI cases or adults, for example, projects differently to patients than a family wellness practice.
Toxicity & Kids: The Importance of Environmental Intake
The old adage is true that children are not little adults. Traditional Chinese medicine (TCM) has long known that the physiology of children is unique, as are the diseases that plague them.
NSAIDs No Better Than Placebo for Spine Pain
A meta-analysis of randomized, placebo-controlled trials comparing the efficacy and safety of NSAIDs with placebo for spinal pain concludes that among 6,065 spine pain patients, "NSAIDs reduced pain and disability, but provided clinically unimportant effects over placebo."
Scope of Chiropractic Practice: Why Now Is the Time to Expand
In my January article, "Scope of Chiropractic Practice: Is It Time for Change?" I discussed the use of the term primary spine care practitioner, the loss of privileges to diagnose in Texas, and the fact that the definition of "chiropractic" varied from state to state.
Integrative Cardiology: The Heart of TCM & Western Medicine
Patient centered therapy is a growing trend in hospitals that are expanding to boutique services.
The First (Only) Choice for Spinal Pain
The study on NSAIDs for spinal pain summarized on the front page of this issue is intriguing on a number of levels, the most obvious being the conclusion that "compared with placebo, NSAIDs do not provide a clinically important effect on spinal pain, and six patients must be treated with NSAIDs for one patient to achieve a clinically important benefit in the short-term."
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 previous articles by David Kent, LMT, NCTMB.
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