Kinesiology THURSDAY – Ankle Jam and the Bicep Femoris (Why Did That Work?!)

“I did a lot of walking and now I have a pain in the front of my ankle,” she said, pointing to the anterior/lateral area of her talocrural (ankle) joint. She felt her ankle impingement with every step. Active and passive ankle dorsiflexion reproduced her symptoms. I asked her to lie prone and palpated a severe trigger point in the bicep femoris (lateral hamstring) tendon as well as a posteriorly displaced fibular head. By the way, if you aren’t sure if the fibular head is posteriorly displaced, the presence of a bicep femoris trigger point is the key. Here’s how to assess and treat it using a muscle energy technique (MET).

I then retested active and passive dorsiflexion and the end feel was normal, with a mild stretch in the gastrocnemius. Pain had been eliminated in both weight bearing and non-weight bearing positions.

Why did that work?!

During dorsiflexion, the fibula moves in several ways:

  1. Externally rotates 2-3 degrees
  2. Head of the fibula moves anterolaterally, which means the distal fibula should move posteriorly
  3. Slightly upward due to expansion of the ankle mortise

The bicep femoris has a unique attachment at the superior end of the fibular head, pulling the fibular head posteriorly and laterally.

If the bicep femoris is short/tight (trigger point), it will prevent the fibular head from moving anterior/lateral during dorsiflexion, which means the distal fibula will remain in the anterior position, causing anterior/lateral talocrural joint impingement with dorsiflexion. You can also fix this by performing a posterior glide of the distal fibula for 6-10 repetitions or a mobilization with movement, holding the distal fibula in the posterior direction while the patient actively dorsiflexes.

The exercise fix then becomes elongating the bicep femoris with the revolving triangle or an anterior cone touch with the opposite hand.

Why this matters: When you pull your toes up, you SHOULD feel a stretch in the back of your leg. If you (or your patient) feel a jam in the front outside of the ankle that blocks dorsiflexion, this may be an impingement the anterior/lateral talocrural joint and repetitive impingement may cause bone irritation and severe pain with walking. Check out the bicep femoris and the fibular head and fix what you find.

Because nobody has time to be in pain.

Until next time…

Kind Regards,
MoveWell Academy
[email protected]

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