Category Archives: lower limb


Fascia (plural fasciae) is found throughout the body and performs several functions. That sausage skin- like coating that each muscle has is fascia. There are sheets of semi-transparent fascia in your abdomen holding your entrails up in place. There is fascia in your palms and soles that make the skin more wear resistently to friction and some of the muscles are attached to other structures via fascia.

Fascia is a tough and flexible connective tissue that envelopes organs and muscles and hold them in correct proximity to one another. Fascia is often wavy or corrugated in structure which helps give it elastic properties. It is like a multi-faceted membrane within your body that acts like a soft skeleton. It’s like a longer continuous piece of shrink wrap that connects all the internal structures.

Like other tissues in the body fascia is helped stay healthy with a good diet and adequate hydration. If it is too stiff it has a general uncomfortable tightening effect on the body and if it is too loose the flesh has a floppier quality about it.

The white strandy tissue (that is not fat) that you sometimes see butchers cut through when filleting meat includes fascia. Scientists are learning new things about fascia all the time, not all of them even agree how different types of fascia should even be categorized.

Tendon, ligament and spinal discs are closely related anatomically and functionally to fascia. When fascia is well hydrated it has a springiness about it that helps tissue it is connected too to return to it’s normal position. Your gastrocnemius (calf muscle) is not joined directly to your heal bone but by a long broad band of fascia.

Even more surprising is that fascia is now being thought of as the biggest and most important sense organ of the lot. This is so because it is honey -combed all through the body which means that if the fascia coating your leg muscles are stretched an internal stretch via the fascia through to other distant parts of the body. Everything on the inside of us is more or less connected together by fascia.

Fascia therefore has an important part to play in proprioception- your body’s awareness of it’s position in space. So fascia is now believed to be related to your posture and balance.

Like other soft tissues in your body fascia can strain and tear and sustain scare tissue when it heals. When you massage your muscles (or have someone else do it for you) your fascia is incidentally getting massaged with your muscles which is good for it’s circulation.


There are two types of muscle tissue in the human body, they are involuntary muscle and voluntary muscle, (the heart muscle is composed of involuntary AND voluntary muscle tissue). Involuntary muscle is found in your internal organs such as in your digestive system, your intestines for instance regularly pushes ingested food along from your oesophagus to your rectum, it is called involuntary because you don’t need to think about it for it to work, it does so automatically in a healthy body. Voluntary muscle on the other hand requires conscious thought for it to work like when your legs move when you are walking and it is this muscle that is conditioned through exercise.

There are two types of voluntary muscle, they are type I slow twitch (red muscle fibre) that operates at low intensity but with greater endurance. Type II fast twitch  (white muscle fibre) operates with greater force but with much shorter duration. Type I and type II muscle fibres use different energy sources within the body. Red muscle fibre (type I)  for instance uses more oxygen, it is used in aerobic exercise and can be sustained for hours at a time like when you walk. White muscle fibre (type II) on the other hand is anaerobic and uses another energy process , it can be sustained only for short periods but with much more force. White muscle fibre is used in short bursts of strenuous activity like sprinting or lifting heavy weights. 

A long distance runner will have more red muscle fibre than a sprinter who has a greater ratio of white muscle fibre. White muscle fibre gets bigger when exercised, a successful body builder can be expected to be white fibre dominant. We tend to inherit these traits from our parents. Sports like football and rock climbing will use both, in continuous low intensity body movements interspersed with short high intensity muscle action.

Good blood circulation helps and is helped by muscles in action, the amount of oxygen consumed by a working muscle can increase 20-50 times more than a relaxed idle muscle. A flexed muscle not only uses more blood it’s shape changes because of the way it’s various fibres interlock.

Apart from your red and white muscle fibre ratio the actual size and strength of your muscles is determined by how much you exercise, your diet, neurology, hormone levels or presence of artificial growth promoters like anabolic steroids.

