Extrinsic Muscles Of The Foot – Shin

During our self evaluation of the foot, we spent a lot of time talking about the three main areas of the foot: 1) the rear foot, 2) the mid foot, and 3) the forefoot. Normal foot and ankle function requires the coordinated use of all three which is what makes healing foot injuries and restoring normal function so challenging. If one part isn’t moving properly or lacks the strength/coordination to move through that mobility, then the other parts will be forced to try and compensate for that.

In the intrinsic posts, we explored the mid and forefoot in more depth by focusing on the smaller muscles in those areas. In this post, we’re going to start our discussion on the rear foot and the long tendons coming down into the foot. Before we dive into the individual muscles though, I wanted to take a few minutes to go over the rearfoot anatomy and how it moves. It’s easy to simplify things as being either “the foot” or the “ankle”, but there is A LOT of overlap between the two. For example, there are two joints responsible for the four movements at the ankle. The talocrural joint moves the foot up and down (into dorsi and plantarflexion) and the subtalar joint tilts the foot in and out (into inversion and eversion). These joints are literally stacked on top of each other in the rearfoot. If one hits the ground wrong, you can guarantee that the other will be as well.

Here’s a visual of what I mean:

Onto the muscles!

 

The front of the lower leg, or the shin, is made up of four extrinsic muscles. Extrinsic just means that the muscle belly is above the ankle while it’s tendon inserts below the ankle somewhere in the foot. The four muscles are: 1) the tibialis anterior (or the anterior tib), 2) the extensor digitorum longus (EDL), 3) the fibularis tertius (or peroneal tertius), and 4) the extensor hallicus longus (EHL). You may remember muscles with similar names from the intrinsic posts. Any easy way to remember the difference is look for the words brevis and longus. Brevis means intrinsic and longus means extrinsic.

#1 Tibialis Anterior (AT)

  • When you look at the muscles along the shin there are essentially three options for where they can originate: strictly on the tibia, on a combination of the tibia and fibula (and the interosseus membrane that holds them together), and strictly on the fibula. The AT muscle originates strictly on the tibia.
  • It then crosses over the shin itself to wrap around the medial arch, attaching to the first cuneiform and the base of the first metatarsal. This is important! If you’re someone with low arches or a super flexible foot that can pronate easily, the AT will definitely be a muscle to watch.
  • The AT is responsible for moving two joints. It dorsiflexes the ankle and inverts the foot.
  • While the AT does not attach directly to any of the foot intrinsics, it is connected fascially to the peroneal longus muscle. Think of it like a belt loop wrapped around your foot. Restrictions in one will 100% affect the other. That means if you’ve been battling peroneal/outer leg pain, you should be working on the anterior tib as well!
  • The common pain referral area for this muscle is the purple circle pictured above. Note: see how most of that pain area is around the tendon versus up in the muscle belly?? This a good example of how working strictly on where it hurts doesn’t always help. Beating up a tendon to loosen it up won’t do much to change restrictions in the muscle itself.
  • In the last post we talked about the plantar interossei. They are directly below the DI in the exact same inter-metatarsal spaces. Problems in one will definitely be present in the other. This is why they share the same pain referral areas.
  • Mobility restrictions/trigger points in the AT are commonly misdiagnosed as compartment syndrome, shin splits, 1rst MTP joint dysfunction, and L5 nerve compression.
  • In the video below, we’ll go over finding the AT muscle/palpating them, as well as,  how to stretch it.

#2 Extensor Digitorum Longus (EDL)

 

  • The EDL is deep to and directly lateral to the anterior tib. It originates on both the tibia and fibula and runs down the shin.
  • The EDL then turns into four tendons, inserting onto the top of toes 2-4.
  • This muscle is responsible for dorsiflexing the ankle and everting the foot (tilting it out). Again, this is two joints that are moving, not just one.
  • Unlike the AT, the EDL does directly attach to two intrinsic muscles on the top of the foot- the dorsal interossei and the extensor digitorum brevis. Restriction in one will affect the other. Click here to review these two intrinsic muscles.
  • The common pain referral area for this muscle is the purple circle pictured above.
  • Mobility restrictions/trigger points in these little muscles are commonly misdiagnosed as misdiagnosed as shin splints, compartment syndrome, nerve entrapments (deep fibular nerve or L4 compression), tarsal joint dysfunction and MTP joint dysfunction.
  • In the video below, we’ll go over finding EDL, as well as, how to stretch it.

#3 Fibularis/Peroneal Tertius (FT)

  • Depending on the terminology used, you will hear this muscle called either the fibularis tertius or the peroneal tertius. Many people use the two interchangeably.
  • In the picture above you’ll see the EDL muscle faded. This is because the FT is technically part of the EDL muscle. In fact, it is the lowest portion of that muscle. However… the FT is one of those muscles that may or may not be present. Some people have it on both sides, or just one, or not at all. Fun, right? 🙂
  • The FT muscle originates strictly from the fibula and follows the EDL tendons before attaching to the 5th metatarsal. This does not impact the long EDL tendon to the 5th toe.
  • This muscle is responsible for dorsiflexing the ankle and everting the foot.
  • One thing to think about with this muscle is that it is part of the peroneal group. There are three muscles in total (the longus, the brevis, and the tertius). While the first two lie behind the lateral malleolus (ankle bone), this one lies in front of it. Remember that fascial loop between the AT and the peroneal longus? Problems in either of those muscles warrant checking this one out as well to make sure that it moves well.
  • The common pain referral area for this muscle actually splits above the ankle into two areas (one in front of the ankle and one behind it where the other peroneal tendons are located).
  • In the video below, we’ll go over finding FT, as well as, how to stretch it.

