PURPOSE:
Evaluation of mechanical lumbar pain
Evaluation also beneficial for:
Knee Pain
Ankle Pain

ANATOMY:
Superficial Posterior Fascial Line (1)
-Plantar fascia
-Gastrocnemius (medial head)
-Hamstrings (semimembranosus/semitendinosus)
-Sacrotuberous ligament
-Erector spinae
-Cranial aponeurosis

PHYSIOLOGY:
Ankle Function
-Triceps surae length
-Talocrural mobility
-Anterior tibialis strength

Knee Function
-Hamstring/popliteus length
-Tibio-femoral mobility
-Rectus femoris strength

Hip Function
-Hamstring/gluteal length
-Acetabulo-femoral mobility
-Rectus femoris strength

Spinal Function
-Erector spinae length
-Facet / sacroiliac mobility
-Rectus abdominis strength

PRIMAY RESTRICTION
Ankle mobility – gastrocnemius length (2, 3)

RATIONALE
The gastrocnemius shortens due to activities of daily living. Basic ambulation requires the muscle to lift our bodyweight thousands of times each day. Further complicating the dysfunction, the vast majority of shoes are heeled where the heel is 1″ taller than the toe. High heels further increase the dysfunction by increasing the tone.

Decreased soft tissue lengths of the gastrocnemius has several effects on the movement. Locally, the gastrocnemius limits ankle dorsiflexion and may actually pull the ankle into plantar flexion (posterior collapse of tibia) to allow the hip hinge to occur. As the tibia falls posteriorly, the distal femur glides anteriorly and the proximal femur moves posteriorly limiting hip flexion. This alters the pelvic mobility creating compensatory hyper flexion typically at L5/S1 but may also be present at L3/4 or L4/5.

Globally, the tightness in the gastrocnemius tensions the entire posterior fascial line making it dysfunctional. This increases the tension in the hamstrings which can create low back pain by tensioning the sacrotuberous ligament. This can also tension the erector spinae that can lead to disc or facet pathologies.

REFERENCES:
1. Myers T. Anatomy Trains: Myofascial Meridians for Movement and Manual Therapists.
2. Kase K. KINESIO – TAPING Course Manual: K1 & K2.
3. Sahrmann S. Diagnosis and Treatment of Movement Impairments