Peroneal/shin mobilizations

In this post I’m going to show you how to use the tennis ball to mobilize the muscles along the shin bone and down the outside of the lower leg . This includes the anterior tibialis, extensor digitorum, and peroneal muscles. The goal with this mobilization is to anchor one end of the muscle down and then actively stretch out the rest of the muscle against it.

Key Points

1) Go back and read the massage post specifically on the hand itself to review the body landmarks and muscles in this region. There is one bony landmark that you will need to be able to find to as your point of reference- the fibular head. This is where the peroneal muscles attach and if you move forward towards the shin from this landmark, where the anterior tib and EDL muscles are.

fibhead1

The fibular head is actually located slightly below the knee. To find it, while sitting with your knee bent, wrap your hand around the upper part of your calf so that the space between your thumb and index finger are directly behind the knee and your fingers are wrapped around towards the front of your knee. The fibular head will be the large, bony bump under your index finger.

fibhead2

2) To perform these mobilizations, you’re going to need a tennis ball and some floor space. The basic idea is to apply pressure with the tennis ball to one of the three yellow x’s (picture below) and to then move the foot/ankle to stretch out the muscle against it. Remember, only go as far as you can comfortably. You’re not trying to force these! If this is too much or the spot is too tender ease up on the pressure or go back to the foam roller. See the video below for full details and demonstration of the mobilizations.

shintennisball

3) Repeat for 10 reps.

4) Same warm up rules apply. Try to do this either following a workout or warm up the area with the foam roller first. Especially if you’re coming back from an injury or this is a problem area.

Video

Lower Back

backmuscle1This region is home to the large muscles of the low back including the paraspinals (erector spinae and multifidus), as well as, the quadratus lumborum and larger overlapping latissimus dorsi muscles. In this section you will find our available treatment plans as well as the different self treatment techniques on this site.

Injury Treatment Plans for this area:

(* note. each treatment plan includes a free downloadable PDF. Here’s a post on how to use them.)

1) Low back strain. Click here.

These plans are part of our “Injury of the Week” blog series. Each post will talk about what the injury is and how it can happen. It will then take you through all five steps of the ATA self treatment system including self massage, mobilizations, kinesiology taping, stretching and strengthening.

Individual Parts of Self Treatment System:

Part 1. Self Muscle Massage.

  1. Blog post with anatomy review, video and picture demonstration of self muscle release techniques for the low back using a foam roller and tennis ball. Click here.
  2. Blog post on additional treatment tools for use in the back, including the RAD Roller, Rumble Roller, and Knobber. Click here.

Part 2. Mobilizations

  1. Blog post on how to perform a tennis ball mobilization/active release of the low back. click here.

Part 3. Stretching.

  1. Blog post on how to stretch out the muscles of the low back. Click here.

Part 4. Kinesiology tape.

  1. Blog post on how to apply tape following a low back strain/sprain. Click here.

Part 5. Strengthening. 

Right now our strength advice is specific to our “injury of the week” blog series (see top of this page for injuries affecting this area). However, all of our strenghtening videos can be found on our youtube channel (link at top of website).

Low Back Pain

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 decrease the amount of pull along the muscles that run parallel to the lumbar spine. This is perfect following a muscle strain to provide support and allow for rest so that the injured muscle/tendon can heal.

Anatomy

backmuscle1

backmuscle21

The large muscles that make the lumbar spine move are actually organized into three separate layers. The first layer is the deepest (closest to the bone) and the third layer is the most superficial. As you can see from the pictures above, some of the muscles within these layers move in a vertical direction, parallel to the spine while others travel diagonally to or away from the spine. For this taping application we are focusing on the muscles that run in the vertical direction. They all share a common insertion point at the base of the spine on the PSIS (aka the posterior superior iliac spine, aka the “dimples” at the bottom or spine where the vertebrae attach to the pelvic bones).

psis

Before we get to the application itself, it is important that you can locate the PSIS on yourself. To find it, you’re going to start with your hands on top of your hip bones so that your thumb is pointing towards your back and your fingers are pointing forwards towards your stomach. As you reach behind with your thumbs, you’re looking for two small bumps on either side of your spine. Visually, you can see them. They are the two “dimples” at the small of your back.