#4 Extensor Hallicus Longus (EHL)

 

  • The EHL muscle is the most lateral of the shin muscles. It lies deep to both the AT and EDL and originates strictly on the fibula. It then crosses over the tibia/shin to insert onto the big toe.
  • This muscle is responsible for extending the big toe both at the MTP and IP joints. It is also responsible for dorsiflexing the ankle and inverting the foot. That’s a lot of movements! If you’re someone who is lacking big toe mobility, this is a muscle that is likely stuck in that short position. Whether a muscle is stuck in a short or stretched out position, it still needs to be mobilized to restore function.
  • Unlike the other muscles above, the EHL has no direct attachments to the other intrinisic muscles. That being said, while not attached, it does have an intrinsic muscle assisting it in moving the big toe however.
  • Muscle restrictions/trigger points in this muscle are often misdiagnosed as 1rst MTP dysfunction.
  • The common pain referral area for this muscle is the purple area pictured above.

Video on how to find these muscles (palpate) and stretch them:

Continue to part two (extrinsics- the outside of the lower leg/peroneals)

Continue to part three (extrinsics on the inside of the lower leg) – coming soon

AC joint

As you may recall from our intro post on kinesiology taping, we’re going to focus on each muscle group/joint and show you how to use kinesiology tape in three distinct ways:

  1. Immediately after injury  (for swelling and pain)
  2. During the healing process (correction techniques to restore normal position and allow for healing)
  3. Techniques to help improve strength + function

In this post, we’ re going to be talking about a taping application for the AC or acromio-clavicular joint. This joint lies on top of the shoulder and is where the clavicle (collar bone) attaches to the scapula. In the case of a “separated shoulder” this attachment is injured and those two bones are able to come apart. Depending on the severity of this injury, the clavicle may actually pop up due to ligament damage. The purpose of this tape application is to hold the bones together to allow the supporting structures to heal.

Anatomy

In your reading, you may have heard of something called the “shoulder girdle”. This is composed of three bones: the scapula, the clavicle, and the humerus. The scapula lays on the back of the rib cage (it is held in place by muscle) and connects to the clavicle/collar bone which wraps around from your breast bone/sternum. These two bones meet on the outside of the shoulder at the acromion (this is the bony bump on the outside of your shoulder). Just beneath the acromion is where the humerus (upper arm bone) attaches to the shoulder blade (the ball or head of the humerus connects to a socket in the scapula known as the glenohumeral fossa). Part of the reason it is referred to as the shoulder girdle versus simply the shoulder joint is because there are actually three joints- 1) where the scapula and the clavicle/collar bone meet at the acromion (this is your AC joint), 2) the glenohumeral joint where the humerus connects to the scapula, and 3) the sternoclavicular or SC Joint where the clavicle attaches to front of the rib cage at the sternum.

 

To find the AC joint, start by placing your fingers on your collar bone (clavicle). Trace this bone out towards your shoulder. You will notice that as you do so the bone curves back and then finishes with a small bump at the end. You can also trace the scapula forward to the acromion. If you’ve injured the AC joint, pressing down on the end of the clavicle will be uncomfortable. In the case of a severe AC injury, the end of the clavicle may actually be elevated and sticking up.

You can read more about the anatomy in this area and find palpation tips here.

What you will need:

1) Roll of kinesiology tape.

2) Sharpest scissors in the house.

Prep work:

1) Clean skin. This means no oils or lotions of any kind. You want your skin to be clean and more importantly dry. Moisture of any kind = tape will fall off or fail to stick altogether.

2) Hair care. Ideally, the less hair the better. Guys, this means that for best results you will need to trim any long leg hair or shave the calf area.

3) If clean, dry, and hairless skin still = no sticking of tape. Time to get some adhesive spray like Tuf Skin.

4) The tape should last 3-5 days. You can get it wet and shower with it on. Just towel dry it after. No hair dryer! The tape is heat activated.

Taping Techniques

1) AC joint mechanical correction strip

Key Points:

  • Prep the skin first. For this application you will want to be seated and sitting up straight with good posture. No slouching! Let the arm rest comfortably at your side.
  • Cut the tape so that it is long enough to cover the top of the shoulder (front to back) with 1-2″ of tape on either side (these are your anchors and must be applied without stretch). Round the edges to keep the tape from curling up on the ends or catching on your clothes.

 

  • For this application you will want to apply 50-75% stretch to the tape. You want to hold that stretch and apply it down onto the AC joint. The goal here is to hold the two bones together and keep the clavicle in place!! Don’t sweat the 50-75%. Think medium stretch versus maximum “how far can I pull this tape” kind of stretch. Hold the anchors, stretch the tape and then with that same stretch, push the tape down over the AC joint.

  • Once the tape is applied, remove the paper backing from the anchors and then simply lay the ends down. Rub the tape to warm up the adhesive. Here is what the finished application looks like:
  • For further instructions on how to incorporate kinesiology taping into your self treatment regimen click here.

References

1) Capobianco, Dr. Steven and van den Dries, Greg. (2009). Power Taping, 2nd Edition, Rock Tape Inc, Los Gatos, CA.

2) Hammer, Warren. (2007). Functional Soft-Tissue Examination and Treatment by Manual Methods, 3rd edition. Jones and Bartlett Publishers, Inc, Sudbury, MA.

3) Kase, Kenzo, Wallis, Jim, and Kase, Tsuyoshi. (2003). Clinical Therapeutic Applications of the Kinesio Taping Method.

4) Muscolino, Joseph. (2009). The Muscle and Bone Palpation Manual. Mosby, Inc, St. Louis, MO.

