Peroneus Brevis Injury

Ozzie Gontang

In article <YVPxc.3192$vO1.28874@nnrp1.uunet.ca>, Doc <stevew@netrover.spmblkr.com> wrote:

> Has anyone had experience with recovering from this
> injury? What worked best? How long of a down time did you
> have? Thoughts? Suggestions?
>
> D. Walker

This may be of some help:

Some Magic On Rehabilitating Sprained Ankles: Free The
Peroneus

I continue to maintain that the problem of the continual re-
spraining of one's ankle is more a function of the peroneus
remaining shortened by the original sprain and the fascia
holding the muscle in that shortened state. Here's some
magic you can work on your own ankle or you can get someone
to help you: Free the peroneus

Some Magic On Rehabilitating Sprained Ankles: Free The
Peroneus by Austin Gontang, September 27, 2000

Some Magic On Rehabilitating Sprained Ankles: Free The
Peroneus
c. 2000 Austin "Ozzie" Gontang, Ph.D.

> Hi, I sprained my ankle a good four months ago and have
> been doing daily exercises to rebuild the strength,
> flexibility, balance etc. They've worked really well and
> now I have progressed to very gentle running. I can hop,
> skip and jump on the ankle now with no problems. However,
> when I've been sitting, or occasionally when I get out of
> bed, the ankle siezes up and is very stiff. I then have to
> hobble about on it gently to ease it back into life. I
> don't understand why it stiffens up when it would appear
> to be almost fully healed and rehabilitated. Any ideas/
> advice ? Thanks, Minnie Mouse

Minnie,

One thing I've found over the years is that the peroneus,
the muscle which runs down the outside of the leg - it lifts
the outside of the foot - often gets pulled and to protect
itself it tightens- i.e. shortens. After the healing of the
ligaments around the ankle, that peroneus (longus and medius
portion) can remain in its semi-contracted state. which
means it doesn't fully relax when the posterior tibialis -
its counterpart - lifts the inside of the foot up.

So often the sprain is gone but those muscles and fascia
which splinted to protect the pulled muscles and strained
ligaments don't let go. Those muscles that hold on are
unknown by most people. They keep thinking ankle and forget
the ankle residue of tightness and/or clicking may be a
symptom. Those muscles and their fascia (the thin
transparent film you see between the skin and the meat on a
chicken breast) must be worked on through transverse
friction, deep tissue massage or fascia release. Once that
muscle group on the outside of the leg is freed up the ankle
joint is freed up and it's ease of movement almost feels
like a miracle has happened. There's no clicking and the
person feels immediately a fuller range of ankle motion.

I continue to maintain that the problem of the continual re-
spraining of one's ankle is more a function of the peroneus
remaining shortened by the original sprain and the fascia
holding the muscle in that shortened state.

Back to my soapbox about my reason for having people train
on unpaved roads, grassy or uncompacted dirt is to train
their stirrup muscles which are postural muscles (peroneus
and posterior Tibialis) that evert and invert the ankles.

If people keep running on flat, level surfaces that are
concrete or asphalt the level, flat surfaces create an
overuse syndrome which never let the ankle act as the semi
swivel (not anatomically correct) it is. My reason for
having people run on grass and unpaved surfaces is to
allow the ankle to do what it was make to do...adjust to
the terrain.

Paved roads create an overuse syndrome because those
muscles never get taken through a wider range of motion
and therefore shorten and the fascia then locks them in
that position.

I think that the solution is counter intuitive. It's not the
unpaved and uneven surfaces which are the problem. It's the
paved even surfaces which never allow for the variability
which the ankle needs to experience to maintain its range of
motion and muscle flexibility.

What To Do About The Tight Or Clicking Ankle

Using A Partner

Start about 3 inches above the ankle bone on the outside.
Hold as if they are going to strangle the outside of your
lower leg- fingers wrap around the lower leg thumbs pointing
toward each other or one thumb rests on the other thumb (if
more pressure is desired).

Have them use light pressure by pushing in with thumbs as
you make a small (emphasis on small), smooth (emphasis on
smooth) circle. As you make small smooth circles with the
foot they slowly to slide the thumbs up the peroneus muscle.

The idea is that you can loosen the muscle from any
adhesions and also you can loosen up the fascia which may be
holding the peroneus from relaxing and going through it full
range of motion.

Stop after 3 or 4 times of small circles and they holding.
Walk a few steps. More often than not, you'll feel less
pressure around the ankle as it can move more freely due to
the freeing of the peroneus higher up the leg.which takes
the tightness off the ankle area.

The peroneus and posterior tibialis are often called stirrup
muscles as they invert and evert the foot. They are also
postural muscles and therefore slow twitch, in that they
help maintain correct posture when functioning properly.

Doing The Loosening On Your Own

To loosen the peroneus on your own, face a railing with a
middle railing (http://www.mindfulness.com/of1.asp). Turn
your body 45 degrees and place the peroneus side of the leg
on the bar, usually the middle bar is better unless you're
very tall. Do the same foot movement as mentioned above to
loosen the peroneus and the fascia that may be constricting
the ankle for its full range of motion. As you make the
small circular movements slide the outside of the leg slowly
down the railing. Start about 3 inches above the ankle bone
and go to about the middle of the lower leg.

If the circle made by the ankle is to big, it will be a
jerky circle and you'll just be straining tendon since the
muscles won't be letting go. So small circles, start penny
size. The circle is not made with just the front of the
foot. The bottom of the heel is scribing a circle also.
Imagine your foot is the bottom of an unside down pie plate
and you get the idea how both the front of the foot and
bottom of the heel are circling. As the foot makes the small
circles at first imagine you're screwing out the foot so
there's more space in the ankle. When the peroneus loosens
up there is a better range of motion in the ankle.

Remember to do this lovingly. If you make big circles, or do
it too hard or too fast, your body will remember the feeling
when it was originally hurt, and tighten up even more to
protect itself.

In health and on the run, Ozzie Gontang Director, San Diego
Marathon Clinic, est. 1975 Maintainer - rec.running FAQ http://www.faqs.org/faqs/running-
faq/ Mindful Running: http://www.mindfulness.com/mr.asp