I recently got this text from Bonnie F.
Hello, My name is Bonnie F. and I have been dealing with peroneal tendonitis for 4 months. After much research, I think cross-fiber friction massage could help. Unfortunately, I live far away in southern orange county. I want to try this massage technique on myself, but I have a question and am willing to pay you for the answer. My pain is located behind the ankle bone, where the tendons turn from going vertical to horizontal. There is a tendon called the superior peroneal retinaculum (spr) that holds them in place here. I don’t know if this area is good for friction massage since there is a tendon on top of other tendons. I don’t know the fiber direction of the spr since it’s kind of square. How much would you charge to advise me on massaging this area?
Thanks so much.
Hi Bonnie, here’s your answer at no charge. I like doing research and sharing my experience. I hope this helps you.
First check out my old posts at:
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Peroneal Tendon Dislocation and Superior Peroneal Retinaculum Injury
I don’t like long complicated answers so here’s goes! I guess I got a little carried away! LOL
Your question is about friction massage and a tendon called the superior peroneal retinaculum (spr). I work on a lot of runners with many similar issues. You don’t say how long ago and how you injured your ankle. You also don’t mention if you have had an MD or specialist look at you and did they refer you to have x-rays or an MRI. If you have insurance the MRI would be very helpful. You also don’t mention if you have had Physical Therapy for your leg and foot. I’ve found in the past that MRI with or without a diagnosis combined with a good physical therapist and a knowledgeable sports LMT works pretty well. Regardless, applying different friction massages in different areas of the foot and leg is what works. I’ve found that you should also work the entire foot, calf muscles, and the front of the leg at many different angles. Unfourtually, most people can’t apply the pressure needed and take the pain that is required to break up the microscopic adhesions and scar tissue to increase blood and oxygen flow in those areas that already have limited blood and oxygen flow.
Good Stretches
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How do you stretch the peroneal nerve?
Lie flat on your back. Bend your knee towards your chest, and pull your foot inwards. This will create a stretch down the outside of the lower leg. You can make the neural stretch stronger by bending your neck forwards.
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How do you loosen tight tendons in the ankle?
Sit with your towel or band around your left foot. Firmly hold each end of the towel with your hands. This time, slowly turn your ankle outward, like you’re facing the sole of your foot to the left. Then pull up with the left-hand side of your towel to deepen the stretch.
Cross-fiber friction massage tool links: these are cheap and work, pick one. I have a professional Cross-fiber friction massage tool but you don’t need that.
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https://www.amazon.com/Stainless-Tools-Massage-Scraping-Mobilization-Physical/dp/B08F7JLZG8/ref=sr_1_18?keywords=cross-fiber+friction+massage+tools&qid=1636675808&qsid=131-5724127-5667616&sr=8-18&sres=B000UZFVG8%2CB0836GSR23%2CB096Z7MDMG%2CB08BF91J9X%2CB075WTVKM6%2CB087LWNCPB%2CB07P5PFFMZ%2CB076DSBHD1%2CB07DPCWV8Z%2CB087LZTBXW%2CB07MGQNWY2%2CB07Z258Y93%2CB07L4P2NN7%2CB076P9CQMD%2CB08K42GQ6W%2CB07HQ4Q4GY%2CB08F7JLZG8%2CB08K7GZGG5%2CB075FXVB39%2CB015RKCWR6
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https://www.amazon.com/Rosenice-Aventurine-Scraping-Acupuncture-Treatment/dp/B074SL6JNN/ref=sr_1_36?keywords=cross-fiber+friction+massage+tools&qid=1636675893&qsid=131-5724127-5667616&sr=8-36&sres=B000UZFVG8%2CB0836GSR23%2CB096Z7MDMG%2CB08BF91J9X%2CB075WTVKM6%2CB087LWNCPB%2CB07P5PFFMZ%2CB076DSBHD1%2CB07DPCWV8Z%2CB087LZTBXW%2CB07MGQNWY2%2CB07Z258Y93%2CB07L4P2NN7%2CB076P9CQMD%2CB08K42GQ6W%2CB07HQ4Q4GY%2CB08F7JLZG8%2CB08K7GZGG5%2CB075FXVB39%2CB015RKCWR6
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https://www.amazon.com/Stainless-Steel-Scraping-Massage-Tool/dp/B075WTVKM6/ref=sr_1_9?keywords=cross-fiber+friction+massage+tools&qid=1636675893&qsid=131-5724127-5667616&sr=8-9&sres=B000UZFVG8%2CB0836GSR23%2CB096Z7MDMG%2CB08BF91J9X%2CB075WTVKM6%2CB087LWNCPB%2CB07P5PFFMZ%2CB076DSBHD1%2CB07DPCWV8Z%2CB087LZTBXW%2CB07MGQNWY2%2CB07Z258Y93%2CB07L4P2NN7%2CB076P9CQMD%2CB08K42GQ6W%2CB07HQ4Q4GY%2CB08F7JLZG8%2CB08K7GZGG5%2CB075FXVB39%2CB015RKCWR6
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more good info on (SPR) Tears and classifications at: https://www.orthobullets.com/foot-and-ankle/7023/peroneal-tendon-tears-and-instability https://www.physio-pedia.com/Deep_Friction_Massage
This is more detailed info if interested:
What is the cross-fiber friction massage technique?