 

Rotator Cuff

As you may recall from our intro post on kinesiology taping, we’re going to focus on each muscle group/joint and show you how to use kinesiology tape in three distinct ways:

  1. Immediately after injury  (for swelling and pain)
  2. During the healing process (correction techniques to restore normal position and allow for healing)
  3. Techniques to help improve strength + function

In this post, we’ re going to be talking about a taping application designed to inhibit the muscles of the shoulder to allow for rest and recovery. This is important in the case of a rotator cuff injury where the small tendons have become pinched and inflamed. When this happens muscle imbalances can occur and the shoulder blade can lose it’s normal alignment/mobility. As the body tries to compensate with the larger muscle groups (i.e. the deltoid), it can make this problem worse and lead to further injury.

Anatomy

For this taping application, we want to look at the muscles of the shoulder. The rotator cuff consists of four separate muscles: the supraspinatus, infraspinatus, teres minor and on the inside of the shoulder blade the subscapularis. All four of these muscles start on the shoulder blade and then insert onto the humerus (upper arm bone). Think of it like a hand laying on the shoulder blade and then wrapping its fingers over the joint. This is why even though it hurts in the front of the shoulder around the tendons, the real problem is in the muscles that become those tendons on the back of the shoulder.

Specifically for this application you will need to be able to find the spine the scapula. Think of the shoulder blade like a bony triangle that sits on the back of the rib cage and is held in place by muscle. The most prominent feature of the shoulder blade is the large bony ridge that runs across it. This is known as the spine of the scapula. If you reach over your shoulder with your fingers, this bony ridge will be easy to feel.

 

You can read more about the anatomy in this area and find palpation tips here.

What you will need:

1) Roll of kinesiology tape.

2) Sharpest scissors in the house.

Prep work:

1) Clean skin. This means no oils or lotions of any kind. You want your skin to be clean and more importantly dry. Moisture of any kind = tape will fall off or fail to stick altogether.

2) Hair care. Ideally, the less hair the better. Guys, this means that for best results you will need to trim any long leg hair or shave the calf area.

3) If clean, dry, and hairless skin still = no sticking of tape. Time to get some adhesive spray like Tuf Skin.

4) The tape should last 3-5 days. You can get it wet and shower with it on. Just towel dry it after. No hair dryer! The tape is heat activated.

Taping Techniques

1) Rotator cuff application (two strips):

Key Points:

  • Prep the skin first. For this application, there are two Y strips and each will require you to place the arm in different positions. For the first strip along the back of the deltoid, you will need to move the arm forward across the body like you are reaching to your opposite shoulder. You will then need to reposition the arm so that you are reaching behind your back (like you would to tuck in your shirt) to apply the second strip along the front of the deltoid. This arm position will remain the same as you apply the second Y-strip along the spine of the scapula. Confused?? All of this is in the video above. 🙂
  • Strip #1- deltoid. Start by placing the anchor at the base of the deltoid muscle. The anchor should be 1-2 inches in length and then you will have the two strips to use. Place the arm in the stretch position and then lay the tape down with NO stretch. Reposition the arm as shown above and repeat for the second strip.
  • Strip #2 - supraspinatus. Start by placing the anchor at the front of the shoulder. You want this to be 1-2 inches below the acromion process (use the palpation tips and link above!) and just to the outside of the line up from the axilla (armpit). For the anatomy guru’s you’re looking for the greater tubercle of the humerus.
  • Once the anchor is in position, move the arm so that the area is on stretch (reach behind the back like tucking in your shirt). The lower strip shoulder follow the spine of the scapula while the upper strip should be just above it. Both strips should be applied with NO stretch.
  • Here is what the finished application looks like:
  • For further instructions on how to incorporate kinesiology taping into your self treatment regimen click here.

References

1) Capobianco, Dr. Steven and van den Dries, Greg. (2009). Power Taping, 2nd Edition, Rock Tape Inc, Los Gatos, CA.

2) Hammer, Warren. (2007). Functional Soft-Tissue Examination and Treatment by Manual Methods, 3rd edition. Jones and Bartlett Publishers, Inc, Sudbury, MA.

3) Kase, Kenzo, Wallis, Jim, and Kase, Tsuyoshi. (2003). Clinical Therapeutic Applications of the Kinesio Taping Method.

4) Muscolino, Joseph. (2009). The Muscle and Bone Palpation Manual. Mosby, Inc, St. Louis, MO.

Shoulder impingement

As you may recall from our intro post on kinesiology taping, we’re going to focus on each muscle group/joint and show you how to use kinesiology tape in three distinct ways:

  1. Immediately after injury (for swelling and pain)
  2. During the healing process (correction techniques to restore normal position and allow for healing)
  3. Techniques to help improve strength + function

In this post, we’ re going to be talking about a taping application designed to restore normal alignment and create space at the front of the shoulder. Impingement syndrome at the front of the shoulder is typically a result of muscle imbalances that allow the humerus (upper arm bone) to slide forward in the joint. Once this happens, the small tendons of the rotator cuff and even the bursa can be pinched when you try to reach overhead. In the case of repetitive motions such as swimming, this can quickly lead to inflammation and pain.

Anatomy

 

For this taping application, we want to look at the bony structure of the shoulder. Essentially we are trying to pull everything back into into it’s normal position with this tape application. The shoulder is composed of three bones: the scapula, the clavicle, and the humerus. The scapula lays on the back of the rib cage and is held in place by muscle. It connects to the clavicle (aka collar bone) which wraps around from your breast bone/sternum. These two bones meet on the outside of the shoulder at the acromion process (this is the bony bump on the outside of your shoulder). Just beneath the acromion is where the humerus (upper arm bone) attaches to the shoulder blade.

