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New Medical Technologies You Need to Know
We're all familiar with how fast computers become obsolete, as well as the rapid pace of development in the field of cell phone technology. The latest smart phones are far more powerful than desktop computers were only a few years ago.
Finders Keepers: The Secret to Relationship-Based Marketing
Becoming a successful practitioner has less to do with what you learned in school, and more to do with your ability to find new patients and keep them!
A Vibrating Capsule for Constipation? Relevance to Your Chiropractic Practice
The relationship between gastrointestinal (GI) complaints and back pain is not typically written about or discussed.
Building From the Bottom Up
I caught up with my dear friend Honora Wolfe, in her Colorado painting studio where, if she is not praying in Bhutan or doing charitable work in a Nepali free clinic, she spends most of her time now.
Peer Points: Always Seeking To Grow
Ellen "Kiki" Geary has spent the last decade honing her craft. As a specialist in integrative holistic care, she went straight from completing her master's degree in acupuncture and chinese herbal medicine from Bastyr University to building a successful and thriving practice in the small community of Anacortes, Washington.
Waking Up the Gluteus Maximus
In previous articles in this series, we expounded on the importance of the gluteus maximus (GM) in athletic performance and protecting the knee from injury. We also know there is a link between iliotibial band syndrome and GM weakness.
MPA Media Wins 7 Publishing Awards
MPA Media, publisher of Dynamic Chiropractic and DC Practice Insights, among other titles, has been recognized for editorial and design excellence with an unprecedented seven publishing awards by the American Society of Business Publication Editors (ASBPE), the nation's largest organization for business-to-business publications.
News in Brief
National Chiropractic Health Month: Be Proactive; Collegiate Roundup: Academic Appointments at Parker, Logan.
Medical Qigong for the Heart: Part III
Part 1 and Part II of this series focused on the physical aspect of the Heart and mental emotional aspects of the Heart respectively. Now, I would like to focus on the spiritual aspect of the Heart.
Pain Underfoot: Metatarsalgia
Foot pain can interfere significantly with normal activities and severely limit participation in sports. Metatarsalgia is foot pain involving the metatarsal bones in the forefoot – the complaint of pain on the bottom of the ball of the foot.
Chiropractic Research in Review
Chiropractic Treatment of Lateral Epicondylitis; Cost / Benefit Analysis: Different Doses of SMT for Low Back Pain; Imaging for Occult Rib and Costal Cartilage Fractures; Treating Neck Pain: Thoracic Thrust Manipulation vs. Non-Thrust Mobilization.
A History Worth Telling
The popularity and the use of acupuncture for the treatment of animals in the United States is at its peak.
CCE Finally Takes a "Baby Step" Toward Reform
During a 16-month period from October 2010 to February 2012, I devoted four separate columns to the heavy-handed attempt by the Council on Chiropractic Education to radically change the chiropractic profession through the accreditation process.
A Guide for Talking to Doctors about Acupuncture and Brain Chemistry
Before I begin any discussion of how to talk about the effects of acupuncture on brain chemistry, nervous and endocrine function, it is essential to understand just what physicians most need help with.
9 Common Causes of Thyroid Imbalance and How You Can Help
How you sleep, how easily you wake up, and how much energy and stamina you have during the day are directly related to levels of the thyroid hormones.
A Chinese Medicine Story: An Interview with Mazin Al-Khafaji
Mazin Al-Khafaji's work has interested me for years. In February 2014, we invited him for the second time to speak at the Southwest Symposium in Austin, Texas.
Why Young People Need Chiropractic Now More Than Ever
According to a recent study published in BMC Musculoskeletal Disorders, "It is now widely acknowledged that neck pain (NP), mid back pain (MBP), and low back pain (LBP) (spinal pain) start early in life and that the lifetime prevalence increases rapidly during adolescence to reach adult levels at the age of 18."
June, 2012, Vol. 12, Issue 06
Achilles Tendon and Foot Pain Caused by Tibialis Posterior
By David Kent, LMT, NCTMB
When patients report subjective complaints of posterior leg (calf) and sole (bottom) of foot pain when walking or running, especially on uneven surfaces, the symptoms are typically not isolated to one muscle.The tibialis posterior muscle is often involved and is the deepest muscle in the posterior compartment of the leg. Let's review the anatomy, myofascial trigger point location, pain referral patterns and a treatment technique for the tibialis posterior muscle.