Transverse friction massage (also known as cross-friction and cross-fiber massage) is a technique that promotes optimal collagen healing by increasing circulation and decreasing collagen cross-linking, thus decreasing the formation of adhesions and scar tissue.
Does cross-fiber friction massage work?
During the massage, the patient experiences a numbing effect from the friction. Following treatment, reassessment typically shows reduced pain and increased strength and mobility. Studies have shown that the application of transverse friction massage leads to immediate pain relief and a reduction in chronic pain.
What is the purpose of cross-fiber friction?
This treatment effectively reduces fibrosis and encourages the formation of strong, pliable scar tissue at the site of healing injuries. This technique, also known as cross-fiber friction, reduces the roughness that forms between tendons and their sheaths that can result in painful tendonitis.
How long should a cross friction massage last on 1 focused area?
“Cross-fiber friction is typically very short, just 3 to 5 minutes, one or two times a day, preferably after exercise.
How do you break up scar tissue in tendons?
To break down scar tissue we first lubricate the affected area with baby oil, lotion, or vitamin E oil. Then we’ll perform different massage techniques including cross friction massage and myofascial release which help improve the alignment of collagen fibers and improve movement. When you do cross friction massage directly on your skin you might have burses so if you don’t want bruises, use a sheet on the leg or leg warmers, etc.
When should you not use friction massage?
Contraindications
- Ossification and calcification of soft tissues.
- Rheumatoid tendinous lesions.
- Ulcers, blisters, or psoriasis.
- Bacterial infections.
- Large hematomas in the area.
- Bursitis.
- Local sepsis.
- Any local skin diseases.
What causes peroneal tightness?
Causes. Improper training or rapid increases in training and poorly fitting shoes can lead to peroneal tendinosis. Also, patients who have high arches may be more susceptible because their heel is turned inwards slightly, which requires the peroneal tendons to work harder to turn the ankle to the outside.
How do you get rid of peroneal tendonitis fast?
Treatments
- Immobilization: Stopping the foot and ankle from moving using a boot or support.
- Medication: Anti-inflammatory drugs, such as ibuprofen, can help relieve pain and swelling.
- Physical therapy: Ice, heat, and ultrasound therapy can reduce pain and swelling.
How can I relieve peroneal tendonitis?
Ice, rest, and a walking boot can help. In addition, anti-inflammatory tablets such as ibuprofen reduce inflammation and pain. GTN patches can also help with the pain. Secondly, physiotherapy to strengthen the peroneal tendons, calf muscles, and small muscles of the foot plays a role.
Do insoles help peroneal tendonitis?
Wearing shoes or shoe insoles that properly support the structures of the foot while also providing correction for alignment issues such as overpronation can help to reduce the likelihood that you will develop peroneal tendonitis.
Can shoes cause peroneal tendonitis?
Most commonly, peroneal tendonitis is caused by sudden increases in training, and the use of badly designed footwear. People who also have hindfoot varus posture are more likely to experience peroneal tendonitis.
How do you fix a deep peroneal nerve?
Peroneal Nerve Injury Treatment
Nonsurgical treatments, including orthotics, braces, or foot splints that fit inside the person’s shoe, can bring relief. Physical therapy and gait retraining can help the person improve their mobility.
How do you release the superficial peroneal nerve?
Surgical decompression may be indicated in cases of superficial peroneal nerve entrapment that is refractory to non-operative options. This can include the release of the nerve at the lateral leg for surgical decompression with partial or full fasciotomy. Some authors have also advocated fasciectomy in select cases.
Does peroneal tendonitis heal on its own?
Peroneal tendonitis is a common injury in runners and endurance athletes. With proper rest and conservative management, it often heals without surgery.
*Disclaimer: This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider.
Please consult your healthcare provider with any questions or concerns you may have regarding your condition.
The information provided is for educational purposes only and is not intended as a diagnosis, treatment, or prescription of any kind. The decision to use, or not to use, any information is the sole responsibility of the reader. These statements are not expressions of legal opinion relative to the scope of practice, medical diagnosis, or medical advice, nor do they represent an endorsement of any product, company, or specific massage therapy technique, modality, or approach. All trademarks, registered trademarks, brand names, registered brand names, logos, and company logos referenced in this post are the property of their owners.
Thank you so much for all this great information! I think the main aggravator for this condition was Zumba, coupled with possible congenital ankle weakness (born with club feet, wore brace as a baby). I have had an MRI but don’t have details yet, but they did say there aren’t torn tendons. I have been going to pt, but I think I might need one who specializes in this issue. Looking for good sports LMT around here. My goal at this point is just to be able to resume normal activities and get back to hiking/walking for recreation, exercise. Thanks again so much for your generous sharing of information and your time.