Specifically for this application you will need to be able to find the coracoid process (aka the bony bump that the pec muscles attach to). To find this process, trace your fingers along your clavicle until you feel it curve back just before it gets to the outside of the shoulder. From here drop your fingers down approx 1 inch and press in. Pull your shoulder blades back together and then round your shoulder forward. You will feel a bony bump push forward. This is the coracoid.

You can read more about the anatomy in this area and find palpation tips here.

What you will need:

  1. Roll of kinesiology tape.
  2. Sharpest scissors in the house.

Prep work:

  1. Clean skin. This means no oils or lotions of any kind. You want your skin to be clean and more importantly dry. Moisture of any kind = tape will fall off or fail to stick altogether.
  2. Hair care. Ideally, the less hair the better. Guys, this means that for best results you will need to trim any long leg hair or shave the calf area.
  3. If clean, dry, and hairless skin still = no sticking of tape. Time to get some adhesive spray like Tuf Skin.
  4. The tape should last 3-5 days. You can get it wet and shower with it on. Just towel dry it after. No hair dryer! The tape is heat activated.

Taping Techniques

1) Shoulder application (two strips)

  • Prep the skin first. For this application you will want to put the muscles at the front of the shoulder on stretch. To do this, straighten your arm at the elbow and move it out to your side. Then pull your shoulder blades back together and rotate your entire arm so that the thumb is pointing up towards the ceiling like the picture above. Only go as far as you can comfortably!
  • With the arm in the starting position, apply the anchor first. This means apply the first 1-2 inches of the tape with NO stretch. For this application, you want this tape to be up into the armpit. If you’re a guy. You’ll want to shave! 🙂 You don’t need to wrap the tape under to the back of the arm, just on the front of the that you can see. Apply the anchor and then rub the tape to warm up the adhesive.
  • Once the anchor is in position, wrap the tape around the back of the shoulder all the way to the spine. Remember, the area is already on stretch. Just lay the tape down as you go.
  • For the second piece of tape, we want to place the anchor over the front of the shoulder at the coracoid process. Use the palpation tips above!!! Apply the anchor and then rub the tape to warm up the adhesive. Move the arm back to the stretch position.
  • Once the anchor is in position, wrap the tape around the back of the shoulder all the way to the spine. Remember, the area is already on stretch. Just lay the tape down as you go. When both strips are applied, the application looks like the picture above.
  • When measuring the tape, make sure that the first strip can reach from the armpit all the way to the spine. The second strip should be long enough to cover from the front of the shoulder past the shoulder blade towards the spine.
  • For further instructions on how to incorporate kinesiology taping into your self treatment regimen click here.

References

1) Capobianco, Dr. Steven and van den Dries, Greg. (2009). Power Taping, 2nd Edition, Rock Tape Inc, Los Gatos, CA.

2) Hammer, Warren. (2007). Functional Soft-Tissue Examination and Treatment by Manual Methods, 3rd edition. Jones and Bartlett Publishers, Inc, Sudbury, MA.

3) Kase, Kenzo, Wallis, Jim, and Kase, Tsuyoshi. (2003). Clinical Therapeutic Applications of the Kinesio Taping Method.

4) Muscolino, Joseph. (2009). The Muscle and Bone Palpation Manual. Mosby, Inc, St. Louis, MO.

 

Stretching Introduction

Before we get into the specific muscle groups and body regions, I just wanted to do a quick write up on stretching as a whole. In the past few years, stretching has taken a beating in the media. It seems that every new study that comes out reports that stretching is a complete waste of time. It won’t help performance, it won’t speed up recovery, it won’t cut back injury rates, blah blah blah. All of that may very well be true, but in the event of an injury where a muscle is stuck in that tight, protective position, stretching is a great way to restore mobility without causing further damage. This allows for healing by breaking up any restrictions in the damaged muscles and can help to flush out swelling and decrease pain. Stretching is also a great way to prevent building restrictions from becoming an injury. Will it 100% bullet proof you from injury? Unfortunately, no, but it can certainly limit the number of repetitive overuse injuries you’ll have and decrease the severity of those injuries. How many times have you been sidelined only to say “you know…that was pretty tight in the days and weeks leading up to it.”??

Why do I need to stretch?

While there is no research based proof to say that stretching will make you faster, stronger, and impervious to injury, I like to look at the importance of stretching in a much simpler way as a clinician. Muscles and joints are designed to MOVE. When muscles lose flexibility, they loose strength and coordination, but more importantly they also negatively impact the joints they move. Every patient that walks into my clinic has the same first goal- restore mobility. From here I can move on to strength and function, but I need them to be able to move first before I can effectively work on those.

Stretching is easy to sell to people who are hurt and who can see first hand that there arm or leg isn’t moving the way the other side does. It’s much more difficult to sell to people who are not hurt and don’t see the point (if it’s not broke, don’t fix it, right?). My answer to the latter group is this- at the very least, regular stretching will maintain healthy muscles and joints. The tighter the tissues are around a joint, the more grinding and rubbing there will be. THAT is how arthritis and other degenerative joint disorders happen, not some sudden event or that your dad had it. Whether that’s a priority now (thanks to an injury) or later (when the cumulative wear and tear has caught up to you ) is your choice. As you’ll see in the upcoming series, it doesn’t take hours to do these stretches and requires no additional equipment or setup. In most cases you can stretch faster than you can whip up your recovery drink. Prevention goes a long way!! If you’re reading this, then hopefully you will also the value. My clinic is full of masters athletes who have rusted into their “golden years”. Don’t be one of them!

When is the best time to stretch?