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) Low back application with correction strip.

backkines

Key Points:

  • Prep the skin first. For this application you will want to put the back extensor muscles on stretch. To do this, start in a seated position with your feet on the floor. Then simply bend forward in your seat as far as you can comfortably.
  • There will be two primary strips that run up the back parallel to the spine. Each will be anchored at or just below the PSIS where the muscles share a common insertion point. From here, move into the stretch position and then apply the tape. The tape works by pulling on itself and you have already put the muscle on stretch to do the work for you. If you are unable to move the muscle into this position, you may add a small amount of stretch to the tape.
  • A secondary correction strip can be applied horizontally across the low back. If you have a sore area in the low back, you want this strip to cover it! Cut the tape so that it is long enough to cover both vertical strips with 1-2″ of tape on either side (these are your anchors and must be applied without stretch). Round the edges, apply 50-75% stretch and place the tape. Then remove the paper backing and lay down the ends. Don’t sweat the 50-75%. Think medium stretch versus maximum “how far can I pull this tape” kind of stretch.
  • When the tape application is complete you will have three strips of tape, 2 vertical and 1 horizontal.

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 pt 10- Low Back

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 stretches specifically for the low back. This includes the long back extensors (erector spinae), the QL and where the large hip flexor (the psoas) sneaks through to insert on the front of the lumbar spine.

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 low back (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, make sure you are using a firm surface where the back is fully supported. A saggy bed mattress for example will make these far more difficult than they need to be. Also, start with the easier stretches in the progression and work your way up.

The Progression:

#1. Double knee to chest

dktc

This is always a good one to start with as it brings both knees up at the same time to stretch out the lower lumbar muscles. Start laying flat on your back and bring both knees up to waist height. From here let your arms do the rest. Gently pull your knees up until a stretch is felt in the low back. If this is too uncomfortable, start by laying on a pillow and wrap a belt/strap behind your knees. Pull up using your arms versus your legs. Hold 20-30 seconds and repeat 4 times.

#2 Single knee to chest

glutestretch

This is a continuation from the stretch above. Start by bringing both knees to your chest and then drop one back down towards the floor. Just let the leg fall as far as it can comfortably can. It may not go all the way down at first. If you’re looking to increase this stretch, try to use a surface where you can drop the lower leg down further. For example, I have people sit on the edge of the table and then lean back with both knees to their chest. As they let one leg go, the leg can come down into full hip extension and the knee can bend freely. Be careful when trying this one. It can be a big stretch! Start by laying flat on the floor and work from there. Hold 20-30 seconds and repeat 4 times each side.

#3 Lower trunk rotation

backrot

Like the stretch above, this stretch allows for a few modifications to make it more challenging as you go. Start by laying flat on the floor with both knees and feet together. From here, drop your knees down to one side. You should feel a stretch in the low back and possibly even wrapping around the hip depending on how tight things are. Hold 20-30 seconds and repeat 4 times to each side.

How to modify this??

1) As you drop both legs to one side, straighten the top knee and keep the bottom one bent. the stretch will also be increased by how high you keep that leg (i.e. waist height and above versus lower).

2) Using the modification above, pull the lower leg back so that your legs are in more of a scissor position. Remember- shoulders must stay flat when you do this. Do what you can to start and work your way up from there.

#4 Quadratus Lumborum Stretch

ITstretch3

To target the QL muscle, we need to use both the upper and lower body. for this you’ll need surface where you can literally hang off the side (this means bed, coffee table, etc). Start by laying on your side. Bring the bottom knee up a little and then keep the top leg straight and bring it back. From here let it drop down. The last part is to add the arms in. Twisting your upper body, reach overhead with you top arm. Bottom arm stays relaxed. This should result in a stretch from your hip to your rib cage. Hold 20-30 seconds and repeat 4 times. Go slow setting it up to make sure both the upper and lower portions are set up correctly.

#4 Hip flexor stretch

hipflex1

For this stretch, start in a lunge position kneeling on the side you want to stretch with the other leg out in front. From here you’re going to want to lunge forward onto the front leg (aka push your hips forward with your back STRAIGHT- no leaning forward). Keep the side you are stretching completely relaxed. You should feel a stretch right in the front of your hip and may even feel it in the top of your quad (thigh muscle). Hold for 20-30 seconds and switch legs. Repeat 4 times.

