Talking about the ankle warrants a discussion of the foot as well, since the ankle exists to move the foot. But, you’ll have to tune in to the next newsletter for that story …

If asked to point to your ankle, you’d probably indicate the knobby bumps just above your feet. Anatomically, these are called malleoli (malleolus is singular) and they are simply the bottom part of the lower leg bones. These malleoli function like pulleys allowing muscles in the lower leg to move the foot.The ankle joint itself is the junction of three bones: the bottom of the fibula, the bottom of the tibia (shin bone) and the talus (a foot bone). The joint acts like a hinge – meaning it only moves up and down. The side to side motion you make is really a movement of the foot. Numerous ligaments bind the bones of the leg and foot together while allowing some movement.

By far the most common ankle injury is a sprain, in which a ligament is torn or overstretched. Other conditions in the neighborhood include shin splints and muscle cramps in the calves, both of which can respond well to massage treatment. A ruptured Achilles tendon is extremely painful and debilitating. After surgery and physical therapy, skilled massage can enhance the recovery.

Maintaining or regaining the function of your ankles allows you to safely propel yourself forward up Dog Mountain, take a jump shot, and pick up your (small) kids.

Originally published by Marsha Hansen, LMT in 2/06 newsletter.

The gemellus, along with the piriformis, are part of the “deep six”, a group of hip muscles responsible for external rotation. If you can kick a soccer ball with the inside part of your foot it’s because you can externally rotate your hip. Sitting cross legged also requires the strength to externally rotate. (It also requires flexibility in the adductors, another topic.)

Trigger points that develop in the gemellus can be expected to behave like trigger points in the piriformis. Hip pain and a pain in the butt would be common. Lost range of motion (hip rotation) could follow if treatment was incomplete. In order for a massage therapist to access the gemellus, she’ll have to work through the gluteus maximus, a large muscle that lays superfically on top of the deep six.

When performing bicep curls with dumbells you would call the supinator into play as you curl the weights toward your chest. See the position of the palms? They’re supinated. Using a (manual) screwdriver requires strength and stamina in the supinator. Turning some doorknobs require the use of the supinator.

Trigger points in the supinator can be dificult to distinguish from trigger points in other forearm muscles. Pain is felt near the lateral part of the elbow and at the base of the thumb. The thumb may also present with a vague numbness.

My friend and colleague, Jim Dwyer, an attorney at Heiling Dwyer & Associates, is a great source for personal injury information. One of the things he likes to educate people about is revealing to your health care team any information about current and old similar injuries. That old back problem from college soccer, the car accident in ‘98, and the foot pain you were experiencing two months before the accident are all important to document.

“Honesty and candor are critical to a full recovery and a successful claim.”

Individual rotatore muscles attach the transverse process of one vertebra to the spinous process of another; this gives it a diagonal placement which causes the rotation when the muscle is put to use. The whole group of rotatores are placed from the lumbar to the cervical vetebrae. Along with two other groups of small spinal muscles, they make up the transversospinalis group.

People with very tight or contracted rotatores may appear to have a stiff back with very limited ability to make minute, subtle spinal movements. Trigger points in the rotatores refer pain close to the source; generally a client will describe pain right next to the spine. Often releasing tension in the deep spinal muscles can make chiropractic adjustment easier. Occasionally, a client will have a “spontaneous adjustment” after trigger points are released.

With its two short tendons attaching to the bottom end of the femur (thigh bone), the gastroc allows you to bend (flex) your knee. The long, inferior tendon was made rather famous by stories about a Greek warrior name Achilles. The Achilles tendon (more properly called the calcaneal tendon) crosses the ankle to attach to the heal bone (the calcaneus), allowing you to point your toe, also known as plantar flexion.

Many activities this holiday season may cause overuse in the gastrocs. Walking up stairs and escalators at the mall, inching along in traffic unable to use cruise control, and standing in line at the post office can create conditions that trigger points find attractive. Trigger points in the gastroc usually cause localized pain and pain in the arch of the foot.

Flying long distances can cause calf trouble for people at risk for deep vien throbmosis (DVT). Cramping in the calves can be caused by trigger points, poor circulation, or inadequate nutrition, especially calcium and magnesium.

LDT can be used as the sole treatment or it can be combined with massage techniques to round out the session. Often I work with people clothed (shorts and tank top). The manual pressure used is just enough to give a slight stretch to the skin.

Because LDT takes concentration to perform, the sessions are usually pretty quiet. Most people on the table fall into a deep state of relaxation. Some people feel “shifting” or “moving” happening within the body.

Although some people can not identify any post-treatment reactions, there can be many physiological “side effects”. These changes may last up to two days. More frequent urination is common, so drinking extra water helps. Some people have “weird” dreams or feel more emotional for a couple of days. Feeling more sleepy or even more energized are normal reactions, too.

The longer term effects include reduction of pain and inflammation, immune system stimulation, and improved recovery from injury or surgery.

Let’s start with the contraindications or the reasons you should not have LDT treatment. Do you have a fever or are you hemorrhaging? If yes, wait until you’ve recovered before seeking lymph treatment. Likewise for the ACUTE phase of an infectious or inflammatory disease. Chronic, serious contraindications include congestive heart failure, blood clots (thrombosis), an aortic aneurysm, or a venous obstruction. There are precautions a therapist should take for some other conditions.

In general, though, LDT is such a gentle treatment that almost anyone with any condition (including good health) can benefit. Remember, lymph drainage (pronounced like “massage”) helps encourage fluid circulation, including lymph fluid, blood, cerebrospinal fluid, and synovial fluid. Activating these systems helps your body eliminate more toxins. It also promotes tissue regeneration and faster healing after illness, injury or surgery.

The immune system can be stimulated as this improved flow of lymph increases the antibody/antigen contact in the lymph nodes. The sympathetic nervous system – the part that keeps us in the “stressed out” mode – can be calmed by LDT, reducing the effects of chronic stress. Pain and muscle spasm are also reduced by lymph drainage therapy.

I’m very excited about the application of LDT in my practice. My favorite referrals are of people who are seeking pain reduction, injury recovery, or surgical support. The pain reduction, tissue rejuvenation and toxin elimination offered by LDT can really benefit these clients.

Clients who come in for maintenance massage can benefit from having lymph drainage incorporated into the session to reduce stress and pain and to boost the immune system.

1. lymph and the lymph system

2. benefits of and contraindications for LDT

3. what to expect during & after a session

The lymph system is a very important component of the immune system. The fluid (lymph fluid) that moves through the system starts from the watery environment outside of tissue cells where cellular waste accumulates. After leaving this area (the interstitial environment), the lymph fluid carries the waste products – including dead cell fragments, proteins, lipids (fats), immune cells, hormones, and junk your body doesn’t use (like food coloring or preservatives) – through a series of vessels.

These vessels gently move the lymph through lymph nodes where the fluid is filtered and concentrated (some of the liquid is reabsorbed by the body). This is also where toxins can be captured and destroyed by the immune cells. The lymph fluid is eventually dumped into the the circulatory system near the heart. From here it is mixed with the blood and circulated to the organs of elimination. You then release the waste products and toxins from your body by urinating, sweating, etc.

When lymph tissues are damaged – by injury, disease, or even some disease treatments (radiation, surgery)- their ability to clear their interstitial areas of waste can be compromised. Cells, in a sense, begin to drown in their own waste which can cause toxicity, edema (swelling), and pain.

LDT helps improve lymph flow by stimulating the lymph vessel contractions. The treatment improves the strength and speed of these contractions. In the next post we’ll look at some of the many, many conditions which can be improved by the use of LDT. Stay tuned…