Warm muscles are best. This can be following a workout or following a warm up with the foam roller. Personally, I rarely stretch in and around actual workouts. Before a race, following a solid warm up, I will do, but for day to day stuff, I barely have time for the workout itself let alone time to stretch after. I’m more of a foam roll + stretch in front of the TV athlete. Why the need for a warm up? It loosens up not only the muscle fibers themselves, but also the tendons that attach them to bones, and the joints that they contract to move. In other words, it loosens up everything. What if you don’t have time for a warm up?? You can absolutely stretch cold muscles and joints. If this is the case, start of super easy and build into the stretches. Use that as your warm up instead of going for a home run on the first stretch and causing damage.

How long do I stretch for?

At a minimum, stretches should be held for 20-30 seconds. This is the requirement for muscle memory to register and is a key part of the puzzle. From there, increasing a muscles natural resting length is all about frequently stretching past it’s current length. To do that, shoot for 3-4 repetitions every time you stretch. Can you hold longer than 20 seconds and just do a full 1-2 minutes instead? Sure, but you’ll be making short term improvements (helpful for acute/new injuries) versus long term improvements (what you’re looking for with chronic/old injuries).

What if I’m hurt?

Simply put, stretching should NEVER hurt, whether you’re fighting an injury or looking to maintain/improve mobility. If you’re injured and it is uncomfortable to stretch out the damaged muscle, you can stretch to the point of pain, but don’t push past it in some “no pain, no gain” attempt. Instead, work to the pain point and focus on frequency. Then shift your focus to the surrounding muscle groups that are also tight from compensating. Remember- muscles work in pairs. If one part of the pair is damaged, the other will likely tighten up as well to protect the injury. Follow your foam roller/tennis ball work with stretching right after for best results!

What if I’m not hurt?

This is still a great time to stretch. At the minimum, try to stretch on days with long or intense workouts on the schedule. A few minutes of foam roller work followed by a few minutes of stretching to your problem areas will help flush out the muscles and decrease post workout soreness/stiffness.

Stretching pt 13- Front of the Shoulder

In the introduction post to this series, we reviewed and answered some common questions regarding stretching, including why, when, how, etc. Click here to review it.

In this post we will be talking about how to stretch out the front of the shoulder. This area is a big intersection area with the larger pec major/minor and deltoid muscles overlapping the smaller rotator cuff and bicep tendons as they sneak through to insert on the front of the shoulder. Intersection areas are prime spots for injury. In particular this area is a common site of tendonitis, muscle sprains/strains and joint impingement (when structures get pinched due to tight overlying muscles and joints).

The Rules:

1) Stretching should NEVER hurt. The goal is to only go until you feel a pull in the muscle. It should not be to go until it hurts in one of those “no pain, no gain” efforts. It should be comfortable and repeatable, allowing you to move a little further with each repetition.2) Perform stretches when the muscles are warmed up. This can be following a workout or following work with the foam roller. Click here to review the self massage post for the front of the shoulder (this includes pictures and video using a foam roller and tennis ball to review 3 self muscle release techniques).

2) Hold for 20-30 seconds and repeat 3-4 times. You can hold longer than the 20 seconds, but the reps are key. You will always get more out of stretching frequently versus one killer session a week.

3) If hurt- be sure to stretch out the opposing muscle groups first. For the front of the shoulder, this means the back of the shoulder, between the shoulder blades and the mid-back region. If it is too painful to stretch out the front of the shoulder due to injury, focus on these groups first and then work your way up  to stretching out the injury itself.

How To:

1) In this post we’re going to focus on one stretch.

 

a) To start, you’re going to need a doorway or corner of the wall. Stand facing the doorway and position your arm so that it’s at about shoulder height with your elbow bent at 90 degrees (the arm should be in an “L” position). From here, the only thing moving is the lower part of your body. Start by rotating your feet away and let the body follow. Try to keep your neck and head relaxed and do not pull on the arm. In fact, as you do this stretch, don’t turn your head/neck at all. Always keep it facing forward and let your body do the work. Hold 20-30 seconds and repeat 4 times on both sides.

b) To modify this stretch you can do a few things. The first is to straighten your elbow and put your hand on the wall instead. Before you try this, make sure you can do the stretch with straining your neck or without pain in the front of the shoulder. The second way to modify this stretch is to change the angle of the arm (moving it above and below shoulder height). This will let you target the upper and lower corners of the front of the shoulder. Start with the arm in the “L” position and then work your way up to straight arm with these. remember- let the lower body rotate and keep your neck relaxed!! same counts. 20-30 seconds for 4 reps.

Foot Intrinsics – Top of the foot

In part four of our posts on the intrinsics, we’re going to tackle the muscles on the top of the foot. If you’re someone battling through pain/symptoms on the bottom of your foot then you can guarantee that the little muscles on the top of your foot are involved as well. These muscles are commonly called in when you start compensating for a shortened/altered stride. Instead of getting to relax as the foot and leg swing through following a strong push off from the big toe, these tiny muscles work hard to pull the toes up so that you don’t trip over your own foot.

Before we dig into the muscles, let’s take a quick look at the bones:

 

This picture is taken standing directly over my foot (lucky you for getting to look at my feet these past few weeks! 🙂 From this view, the lower leg bones (the larger tibia bone on the inside and the skinny fibula on the outside) are stacked directly on top of the talus which is then stacked directly on top of the calcaneus (heel bone). That’s why the tibia and fibula have lines through them. They will effectively block the view of calcaneus and most of the talus. So… even though you can see the calcaneus labeled in the picture above, understand that it is not on the surface of the top of the foot. It is deep below more superficial structures.