Click here for ways to modify this stretch.

Tennis ball mobilization- low back

In this post we’re going to use a tennis ball to try and break up soft tissue restrictions in the low back. The goal is to anchor down one end and then to slowly stretch the muscle out against it.

Key Points:

1) Go back and read the massage post specifically on the back itself to review the body landmarks and muscles in the lumbar region. The main area you will want to be able to locate for this mobilization is the PSIS (aka the posterior superior iliac spine). This is the common insertion point of the long back extensors and you will need to be able to find it so that you can accurately position the tennis ball.

psis

2) This is a two part move. The first part is moving into a pelvic tilt. The goal of this is to engage the lower abdominals and stabilize the lumbar spine. See the video below for full details.

3) When performing a rep, lay flat on your back with your legs straight and the tennis ball in position. Then move into the pelvic tilt. From here, slowly try to bring your knee up towards your chest. Do not force the movement. You may not be able to bring the knee all the way on the first few tries. Go as far as you can comfortably and then return back to the start. Try to hold the tilt throughout all of the repetitions. If you can not, stop, rest, and then reset before continuing.

4) Try to perform 10 reps.

5) Same warm up rules apply. Try to do this either following a workout or warm up the area with the foam roller first. Especially if you’re coming back from an injury or this is a problem area

Video

Self Muscle Massage- Neck/Back Extra Credit

Working on the back as a whole can be tricky. The muscle groups are arranged in overlapping layers and for every large muscle there are five tiny little ones buried beneath it that run solely from one vertebrae to the next. That being said- it can be REALLY tricky to get in there and loosen up the little guys with a traditional foam roller or tennis/trigger point ball. So with that in mind I wanted to take a few minutes to share with you some of the other self muscle release products out there that may help you out if your neck and back are a common problem area.

If you missed any of the previous posts on the low back, midback, or neck, click here.

#1 RAD Roller

rad

This small little roller was created specifically to work on those small muscles that run alongside the spine (the paraspinals or erector spinae) but really you can use it on almost any muscle group. As you can see, in between the two trigger point balls is a little space (the small black piece in the middle). By lining up that space along the middle of your spine, you will have perfect access to the area along either side. This allows you to lay down on the Rad and use it as a deeper roller to work your way all the way up the spine segment by segment (you can further isolate one side by rolling into it or curling up into a mini crunch as well). Once you find any problem areas, it can also act as a tennis ball/trigger point ball to sink in deeper for those cross friction/trigger point release techniques.

Where the RAD really excels is in that mid back/lower cervical area. It’s great for working between the shoulder blades all the way up into the neck. You can use it as a roller to warm up the muscles and then sink in for the deeper techniques instead of swapping back and forth between the roller and tennis ball. As an added bonus, it also makes for a compact travel roller. You can easily work on your legs with it, although I will warn you- this is a firm roller. Jumping right onto a sore muscle the way you would a softer roller, will definitely get your attention so start off easy.

To see more about the RAD, check out their website www.radroller.com.

#2 Rumble Roller

rumble

The Rumble starts off as a traditional foam roller and then adds 200+ soft foam knobs to its surface. The goal in doing so is to replicate the thumbs of a massage therapist and to allow you to work deeper into the muscles than a flat, non-shaped roller would. The knobs themselves are soft so you don’t have to worry about hitting bone and they are positioned so that they build on each other. As you roll over one, it provides a stretch to the muscle so that the next knob can sink in deeper. With that in mind, this is great for working on the deeper areas of the back and neck (especially as you rotate over to really let the knobs sink in), but also doubles as your all purpose foam roller for legs, hips, and arms.

If your back and neck are common problem areas and your in the market for a new roller, definitely consider this one over the traditional flat/non-shaped roller.

Click here for more info on the Rumble http://www.rumbleroller.com/index.html

#3 The Back Nobber

An innovative deep muscle massage tool for the back to help relieve muscular pain.