Your muscles are the motors of your body’s movements and posture, we cannot even breathe without them.

About 40% of average body mass is voluntary muscle and most of the rest of our mass is composed of involuntary muscle.

Stress stiffens muscle because when we are stressed the body primes itself for a flight or fight response by flooding your skeletal (voluntary) muscle with extra blood. This creates added strength to save yourself even if you are not actually in physical danger.

During short contractions your jaw muscles are strongest while the muscles of your thigh and butt are stronger in longer contractions. When muscles are stretched the interlocking myosin and actin fibres in your muscle are relaxed and help restore full extension to your joints.

When muscle strength is even between the front and back of your body and between the left and right sides of your body your posture will be upright and straight.

Other body tissues respond well to massage too but muscles respond best. It is easy to forget what it’s like to feel normal, it is too easy to attribute your aches and pains to aging alone. It is how you feel after some regular massage that tells you how young you can still feel.



The function of ligament is to join bone to bone, without ligament our joints would have no stability. All joints (this includes the vertebrae in your spine) have ligament, the ligaments of the knee tend to be the most spoken about  because they are often traumatised in sport. Knee ligaments sprain and tear when the joint is put in positions under force that it is not naturally designed to move in- sideways and backwards.

Ligament is a tough fibrous tissue that is flat on the outside of the joint beneath the skin such as in the medial knee ligament or cord like when it is stabilizing the inside of the joint as with the anterior cruciate ligament. Whether the ligament is flat or cord-like they are painful when sprained or torn and the joint loses stability. A sudden tearing of ligaments can even produce an audible snapping noise.

Ligaments are slow to heal which is why surgery is performed. Ligaments are strained when joints dislocate too, as happens with the shoulder. After multiple dislocations ligaments weaken which undermines the general stability of the joint which makes re-dislocations more likely. Artificial ligament is used to reinforce shoulders that are prone to dislocation.

When people stretch too far ligaments can be damaged though muscle tearing is more likely to happen first. Ligaments and muscles may be both injured at the same time. Ligament and muscle tearing is unlikely to happen when you are doing regular age appropriate stretching exercises, when tension is gradually applied to any joint during a stretch you will feel it is about to reach an uncomfortable point before damage is caused. So long as your balance is controlled stretching will usually be safe.

If you are recovering from a ligament injury re-introducing the affected joint to stretching exercise must be gradual and preferably under professional supervision atleast to start with, especially after surgery. Specific stretching exercises post-operative tend to be different to the ones illustrated in Self Massage.

Ligament is present in the parts of the joint that are not meant to bend. Using the example of the knee joint you will find ligament on the inside and outside of the joint because knees due to their structure cannot and should not bend sideways. Ligaments are also located on the back of the knee because knees cannot and should not bend backwards.

You will commonly see footballers with strapped knees, the strapping helps compensate weakened and damaged knee ligaments. Due to the nature of competative sport even with strapping your knees will heal more slowly and re-injure more easily until healing occurs. Unfortunately many sporting careers prematurely end when ligaments become damaged beyond full repair.

Strapping of an injured ankle ligaments might get you through an important game at the end of the season but using strapping as an ongoing method of protecting an unstable ankle will only undermine the health of your knee joint long term.

Damaged ligaments in your leg can create lower back pain because of the lop sided effect on your stride, Self Massage of the lower back and hips can help keep the symptoms under control. 



Cartilege occurs in many parts of the body, the cartilege in the septum of your nose (middle part) and your ears is called elastic cartilage because of it’s flexability. There is cartilage between your ribs and sternum, in your airways and your spine between the discs. The cartilage that lines the ends of your bones, articular cartilage is what today’s post is about.

Articular cartilage exists in 4 layers and it’s function is to cushion shock, distribute weight evenly and allow the smooth gliding motion of healthy joint action. Articular cartilage is found in the joints of your hands, wrists,  feet, ankles, knees, elbows and hips. It is white, rubbery and slippery when wet, the “grissle” in chicken and lamb legs is articular cartilage.