 

The top of the foot features a combination of long tendons coming from muscles above the ankle (aka the extrinsic muscles of the foot), as well as, the small intrinsic muscles themselves. There are three muscles on the top of the foot: 1) the dorsal interossei, 2) the extensor hallicus brevis and 3) the extensor digitorum brevis.

#1 Dorsal Interossei (DI)

  • There are actually four little muscles that make up the DI. They originate along the metatarsal bones and attach on either side of the proximal phalanx of toes 2, 3, and 4 (the big toe is number 1 and the little toe is number 5).
  • In the picture above you can see that the tendons attach to the funky looking white diamond. That diamond shape is the extensor mechanism and is responsible for pulling the toes back into extension. The long extensor digitorum tendon runs through the middle, on top of the foot intrinsics. I only included part of it in the picture above to better show the DI.
  • These muscles are responsible for several movements. The first is that they abduct (pull apart) and flex toes 2-4 at the MTP joint. Remember- this is the joint between the long metarsal bone and the first phalange, not the tiny little toe joints themselves. The second movement is to extend the toes at the furthest interphalangeal joints via the extensor mechanism.
  • The important thing here is to realize that these little muscles are tied to a muscle above the ankle (aka the EDL- extensor digitorum longus). That means restrictions either in the DI or the EDL will impact each other.
  • The common pain referral areas for this muscle are the two purple circles pictured above. Note: these areas are also present on the bottom of the foot.
  • In the last post we talked about the plantar interossei. They are directly below the DI in the exact same inter-metatarsal spaces. Problems in one will definitely be present in the other. This is why they share the same pain referral areas.
  • Mobility restrictions/trigger points in these little muscles are commonly misdiagnosed as suspected stress fractures, nerve entrapments, and tarsal joint dysfunction.
  • In the video below, we’ll go over finding the DI muscles/palpating them, as well as,  how to stretch them.

#2 + 3 The Extensor Digitorum Brevis (EDB) and the Extensor Hallicus Brevis (EHB)

  • As the caption above says, I’m combining these two muscles because they share a common origin. The difference between them is that ones goes strictly to the big toe and one goes to toes 2-4. As a general rule of thumb, any muscle with the word “hallicus” in the title means big toe. Any muscle with the word “digitorum” in the title means digits/toes.
  • Both of these muscles originate from the top of the calcaneus and move down the top of the foot to insert onto the lateral side of the proximal phalanx for toes 1-4. The EHB goes alone to the big toe while the EDB tendons attach to the overlying EDL tendons via the extensor mechanism.
  • Again, this is important. That means the EDB are also attached to a muscle above the ankle (an extrinsic muscle). That means that restrictions in one will affect the other and vice versa.
  • The common pain referral area for this muscle is the big purple circle pictured above.
  • Mobility restrictions/trigger points in this area are commonly misdiagnosed as suspected metatarsal stress fractures and nerve entrapments.
  • In the video below, we’ll go over finding the muscles/palpating them, as well as, how to stretch them to test their mobility.

Video – Palpation (aka how to find the muscles in your foot) and Stretching

Over the past few posts we’ve spent a lot of time talking about the extrinsic muscles and what their tendons in the foot attach to. In the next post we’re going to tackle the extrinsic muscles themselves. From there we’re going to talk treatment and what other areas you should be thinking about when symptoms/injuries arise.

Click here to go back to part three: the middle toes

Click here to go back to part two: the little toe

Click here to go back to part one: the big toe

Click here to continue on to the extrinsic muscles (coming soon)

 

Foot Intrinsics – Big Toe

The colored areas above are common pain locations for each of the tiny muscles in the foot. These muscles are known as the intrinsic muscles and all of them are arranged in layers beneath the fascia. However, unlike the fascia which is a thick fibrous band that is stretched out with weightbearing, the intrinsics are muscles. They contract and relax and play a big role in how the foot functions. Not only do they help with shock absorption, but they then help stabilize the foot and arches to prepare for push off/propulsion. Just like every other muscle in the body, they can also be overused and injured making them stiffen up and become inefficient.

In this post, we’re going to go through each intrinsic muscle one by one and decode the picture above by doing the following:

  • teaching you where each muscle is and how to find it on yourself.
  • showing you where you’d feel symptoms if that muscle was restricted/injured.
  • showing you how to combine self massage and stretching to restore mobility.
  • showing you how to strengthen the intrinsics to restore function.

Lastly we’ll talk about common misdiagnoses involving the intrinsics. Sound like a lot of information? It is! That’s why I’m breaking this down into smaller chunks (big toe, middle toes, little toe, and the top of foot). To kick things off, we’re starting with the big toe.

There are three intrinsic muscles on the bottom of the foot dedicated to moving the big toe and they are pictured above. While it’s easy to focus on flexion and extension as the sole movements, the big toe actually moves in four directions: flexion, extension, abduction, and adduction. The last two are critical to normal gait and propulsion (they spread the toes for a better base of support and increase the mechanical advantage of each muscle making it easier for them to contract fully). Unfortunately, they’re also the first things to be lost when you start compensating for muscle restrictions (both in the foot itself and above it in the rest of the leg).

#1 – Flexor Hallicus Brevis (FHB)

  • The FHB muscle originates in the tarsal bones (cuboid + 3rd cunieform) and moves diagonally to the base of the proximal phalanx of the big toe. There are two muscle heads in this muscle. Each contains a sesamoid bone in it’s tendon.
  • This muscle is responsible for flexing the big toe at the MTP joint. Remember- this is the big joint under the ball of the foot, not the toe segments themselves. Those are moved by extrinsic muscles (muscles located above the ankle that have long tendons traveling down into the foot).
  • The common pain referal area for this muscle is the big purple circle pictured above. This area also includes the top of the foot as well!
  • Mobility restrictions/trigger points in this area are commonly misdiagnosed as plantar fasciitis, sesamoid injuries, and gout flare ups.
  • In the video below, we’ll go over finding the muscle/palpating it and how to stretch it to test it’s mobility.