 

When it comes to digging out muscle spasms and trigger points in your neck and between the shoulder blades, the tennis ball/trigger point ball can often come up short. Even standing up and leaning back into the wall onto the tennis ball might not give you the kind of pressure you need to truly sink into the muscle and work on it. Even then, the ball may slide around. For that, you have the Back Nobber. This is a trigger point release cane with two different sized trigger point balls on either end. Once you position the ball onto the area you want to work, the shape of the cane will do all the work for you and from there you can apply as little or as much pressure as you want. You can use the cane either standing up or sitting down which is key in the case of a stiff and sore neck. Of all the items in the clinic, these tend to go “missing” the most.

Click here for more info on the nobber- http://www.pressurepositive.com/store/Massage-Tools-OSCAR_10.aspx

#4 The Thera cane

thera_cane_small

 

Like the knobber above, the Thera cane is geared towards digging out trigger points and muscle spasms anywhere from the neck down to the low back. One of the added bonuses of this gadget is that it has six different knobs for you to work with and multiple hand holds. Personally, I’m also a big fan of using this to work on some problem areas in my hips and legs.

Click here to read more about the Theracane at www.theracane.com. Be sure to check out their resource tabs and tip sheets.

 

 

Self Muscle Massage pt 10- Low Back

This is part ten in the Self Muscle Massage Series. In the introduction post to this series we introduced and demonstrated the three muscle release techniques that will be used in this post. If you would like to review them, click here. If you would like to see any other parts of the series, click here.

In this installment of the series, we’re going to be talking about the Low Back (Lumbar Spine). This area plays a major role in stabilizing the spine and holding the body upright. It is frequently injured in athletes due to it’s involvement with the hip as part of the Lumbo-pelvic complex (meaning…if the hip is tight/weak, extra strain can be placed on the low back and vice versa). The primary example of this is an anterior pelvic tilt (when the front of the pelvis tips down towards the ground due to muscle imbalances). When this occurs, the muscles in the front of the hip are kept in a shortened position and can become stuck that way. As a result, the hamstring and glute muscles in the back of the thigh are kept in a lengthened position and become weak under the increased strain. The result is that the pelvis becomes stuck in this forward tilt and the low back becomes stuck in that tight/shortened position. The abs become weak and the low back is left to carry the the workload for maintaining posture and stability. Once that happens, it doesn’t take much to injure the low back muscles.

Anatomy:

Bony Landmarks

lumbarbone

#1 L1-5 (aka the five lumbar vertebrae). You may have heard of the spine being described by letters and numbers. Traditionally, the spinal column is broken down into four regions (the neck/cervical – C, thoracic/midback – T, lumbar/low back – L, and sacrum/tailbone- S) and then given a number based on it’s level. The number refers to each specific vertebrae (they are stacked up one on top of the other). The easiest way to visualize the the level is to count the little bumps down the middle of your back. These are the spinous processes ( the little circles in the middle of the picture above). There are five vertebrae in the lumbar spine, numbered one thru five. In the picture above, you’ll also notice little “knobs” coming off either side of the vertebrae. These are the transverse processes.

#2 Upper Border- T12/Last Rib. The easiest way to find L1 is to start by finding the last rib. The thoracic/midback spine are the easiest to identify because each level in this region has a rib coming off it’s side. Start with your hands on your rib cage and work your way down till you find the last one (note: not all of the lower ribs reach around to the front; the lower two in particular do not. For this reason, keep your thumbs on your back and your hands on your side to make sure you feel them). When you find the last one, follow it to the spine and find the little bump (spinous process). This is T12 (or vertebrae #12 of the thoracic spine). If you drop just below it to the next bump you will have found L1. The key here is that when working on the muscles of the low back you need to work all the way up to the rib cage! Consider this the upper border for the area when trying to loosen up the muscles.

#3 Lower Border – Illiac Crest/Hip Bone. The easiest way to find L5 is to start by placing your hands on your hips on the top of your hip bones (iliac crests). If you follow this level to the spine, you will be at the L4 level. From here drop down to the next bump (spinous process) and you will have the last lumbar vertebrae, L5. The key here is that when working on the muscles of the low back you need to work all the way down to just below the level of the hip. This area may seem rather bony depending on your body type, but there are plenty of little muscles that love to be problematic nestled in there.

