Anterior Muscles of the Lower Leg: Exploring Structure, Function, & Energetic Concepts
By
Lynn Teachworth,
BS, LMT, KMI, GIFT
April 30, 2018
Anterior Muscles of the Lower Leg: Exploring Structure, Function, & Energetic Concepts
By
Lynn Teachworth,
BS, LMT, KMI, GIFT
April 30, 2018
Therefore, I will explore the functional relationship of the anterior lower leg muscles and the rest of the body in motion, postural relationships with the body, and the body's relationship to gravity. Even though we are primarily treating people on a table, it is important to understand function and structure in order for our work to be intentional towards restoring and improving function, rather than just releasing tissue.
In this day and age most of the places we walk are modern, developed environments where most surfaces are perfectly flat. While this makes our lives easier, our ankles and feet rarely go through a full range of motion which leads to a lack of function, coordination, and development in the muscles of our lower legs. It is very rare to see a client with any structural or functional pathology who does not have some aspect of lower leg muscle and fascia shortening and dysfunction to be addressed.
The Muscles
- Tibialis anterior
- Extensor hallucis longus
- Peroneus tertius
- Extensor digitorum longus
- Peronus longus and brevis
Anatomy & Structure
When looking at the anatomy of these muscles, particularly the fascial continuities, it is easy to understand how the entire body is affected and compromised when this area is restricted and compromised.
The lower leg is divided into compartments by the fascial septa which run in between each muscle. Traditionally the lower leg is divided into four compartments but we will only be discussing the musculature in the anterior and lateral compartments as that helps us to understand function and structure more accurately. In reality all of the muscles in the lower leg work in synergy together.
As the lower leg area becomes restricted this will often lead to a shortening of the muscles/fascia which can lead to external rotation of the leg as well as pulling the knees more over the front of the foot and toes in standing. Locally this can lead to internal rotation of the tibia (the main structural cause of bunions), collapsing of the arch, and, as these muscles shorten even more, hammer toes. Hammer toes can often lead to a lot of pain under the metatarsal heads as they have to deal with the force of the body’s weight instead of the metatarsal pads.
Other compensations in the body can differ depending on many factors but the externally rotated leg will often lead to chronic gluteal tension and weakness as well as sacroiliac issues as the ilium and sacrum are jammed together. The pelvis can then be forced to compensate by posteriorly or anteriorly tilting, often accompanied by a posterior ribcage tilt as the quadratus lumborum and abdominal oblique muscles shorten and adapt.
This will often set up the head to come forward to keep the body from falling backwards, leading to a lack of cervical curve and forcing the body to shorten the sub-occipital muscles to keep the head looking forward and horizontally. Therefore, if you have clients that have a lot of issues with atlas subluxations or tension headaches, check out their lower anterior legs and you may find an important contributing factor.
Understanding Function
Muscle function is typically taught by observing what the muscle does as the client is laying on a table. Although the muscles we are referring to will dorsiflex and laterally rotate the foot while sitting or laying down, we should be more concerned with the true function of the anterior shin muscles when we are walking, standing, running and performing daily activities.
Once the body is upright, moving, and reacting to ground force reaction coupled with gravity, their function is more of an eccentric load and deceleration of the knee and pelvis with ankle stabilization. Try feeling this motion as you walk. You will notice that you don’t contract these muscles to dorsiflex in gait, the action of the anterior shin muscles is actually the opposite: to decelerate the knee and pelvis in the transverse plane as the body moves over the foot in gait and then to provide an efficient means of powerful external rotation through the leg and pelvis.
When following this functional fascial chain up the hamstring, quads, and iliotibial band you will find that the muscle/fascia morphs into the anterior hip flexors, lateral hamstring, as well as the gluteals. Which part of these structures is loaded eccentrically is dependent on how much transverse plane motion is occurring in the ankle and pelvis.