When cartilage is worn it can feel and even sound like sandy grits are moving in the joint, when wear becomes extreme as in the case of advanced osteo arthritis a painful grinding bone on bone sensation that sounds like the timber on an wooden ship can be quite audible. I once nursed an elderly female patient whose OA was so extreme I could feel her knees vibrate all the way to her wrists when I helped her stand up. OA is very painful when it gets to that point.

Excess body weight, poor nutrition and hydration, bad posture, lack of exercise, genetic factors and trauma all take a toll on articular cartilage. For as long as the surface of joint cartilage is intact the it will bend and straighten smoothly (provided the other tissues of the joint are working).

Kneeling down on hard surfaces pressurizes and can progressively damage the cartilage behind your knee cap. Bending any joint too far or in the wrong direction can damage cartilage too. Auto immune diseases such as  rheumatoid arthritis and polymyalgia rheumatica can make cartilage swell and make the joint weak and painful. Costochondria can result from a rib cartilage injury and make breathing painful. Shoulder dislocations can damage cartilage too.

Cartilage contains no blood, it’s nutrition occurs through cellular food and waste leeching back and forth through it’s outer membrane. This makes cartilage slow to heal, knee meniscus, shoulder rotator cuff and hip labrum are all terms describing cartilage of different locations.

Joint replacement (and partial replacement) is most often performed because of irreparable cartilage damage. Stem cell injection at the time of writing has produced some very promising results but does not work as well on everybody and steroids can reduce cartilage inflammation.

Sports clinics are kept very busy with cartilage injuries, particularly of the knee. Cartilage trauma is often accompanied by by ligament and tendon trauma too particular when the joint twists too far.

There was an American rheumatologist who got interested in the apparent benefits of consuming shark fin cartilage as a cure for arthritic pain. He ran a trial of 15 OA patients who had not responded that well to the drugs he gave them so he ground down ordinary chicken cartilage and put it in capsules that his trial patients took 3 times a day. He reported that after 6 weeks 13 of them had noted improved symptoms.

Not all things work as well for all people, but keeping your weight down and having good balance and posture will all help sustain healthy cartilage. Damaged leg cartilage may cause you to limp and this can create lower back pain, Self Massage to the back and hips can help keep you going.

Hammer toes

Hammer toe is a condition of your feet where the toes permanently curl forward. This can be caused by muscular spasticity  in your soles but more usually is the result of wearing thongs, flip flops, jangles, haviannas……whatever you choose to call rubber open summer footwear with no heel strap.

Your flip flops stay on your feet because you unconsciously are gripping with your toes to keep them on. This constant gripping of the toes eventually claws them forward which can make them painful and interferes with your walking and running. This style of cheap footwear usually has no arch support and can contribute to plantar fasceitis, fallen foot arches that inturn can produce knee pain. Wearing flip flops that are a bit too big for you are even harder on your feet.

Flip flops and jangles have a high convenience factor if you are bare foot and want to cross hot pavement or sand on a sunny day but please limit the distances you walk in them because they teach your toes bad habits.

There are a number of foot massage and exercise techniques in Self Massage &+40 Fitness that can help you help your hammer toes. They are best applied regularly and often particularly in the warmer months when these foot coverings are worn. Stretching your toes backwards is particularly useful.

It can be surprisingly difficult convincing someone with hammer toes that their flip flops are probably the main culprit, some people’s hammer toes curl so far forward that when bare foot their toe nails scrape the pavement when they are barefoot. Flip flops when wet can get very slippery and injure your feet and ankles.

Hammer toes don’t look great either when scrunched inside an open woman’s shoe.

Hammer toes can lead to plantar fasceitis (a painful foot condition) and tight calf muscles that are also prone to cramping.

Sandles with a heel strap will keep your feet cool in summer without producing hammer toe.