Muscles

The large muscles that make the lumbar spine move are actually organized into three seperate layers. The first layer is the deepest (closest to the bone) and the third layer is the most superficial. While these three layers are in the back, there is also an additional layer that inserts into the front of the lumbar spine.

backmuscle1

Layer One:

There are two muscles in the deepest of the three layers: the Quadratus Lumborum (QL) and the Multifidus.

1) Quadratus Lumborum- this muscle starts on the posterior hip bone and then moves up and in to insert on the spinous processes of the lumbar spine and the lower rib. This muscle helps hike the hip up towards the ribs, as well as, extend the spine  (bend backwards) and sidebend towards that side. This muscle is most easily found closer to it’s attachment to the hip. As you move closer to the spine itself, the muscle travels underneath layer #2 (which you can see on the left). To find this muscle, start with your hand on your hip while standing. You want your thumb to be towards your back. From here, hike that hip up so that your foot comes off the floor (keep the leg straight! you don’t want to bend your knee and use your hip muscles). As you hike your hip, you will feel the muscle move under your thumb. From here you can trace it up and in towards the spine. Note: you will only be able to palpate (feel) the outer portion of this muscle. As you move closer to the spine, it will be hidden underneath the muscles in the second layer.

2) Multifidus- this muscle starts lower on the spine of the sacrum itself. From there, it moves up along the lumbar spine, inserting onto the spinous processes. The muscle fibers move up and in for this muscle, running from the transverse process of one vertebral level to the spinous process of the level above. This allows the muscle to extend the spine (bend backwards), sidebend, and rotate towards the opposite side. To find this muscle, you’ll first want to find your PSIS (bony landmark on the back of the hip).

psis1

To find the PSIS (posterior superior illiac spine), you’re going to start with your hands on your hip bones (iliac crest) so that your thumb is pointing towards your back and your fingers are pointing forwards towards your stomach. As you reach behind with your thumbs, you’re looking for two small bumps on either side of your spine. Visually, you can see them. They are the two “dimples” at the small of your back. Once you find the PSIS, move to the middle of the spine. This in between area is where the multifidus muscle lies. It looks like a skinny triangle that is thickest at the bottom and gets smaller as it moves up the lumbar spine. Note: this muscle is deep to the overlying muscles in layer two. To differentiate it, lay flat on your stomach. Extend your neck and upper back. As you do this, try to rotate away from the side you are working on. This rotation will trigger just the multifidus and the top layer will remain relaxed.

Layer Two:

In this layer, there are also two muscles: the Erector Spinae (ES) and the Serratus Posterior (SP).

backmuscle1

1) Erector Spinae (ES). The ES is actually three seperate muscles that work together as a thick “rope” that runs parallel to the spine. These muscles are easy to find due to their thickness and are primarily responsible for extending the spine (bending backwards). It is important to note that these muscle fibers run vertically from the sacrum all the way to the base of the skull. When working on these muscles, use the PSIS and spinous processes as your borders and stay in between them for best results. The ES muscles run vertically between those two landmarks. When trying to differentiate the ES from the multifidus, lay flat on your stomach and lift your neck and upper back up from the floor. This motion will activate the ES from skull to sacrum. If you add in rotation, you will trigger the multifidus.

2) Serratus Posterior (SP). This muscle is a small breathing muscle that overlaps the ES muscles (so technically it is between the second and third layer of muscles). The reason for it’s inclusion is that it can be a site for trigger points along the lower rib cage. The muscle itself runs from the transverse processes of L1 + L2 up and out to the lower four ribs. It’s muscle fibers run in the same direction as the larger and more superficial muscle of the latissimus dorsi.

Layer Three:

backmuscle21

There is one muscle in this layer, the Latissimus Dorsi, and it covers the previous two layers completely. It starts on the sacrum and posterior illiac crest (hip bone) and runs up to the humerus (upper arm bone). It’s primary function is to move the shoulder backwards and in towards the body, however, due to it’s attachments in the low back, it also assists with positioning of the pelvis. Note: the reason for it’s involvement here in the low back is that if the muscle is overused or becomes stuck in a tightened position, it can put extra strain on it’s attachments along the lumbar spine. This muscle is easy to find. While sitting, move your arm straight back behind you with your elbow straight. You will feel the muscle moving over the back and towards the outside of the rib cage as the muscle moves up and out to the back of the shoulder. The thickest part of the Lats are along the rib cage and are where you want to look for trigger points or muscle spasms.