#2 Adductor Hallicus (AH)

  • Like the FHB, the adductor hallicus has two muscle heads- the transverse head and the oblique head. An easy way to remember them is to think of them in terms of the direction they move towards the big toe. The transverse head moves almost horizontally from the little toe to the big toe, while the oblique travels up in a diagnonal direction. The important thing to think about with the AH is that the oblique head attaches to the peroneal longus tendon. This is huge! Restrictions here will absolutely affect the big toes ability to abduct for a strong push off. Instead the big toe will be pulled in (adducted). If you’re someone with chronically tight or painful peroneals, this is a muscle you need to pay attention to!
  • Bunion people, this is one you need to pay attention to as well! A bunion starts when that big toe starts moving in towards the other toes. That means the AH muscle gets stuck in that tight position, making it harder to keep the foot pointing forward. The normal compensation pattern is to then rotate the foot out to get away from the big toe. Instead of pushing off of it, you roll off the side of it, making the bunion worse.
  • The common pain referral area for this muscle is the big purple circle pictured above.
  • Mobility restrictions/trigger points in this muscle are often misdiagnosed as Plantar fasciitis and metatarsal stress fractures.
  • In the video below, we’ll go over finding the muscle/palpating it and how to stretch it to test it’s mobility.

#3 Abductor Hallicus Brevis

  • When it comes to important intrinsic muscles, the AHB is easily one of the big three in my book. It’s responsible for getting the big toe into position for push off and also plays a huge role in reinforcing that medial arch and preventing the navicular bone from sagging down.
  • Attachment wise, the AHB originates off of the medial calcaneal tuberosity and runs up the lateral aspect of the proximal phalanx. Like the other big toe intrinsics, it’s important to note that all three attach to the same bone. and all three are responsible for moving the MTP joint, NOT the little toe joint.
  • The common pain referal area is the purple area pictured above. See how that area wraps around the heel, below where the muscle ends?? This is why injuries to this muscle are commonly misdiagnosed as insertional achilles tendonitis. It’s also commonly misdiagnosed as plantar fasciitis.
  • In the video below, we’ll go over finding the muscle/palpating it and how to stretch it to test it’s mobility.

 

Video – Palpation (aka how to find the muscles in your foot) and Stretching

In the next post, we move onto the little toe intrinsics. Once we’re through all of the little muscles, we’re going to talk treatment and what other areas you should be thinking about

Click here to continue to part two (little toe)

Foot Intrinsics – Little Toe

In this post we’re going to move onto the intrinsic muscles responsible for moving the little toe (on the bottom of the foot). Like the big toe, the little toe plays a big role in weight bearing and ambulation. That’s why it has its own muscles, seperate from the other toes. Every time the foot lands on the heel, the body then moves forward. During this shock absorption phase, the outside of the foot gets loaded first calling these muscles into action. As they accept the weight load, they shift this to the middle toes and lastly to the big. They then help stabilize the foot to prepare for push off. This is accomplished by helping to spread the toes and position the metatarsals so that the long tendons can do their job and propel us forward.

Sound complicated? It is! Here’s an easy way to think of it: for these little muscles to do their job completely requires them to be able to contract and then relax as they set up the big toe to do the heavy lifting. If something is off (either in the foot itself or upstream in the ankle or leg) and that process is rushed, these two little muscles will get beat up quickly. Over time, they’ll just stop working altogether and atrophy.

#1 Flexor Digiti Minimi (FDM)

  •  The FDM is responsible for bending the little toe at the MTP joint, NOT the little joints up in the toe itself. It originates on the fifth metarsal and the peroneal longus tendon before traveling up into the little toe. The peroneal attachment is key! Restrictions either in the peroneal or in FDM will affect each other. Likewise, the AH (which supplies the big toe) also attaches to the peroneal tendon. The same restriction rules apply.
  • For those of you battling peroneal problems/lateral foot pain, this is a muscle you want to pay attention to! Anything that pulls that tendon tighter against the bone (like the FDM and AH), will create more inflammation and pain.
  • The common pain referral area for this muscle is the purple circle above.
  • Muscle restrictions/trigger points in this muscle are commonly misdiagnosed as possible stress fractures in the fifth metatarsal.
  • In the video below, we’ll go over finding the muscle/palpating it and how to stretch it to test it’s mobility.

#2 Abductor Digiti Minimi

  • The ADM muscle lies on top of the FDM muscle. It attaches to the calcaneus and travels up into the little toe. It is the most lateral intrinsic muscle and like the AHB on the big toe side, is one of the bigger muscles as well. This muscle is in the most superficial layer directly beneath the plantar fascia.
  • This muscle is responsible for abducting and flexing the little toe at the MTP joint. This is important because spreading the toes improves the base of support for push off/propulsion. Restrictions here will make it difficult to flatten the foot and get to the big toe.
  • The common pain referral area for this muscle is the purple circle above. Note: most of the symptoms for this muscle will be up near the tendon and not down in the muscle belly itself.
  • Muscle restrictions/trigger points in this area are the same as for the FDM- suspected stress fractures in the fifth metatarsal.
  • In the video below, we’ll go over finding the muscle/palpating it and how to stretch it to test it’s mobility.

 

Video – Palpation (aka how to find the muscles in your foot) and Stretching

In the next post, we move onto the middle toe intrinsics. Once we’re through all of the little muscles, we’re going to talk treatment and what other areas you should be thinking about!