The region between the knee and ankle is called the leg, it is divided into three compartments: anterior (front), lateral (side) and posterior (back). The posterior (flexor) compartment is the largest and contains seven muscles, which can be divided into a superficial and deep group. (Photo 1)
The superficial group includes gastrocnemius, soleus and plantaris. The deep group includes tibialis posterior, flexor digitorum longus, flexor hallucis longus, and popliteus. (Photo 1)
The tibialis posterior muscle is positioned between the tibia and fibula. (Photo 2) Medially, it is covered by the flexor digitorum longus muscle and laterally by the flexor hallucis longus muscle. (Photo 3) These muscles influence the ankle and foot joints. The popliteus is also in the deep compartment, however, it affects the knee joint.
The tibialis posterior muscle attaches proximally to the tibia, fibula, adjoining interosseous membrane and the intermuscular septum. (Photo 2)
Distally, the tendon runs behind the medial malleolus to attach on the navicular, the calcaneus, the cuboid, three cuniform and the second through fourth metatarsals. (Photo 2)
When the tibialis posterior contracts, it produces inversion of the foot, with plantar flexion of the ankle joint. If the muscle is weak it contributes to pronation of the foot and a loss of support of the longitudinal arch. (Read Practice Building with Postural Analysis MT, January 2012.)
The fibularis (peronial) longus and bervis are main antagonists to the inversion action of the tibialis posterior.
Patients with myofascial trigger points in the tibialis posterior muscle report calf and foot pain when walking or running. The pain is more intense when walking of running on uneven brick or cobblestone surfaces, as the muscle contracts while producing inversion of the foot and plantar flexion of the ankle joint.
Active myofascial trigger points can typically be located in the proximal third of the tibialis posterior muscle. The referred pain is most intense in the achilles tendon and the sole of the foot. A spillover pain, felt to a lesser degree, is experience in the calf. (Photo 4)
Visual aids such as anatomical models and charts are great patient education tools to demonstrate the muscle layers, trigger point location and pain referral patterns prior to treatment. Show patients how your charts work and what they may expect if you palpate a trigger point. For example, in Photo 5, "X" indicates the common location of trigger points within the muscle. Solid red areas indicate an essential pain zone or area of pain experienced by every patient that had that trigger point activated during research studies. The red dots indicate spillover pain zones. These are areas of pain experienced by some, but not all, patients outside of the essential pain zones. (Read Getting In Our Patients Head MT, January 2011)
The patient's subjective complaints and your objective findings will determine the appropriate treatment techniques to integrate. Care for yourself while providing quality care for your patients by using proper body mechanics and adjusting the treatment table height accordingly. One goal during treatment is to reduce pain, not create it. Patient comfort should always be considered. Pillows and bolstering systems allow for a wide range of positioning options, with sections that adjust to various angles. Continually confirm with the patient during treatment that treatment pressure is comfortable. (Read Learning to Engage All The Senses MT, March 2012)
Whenever deep muscles require therapy the superficial tissues must first be properly released prior to treating deep structures. There are numerous techniques for treating the tibialis posterior muscle, this article will touch on only one.
Outline of the treatment technique:
Step 1 – First, shorten the superficial gastrocnemius and soleus muscles by positioning the patient prone with support like a bolster under the ankle to create knee flexion and plantar flexion of the foot. Apply oil or cream to posterior leg. (Photo 6)
Step 2 – Superficial Gliding. Start on the medial side of the calf. Using distal to proximal movements, from the ankle to the knee, treat in thumb width strips starting on the medial side and moving to the lateral side gliding over the gastrocnemius and soleus muscles. (Photo 6)
Step 3 – Pincer Compression. Isolate and examine the bellies of the gastrocnemius and soleus utilizing pincer compression. Note, if your hands are slipping on the skin during this step, due to oil of cream on the skin, treat through a tissue or linen. (Photo 7)
Step 4 – Tibia and Fibula attachments. Glide distal to proximal on the posterior aspect of the fibula, then repeat the same on the posterior aspect of the fibula. Caution to avoid the common fibular nerve located between the skin and the fibular head. (Photo 8)
Step 6 – Release distal attachments in the foot. (Photo 10)
Symptoms of pain when walking or running in the calf and foot are typically not isolated to one muscle. The tibialis posterior is the deepest leg muscle and often involved. I hope this article provides you with empowering knowledge that can be applied immediately to your patients.
Click here for more information about David Kent, LMT, NCTMB.
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