Layer Four (Front Layer):

psoaspostview

Layer four is made up of the large hip flexor (Psoas) muscle. This muscle runs from the front of the hip and femur (large thigh bone) up to insert on the front of the lumbar spine. Soft tissue restrictions in this muscle will likely impact the low back so it is important to remember this muscle group when working to relieve tension in the low back. For more details on the how to find and work on the front of the hip, click here.

Soft Tissue Release

What you’ll need: stick/foam roller and tennis ball

The techniques: click here for an introduction to the techniques and a video demonstration

1) Lengthening/elongation with the foam roller or stick.

2) Cross friction with your hand or tennis ball.

3) Sustained pressure or trigger point release with the tennis ball.

Key Areas to Work On

#1 When working on the muscles of the low back, try to visualize the muscles moving in three different directions:

lumbarkeyarea

a) Running vertically (or parallel) along either side of the spine (yellow line 1 in the picture).

b) Running up and in towards the spine from the hip bone (illiac crest) and PSIS (yellow line 2 in the picture).

c) Running up and away from the spine towards the back of the shoulder (yellow line 3 in the picture).

#2 Always start with the foam roller to warm up the muscle and lengthen the muscle fibers before moving on to the deeper cross friction and trigger point techniques.

#3 Cross friction works best on the ES and multifidus muscles. Remember- let the tennis ball sink into the muscle and work PERPENDICULAR to the way the muscle fibers run. There should be minimal movement of the tennis ball (approx 1 inch) when performing this technique.

#4 Here are some popular trigger points in the low back (trigger points = yellow x’s. note: for the ES muscle, there may be multiple points. start at the lower border and work your way up- follow the yellow up arrow):

lumbartrigger

#5 Don’t forget to include work on the hip flexors!!! They insert onto the front of the lumbar spine and can all kinds of problems, especially with long distance biking and running. Click here for specifics on how to target this area.

Video

Here is a video demonstration of these techniques on the low back.
#5 Don’t forget to include work on the hip flexors!!! They insert onto the front of the lumbar spine and can all kinds of problems, especially with long distance biking and running. Click here for specifics on how to target this area.

Video

Here is a video demonstration of these techniques on the low back.

References

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

2) Hyde, Thomas and Gengenbach, Marianne. (2007). Conservative Management of Sports Injuries, 2nd edition. Jones and Bartlett Publishers, Inc, Sudbury, MA.

3) Moore, Keith and Dalley, Arthur. (1999). Clinically Oriented Anatomy, 4th edition. Lippincott Williams and Wilkins, Baltimore, MD.

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

Elbow Forearm

wristflexormuscleThe forearm/wrist consists of the muscles that bend and straighten the wrist, namely the wrist flexors and extensors. This area is commonly injured with lateral and medial epicondylitis (aka tennis and golfers elbow). In this section you will find our available treatment plans as well as the different self treatment techniques on this site.

Injury Treatment Plans

(* note. each treatment plan includes a free downloadable PDF. Here’s a post on how to use them.)

1. Tennis elbow (lateral epicondylitis).  Click here.

This is part of our “Injury of the Week” blog series. Each post will talk about what the injury is and how it can happen. It will then take you through all five steps of the ATA self treatment system including self massage, mobilizations, kinesiology taping, stretching and strengthening.

Individual Parts of Self Treatment System:

Part 1. Self Muscle Massage.

  1. Blog post with anatomy review, video and picture demonstration of self muscle release techniques for the forearm and wrist using a foam roller and tennis ball. Click here.

Part 2. Mobilizations.

  1. Blog post on tennis ball/active mobilizations for the wrist flexors and extensors. Click here.
  2. Blog post on wrist joint mobilization using resistance band/tubing. Click here.

Part 3. Stretching.