Click here to go back to part one (big toe)

Click here to continue to part three (middle toes)

Foot Intrinsics – Middle Toes


In part three of our posts on the intrinsics, we’re going to tackle the muscles responsible for moving the middle toes (aka toes 2-4, with 1 being the big toe and 5 being the little toe). Just like the little toe, these muscles are responsible for stabilizing the foot and continuing to shift weight to the big toe for push off/propulsion. Unfortunately, these muscles are also the middle man. Restrictions on either side (or upstream in the ankle and leg) will trap the workload here instead of at the big toe where the big intrinsics are waiting to do the heavy lifting. When this happens, it’s very common to see compression injuries in the form of nerve entrapments/neuromas and stress fractures.

Even though you can’t see them in the picture above, there are four muscles in this area of the foot. They are arranged in layers. We’re going to start in the deepest layer.

#1 Plantar Interossei (PI)

  • The PI are actually three little muscles instead of one. Each originates along the medial (inner) side of the last three metatarsals and attaches to the proximal phalanx of each respective toe.
  • The PI are responsible for adducting the toes at the MTP joint (aka pulling those toes in).
  • The thing to remember about these muscles is that even though they are deep to three other muscles, they are actually in there. Restrictions here can affect the tiny little nerves that run between the toes, causing pain and burning in the foot.
  • The common areas where pain is referred to from these muscles are the two purple circles pictured above. An easy way to visualize these strips is as a vertical strip running down between the 2nd and 3rd toe, and a second strip running down between the 4th and 5th toe as well. These strips are also present on top of the foot as well.
  • Muscle restrictions/trigger points in these muscles are commonly misdiagnosed as suspected stress fractures and interdigital nerve entrapments.
  • In the video below, we’ll go over finding the muscle/palpating it and how to stretch it to test it’s mobility.

#2 Lumbricals

  • Like the PI, the lumbricals are actually several little muscles. In this case, there are four, one each for the last four toes. Unlike the other intrinsics, however, the lumbricals have no direct bony attachments. Instead they originate on the FDL tendon as it wraps around to the bottom of the foot (the FDL itself is located up above the ankle). They then attach to the FDL’s counterpart on the top of the foot- the EDL.
  • The attachments for this muscle are important! You essentially have four little muscles whose function is entirely dependent on the long tendons they are attached to. To complicate that more, these muscles move the toes in two ways- they flex toes 2-5 at the MTP joint (at ball of foot) and extend them at the little toe joints (IP joints).
  • In a foot where the mechanics are off even a little, propulsion is diminished. A typical compensation for this is to shift push off duties to the middle toes and then pull the toes up to keep from tripping over them. This is a double whammy for the lumbricals. Not only does their workload increase to the point of injury, but they will then also be be stretched by what’s happening on top of the foot.
  • The common area where pain is referred for the lumbricals is the same as the PI muscles above. Remember- that pain area is also on the top of the foot. This is definitely the case where the lumbricals are concerned!
  • Like the PI, muscle restrictions/trigger points in these muscles are commonly misdiagnosed as suspected stress fractures and interdigital nerve entrapments.
  • In the video below, we’ll go over finding the muscle/palpating it and how to stretch it to test it’s mobility.

#3 Quadratus Plantae (QP)

  • Keep that FDL tendon in mind for this next one. While the lumbricals are in the mid/forefoot, another muscle attaches to this tendon- the Quadratus Plantae (QP).
  • The QP is definitely a muscle that getes overlooked or mistaken for something else. It originates on the calcaneal tuberosity (deep to the overlying big three: ABH, FDB, and ABDM).
  • I consider the calcaneal tuberosity bone spur territory or in this case heel spur territory. A spur starts as inflammation where a tendon attaches to bone. If that tension and inflammation remain in place, the tendon can get damaged and bone can actually grow in it’s place instead of new tendon. While the new bone itself may not hurt, what will hurt is whatever that spur hits. While older research has always believed that these occurred from chronic tightness/inflammation in the plantar fasciitis itself, newer research has been finding proof that the spurs are actually started in the intrinsics.
  • The QP is responsible for flexing toes 2-5 by helping the FDL tendon. It also helps to offset the diagonal pull of the FDL by pulling straight back towards the heel.
  • The common area of pain referral is the purple circle above. See how this area includes the whole heel? This is why muscle restrictions/trigger points in the QP are often misdiagnosed for plantar fasciitis, achilles tendonitis, and spurs.
  • In the video below, we’ll go over finding the muscle/palpating it and how to stretch it to test it’s mobility.

#4 Flexor Digitorum Brevis

  • The most superficial and largest of the middle intrinsics is the FDB muscle. It sits on top of the QP in terms of layers and also attaches to the calcaneal tuberosity. From there it travels up the foot to toes 2-5 and splits to insert to either side of the middle phalange. The reason for this split is to allow the FDL tendons to sneak through underneath to the distal phalanges.
  • Like the other muscles in this section, restrictions below will affect the FDB and vice versa.
  • The common area where pain is referred is the purple circle above. Again, note how this area is near the tendons and not down in the muscle belly itself!
  • Muscle restrictions/trigger points in this muscle are often misdiagnosed as plantar fasciitis and suspected metatarsal stress fractures.
  • In the video below, we’ll go over finding the muscle/palpating it and how to stretch it to test it’s mobility.

Video – Palpation (aka how to find the muscles in your foot) + How to stretch them

In the next post, we move to the top of the foot. Once we’re through all of the little muscles, we’re going to talk treatment and what other areas you should be thinking about!

Click here to go back to part two (the little toe intrinsics)

Click here to go back to part one (the big toe)

Or…. click here to continue to part four (the top of the foot)