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Peroneal muscle inhibition

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Craig Payne, Jan 3, 2022.

  1. Craig Payne

    Craig Payne Moderator

    Articles:
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    I been doing some work on getting a better understanding of peroneal muscle inhibition.
    I see it clinically; I see some dramatic increases in muscle strength testing with the proximal and distal tib-fib mobilization.
    I see the symptoms improve.

    HOWEVER, I struggle with the understanding of the mechanisms involved and without a coherent explanation, the whole concept runs the risk of being out into the "magical thinking" category by scientists.

    I acknowledge that the lack of objective data on the concept is a real issue.

    Anyone want to offer up a mechanism or causal pathway between the restrictions at the tib-fib joints and an inhibition of the peroneal longus muscle to work?
     
  2. Dananberg

    Dananberg Active Member

    Craig has asked me privately to respond to this query.

    Arthrogenuc inhibition is a well known phenomena in medicine, although the actual relationship between joint function and muscle physiology is not well understood. It can be seen following arthroscopic knee surgery with marked inhibition in the vastus medialis with terrible consequences. I once treated an NFL linebacker who lost all VMO function (with marked atrophy) following a simple knee twist injury.

    Regarding the peroneus longus, it is so common that it’s involvement in 1st ray function is something that I have learned to test for when evaluating Hallux Limitus or Hallux Valgus. By using manipulation of the ankle/cuboid, muscular restoration is often rapidly restored. As to why it works is just conjecture but I’ll offer a theory.

    When predators hunt prey, they tend to search out the weakest one of the herd. They seem able to determine this by observing alterations in its movement pattern. As we are no longer part of this food chain link, we seem to have a mechanism which promotes a change in gait patterns, ie limping. So rather than having become something’s dinner, we develop some type of chronic pain pattern and associated gait disturbance. Is the joint function, muscle inhibition relationship part of this process? Perhaps. Hope that this helps answer Craig’s question.
     
  3. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    Thanks Howard. I guess my issue is this...
    ...the lack of a coherent model/theory to explain that relationship.
     
  4. Bruce Williams

    Bruce Williams Well-Known Member

    Craig,
    It’s kind of a chicken egg thing in some respects I think. In one way, if the AJ doesn’t dorsiflex enough and when it should, then the fibula will not be displaced both proximally and posteriorly. The fibula has to do this OR the PL won’t effectively cause the 1st Metahead to plantarlex allowing the 1st MPJ to extend for proper propulsion.
    Now some will say it’s b/c of prolonged STJ pronation that causes the functional hallux limitus, which is fine I guess, but the result is still the same.
    But, the cause can also be a primary AJ limitation in Dorsiflexion and the STJ could be secondary.
    Also let’s add in the length of the 1st metatarsal that can cause retrograde functional hallux limitus.
    Regardless, w/o that proximal displacement of the fibula to put tension on the PL tendon, the PL will be weak or inhibited until you manipulated the AJ, and/or use a heel lift and a 1st ray cutout.
    Cheers,
    Bruce
     
  5. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    Thanks Simon. Yeh, it is probably something along those lines.
    I just find the whole concept frustrating. I know what I see clinically (and I know that is seen through all sorts of biases and preconceptions), but trying to be objective at explaining and interpreting what is going on in the absence of any objective data on the concept is of concern.
     
  6. bestfootforward

    bestfootforward Welcome New Poster

    Hypothetically speaking, Is there possibility of PN compression/ tethering ? That TF mobs are analogous to slides / gliders used to manage LSp and peripheral Nerve radicular / radiculopathy issues ?

     
  7. efuller

    efuller MVP

    There was the old paper by Talliard seeing peroneal inhibition with sinus tarsi syndrome. When the subject was injected with local anesthetic in the sinus tarsi the EMG recording returned to normal. I did not like the theory proposed in the paper that the inhibition was caused by an old inversion injury. I preferred the idea that when the STJ is at it's end of range of motion, with residual pronation moment, the compressive forces in the sinus tarsi cause pain. (Described well in Kevin's rotational equilibrium paper.) The inhibition of the peroneal muscles is a pain avoidance behavior. Any activation of the peroneals will increase the compressive forces in the sinus tarsi and increase the pain. This explains Tailiard's local anesthetic effect on the EMG.

    The pain avoidance behavior is only needed while walking, but might still be present the first or second, time you test muscle function. Maybe the manipulation gives the patient time to overcome their behavioral inhibition of the peroneal muscles. It seems that the mechanism of peroneal inhibition would have to go through the CNS somehow. The only other option is learned reflexes at the spinal level.
     
  8. William Fowler

    William Fowler Active Member

    Does this happen for other muscles in the leg?
     
  9. Nathalie Kirsh

    Nathalie Kirsh Welcome New Poster

    I have a 15 yr old patient..who is very active ballet gymnastics as has chronic pain preoneus longest area.. her mechanics show her toes floating..except her first Mpj...she has been off exercise for more than 6 weeks as per orthopods instruction..and still has pain...also up her whole lateral aspect of her leg.. I haven't checked Hallux rigidity..what other advice ...pls?she has a cavoid type foot..and seems to Supinate..
     
  10. efuller

    efuller MVP

    This doesn't quite belong in this thread, but I can see how you got here.
    You have just described a foot with a laterally positioned STJ axis. The ground will tend to cause supination in this foot and this will make the patient use their peroneal muscles more than average. I have had success with valgus wedging with peroneal overuse. Are you familiar with subtalar joint axis location and rotational equilibrium theory of foot function?
     
  11. Dananberg

    Dananberg Active Member

    The article link below was rerun in todays NY Times and was a recent reprint from 2020. The insight involves progressive strength being as much related to neurologic as muscular mechanisms. Tends to indicate that the weakness/strength in the peroneus longus likely have a neuromechanical basis, and is not simply a muscle strength issue.

    https://www.nytimes.com/2020/07/01/well/move/how-we-get-stronger.htm

    Howard
     
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