  1. Blog post on stretches for wrist flexor and extensor muscle groups. Click here.

Part 4. Kinesiology tape

See tennis elbow post below for tennis elbow application.

Part 5. Strengthening

Right now our strength advice is specific to our “injury of the week” blog series (see top of this page for injuries affecting this area). However, all of our strenghtening videos can be found on our youtube channel (link at top of website).

Stretching pt 16- Forearm

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 forearm. This area includes the wrist flexors and extensors which are the common culprits behind lateral and medial epicondylitis (aka tennis and golfers elbow).

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 forearm (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 surrounding muscle groups first. For the forearm, this means stretching out the elbow and upper arm where the biceps and triceps are. As the injury allows, work you’re way up to stretching the injured muscle out.

The Stretches:

#1 Wrist Extensors

wristext

This stretch can be performed while sitting down. Start with the elbow straight and arm at shoulder height. If this is too much or uncomfortable for the shoulder, drop the arm down and bend the elbow to make it easier. From here, use your free arm to pull your hand and fingers down towards the floor like the picture above. You should feel a pull along the top of your forearm (between your elbow and wrist). Hold for 20-30 seconds and repeat 4 times.

#2 Wrist Flexors

wristflex

This stretch is exactly the same as above except for one difference. Instead of pulling your hand and fingers down towards the floor, you are going to pull them up towards the ceiling. Should feel a pull along the bottom of your forearm as you do so. If the straight arm at shoulder height is too much, you can lower the arm or bend and bend the elbow to make it easier. Again, we’re looking for 20-30 second holds for 4 reps.

Forearm/Elbow Mobilizations

In this post I’m going to show you how to use the tennis ball to mobilize the muscles of your forearm. This includes the wrist flexor and extensor muscles. The goal with this mobilization is to anchor one end of the muscle down and then actively stretch out the rest of the muscle against it.

Key Points

1) Go back and read the massage post specifically on the forearm to review the body landmarks and muscles in this region. The primary area you will need to be able to locate for these mobilizations are the medial and lateral epicondyles. f you cup your hand under your elbow you will feel the two “knobs” on either side. These are the epicondyles and they are the two main attachment points for most of the muscles in the forearm. The epicondyle closest to your side is the called the medial epicondyle. This is where the wrist flexors attach (meaning the muscles that bend your wrist up towards your palm). The epicondyle on the outside is called the lateral epicondyle. This is where the wrist extensors attach (meaning the muscles that bend your wrist up towards the back of your hand). For these soft tissue mobilizations, you want to be able to find these epicondyles and then move 1-2 inches down from them onto the common muscle group tendons. To find the muscle groups, place your thumb on one epicondyle and slide down the forearm a bit. When you bend your wrist back and forth you will feel the muscles move beneath your fingers. Before starting the mobilization make sure you can find them! See the link to the post above for further details.

elbowbone

2) To perform this mobilization, you’re going to need a tennis ball, a raised surface to work on (such as a coffee table) so that you you can move the arm freely, and a corner of the wall to lean against. See the video below for a full demonstration.

For the wrist flexors: To begin the mobilization, start by bending your elbow and facing your palm down towards the table. Start the medial epicondyle and then position the tennis ball approx 1-2 inches below it (you can make sure your on the muscles by moving your wrist up and down; you will feel them move. if you don’t stop and find them per the advice above!). Once you have the spot, apply pressure with the tennis ball and then slowly try to bend you wrist up towards the ceiling. Remember, only go as far as you can comfortably. You’re not trying to force these!

For the wrist extensors: To begin the mobilization, start by leaning standing against the wall with your elbow bent and position the tennis ball just below the outer/lateral epicondyle (remember- find the spot before doing the mobilization per the advice above!). With the wrist bent back, lean into the tennis ball to apply pressure.  Then try to bend your wrist down. Same rules. Don’t force it. Build through the reps and do what you can.

3) Try to do 10 reps for each muscle. As you’ll see in the video, you can work your way down from the elbow towards the wrist (if you do this, try 10 reps for each spot you work on).

4) Same warm up rules apply. Try to do this either following a workout or warm up the area with the foam roller first. Especially if you’re coming back from an injury or this is a problem area.

Video

Here is a video demonstration of the mobilizations.