Of course there will be some dorsiflexion motion of the anterior shin muscles. For instance if someone is a soccer player or playing hacky-sack, you will use these muscles to slightly dorsiflex and allow more control for contact and control with the ball. In general, for our purposes as therapists, we want to understand function in everyday movement patterns rather than merely in isolated movements.
If you’ve gone for a walk, even a jog, you may have now experienced the eccentric loading of these muscles in decelerating the knee. Understanding this muscle function and following the functional fascial chain through the body, allows us to see how and why ankle, knee, sacroiliac joint pain, lower back pain, and cervical issues, (especially atlanto-occipital joint dysfunction) will most likely require addressing the muscles and fascia in the lower leg.
Locally, restrictions in the anterior lower leg will of course lead to ankle restriction and pain, poor loading of the foot during pronation, patellar tracking/tendonitis issues and almost certainly will have an effect on almost every type of knee pain and dysfunction.
Chronic restriction can also lead to an internally rotated tibia which will lead to hammer toes, a collapsed arch and eventually will be a major factor in bunion formation. This is where I always start my treatment if there is pain or poor function in the knees, ankles, and/or feet. Once this is released, many of the other factors can be more easily addressed.
Superiorly from the knee, once these muscles are released, you will notice that many of the chronic tension patterns in the lateral hamstrings, gluteals, erector spinae group, trapezius, anterior neck, and posterior neck muscles, especially the sub-occipital group, will be more relaxed, requiring a lot less work to return them to healthy muscle tone and balance.
It is important to note that a narrow view of looking at fascial continuities without function can lead us to miss the big picture. Addressing anatomy without knowledge of function often keeps us frustrated and limited in our results. For example: after addressing the anterior lower legs, one must decide whether to spend more time in the quads, hip flexors, or hamstrings.
The results will be most effective and impactful for the client if this decision is guided by understanding their particular functional dysfunction rather than just loosening up muscles and fascia because they are tight. We must always inquire why these muscles are tight and/or spasmed, as opposed to just releasing fascia and muscle because it is restricted.
We often see the same pain and tension patterns returning over and over again unless we begin understanding the underlying functional patterns and addressing structure accordingly. Many times we are doing our clients a disservice by just releasing every area of tension in the body as this can take our clients into further dysfunction, and after the initial relief dissipates, pain.
Most of my orthopedic evaluations, are based on looking at someone laying down and moving passively or standing still and observing posture. Testing flexibility and range of motion passively while a client is laying on our massage table may show us where some tension is held but it doesn’t give us much indication as to where we should work as it doesn’t consider structural and functional relationship.
In fact, the restriction may be a necessary compensation to protect the body. While these assessments are valuable tools to have, viewing and treating our clients only through these lenses is a major reason why the same issues and patterns return repeatedly for our clients.
Energetically
In addition to the structural and functional perspectives, we can also look at the energetic or “informational” perspectives to expand our understanding of the body dynamics. The anterior shin muscles are controlled by many factors. In Chinese medical theory, these muscles are controlled by the water element as well as the stomach, liver and gall bladder meridians.
The emotion of fear and a controlling nature (which always comes from fear) can also create tension in these muscles. Likewise, if the muscles are chronically tense, this can work in the opposite direction, leading to fear and controlling patterns, or at least a feeling of needing more control to create safety. It is no wonder with everything going on in the world, and media constantly focusing and creating negativity that the lower leg muscles are so commonly in need of treatment.
In closing, I hope to have shown you a way of thinking about the lower leg muscles that integrates structural, functional, and energetic perspectives. Given the widespread impact of restriction in these muscles on the rest of the body, they should be a priority area in treatment of your chronic pain patients and athletes who want to perform at high levels.
Please review this YouTube video that shows you how to stretch this muscle functionally and a review of how the anterior muscles of the lower leg can affect posture and function. You can also search YouTube with the keywords: anterior lower leg, massage theory and approach, or Trunamics.