Understanding The Impact of Muscle Weakness
- Volume 15 - Issue 4 - April 2002
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Q: Is there a similar effect to ankle manipulation on the posterior tibial muscle?
A: Dr. Guiliano says you first should perform neurolymphatic stimulation to address the inhibition of these muscles. Neurolymphatic stimulation is based on Chapman points, which are correlated with specific muscles. She describes these points as “light switches” to her patients, explaining every muscle in the body has a light switch that can turn it on and off. When you properly stimulate the point associated with a dysfunctioning muscle, there will be an increase in strength of that muscle when you test it again.
“This is a wonderful exercise for patients because they will be able to see and feel the lack of strength upon initial testing and the dramatic improvement following the neurolymphatic stimulation,” explains Dr. Guiliano.
You would perform neurolymphatic stimulation with a light touch in a circular, very subtle motion. When there is a chronic dysfunction of the muscle, the point will be very sensitive and often will feel like a pea underneath the skin. Dr. Guiliano says deep palpation is not required to find the point. It is very superficial, as though it is in the subcutaneous tissue.
You should also note these points are more like energy points because you will not find them along the nerve or lymph vessels that support the specific muscles. For example, you’ll locate the peroneal point on the anterior pubis bone lateral to the pubic symphysis on the affected side and you will find the posterior tibial point two inches up and one inch over from the umbilicus on the affected side.
Dr. Guiliano notes the posterior tibial point is the hardest to find because it is not located over a specific bony landmark and it varies with torso length and other malalignments of the body. As she explains, this explanation is just a brief introduction to neurolymphatic stimulation and it takes time and practice to palpate and stimulate these points readily. Then perform manual muscle testing to ensure adequate stimulation occurred.
“While we can address inhibition of muscles through neurolymphatic stimulation, often there is an underlying cause to the chronic inhibition and this must be addressed as well,” says Dr. Guiliano. “Lack of ankle dorsiflexion can cause this inhibition and I feel ankle manipulation can have a positive effect on the posterior tibial muscle.”
While ankle joint and superior tibio-fibula joint mobilization can facilitate inhibited peroneal function, Mr. Prior says he is unaware of a similar mobilization that has the same result for tibialis posterior. However, many patients with inhibition and recurrent pronation will present with reduced talo-navicular, first ray and first MTPJ motion. Mobilizations of the affected joints can improve motion, dynamic function and complement the strengthening program. Muscle stimulation points have been described for both the peroneals and tibialis posterior muscles, and can be a useful adjunct in this treatment process.
You should note mobilization and muscle facilitation are usually part of the treatment process and rarely replace the need for addressing the underlying biomechanical abnormalities. However, Mr. Prior emphasizes that clinicians who make the effort to learn and master these techniques will have an invaluable tool for enhancing patient care. Mr. Prior has found these techniques particularly beneficial in reducing the dysfunction caused by post-operative stiffness.
Dr. Dananberg (pictured) practices in Bedford, NH.
Dr. Guiliano has a private practice in Rutland, Vt. with an emphasis on holistic podiatric care. Mr. Prior has a private practice in London and is a National Health Service consultant in the U.K.