Balance isn’t easy. Whether in our life or in our body, finding the sweet spot between life’s extremes can be complicated.

For example, simply standing upright is a tremendously complex balancing act. In order to stand, our brain must constantly monitor and respond to input from the environment via our eyes, from our movement in space via our inner ears, and from our body itself via sensory nerve endings (mechanoreceptors) in the soft tissues of the body.¹

Concentrated around joints, these specialized neurons talk to our central nervous system about mechanical force and position. In turn, the brain (specifically, the brain stem, cerebellum, and cerebral cortex) uses this information to orchestrate the reflexes, tension, and coordination we need to balance, stand, and move.

The Tibiotalar Joint

The lower in the body we look, the greater the forces of standing and balancing become. For example, the neck balances the head’s weight, and the pelvis bears and balances the entire weight of everything above it. But the foot modulates more force than any other body part. This is especially true of the tibiotalar joint, where the tibia rests on the talus (the small, oddly shaped bone at the top of the foot). Here, the entire weight of the body is concentrated into a slippery, domed joint surface about the size of a quarter.^{2, 3}

Though the talus is unique in that no muscles directly attach to it, it is surrounded on all sides by layers of soft tissue (Image 1), including joint capsules, ligaments, tendons and their sheaths, retinacula, deep and superficial fascia, and skin. All these are richly embedded with mechanoreceptors that monitor the enormous forces at this crucial joint and rapidly communicate this information to the brain. It is thanks to this stream of sensory information that we’re able to balance on the relatively small tibiotalar platform. Without the mechanoreceptors arrayed around the tibiotalar joint, the brain could not sense, prioritize, or respond to changes of ankle angle, position, or load, and walking would be impossible—often as not, we’d simply fall over.

Key Points: The Tibiotalar Technique

Indications

• Agitation, autonomic arousal, stress

• Balance or gait issues

• Limited or painful ankle dorsiflexion

Purpose

• Autonomic calming via novel sensory input

• Refine proprioceptive acuity of the tibia-talus relationship

• Increase options for translation (glide) at the tibiotalar joint

Instructions

• Posterior tibial glide: Gently lean on the distal end of the tibia with the flat of your forearm (Images 2 and 3, page 84) or open hand, encouraging your client to relax, breathe, and settle in.

• Posterior talar glide (see video): Grip the talus between your thumb (medially) and forefinger (laterally). Use the web of your hand to gently but firmly roll the talus under the tibia, moving the ankle into slight passive dorsiflexion.

For More Learning

• Watch the “Leg, Knee & Foot” (https://a-t.tv/legvideo) or “Whiplash” (https://a-t.tv/whiplashvideo) videos in the Advanced Myofascial Techniques series of workshops, live-online, and recorded video courses.

• Tune in to the “Myofascial Techniques: Working with Whiplash” webinar featuring Til Luchau in the ABMP Education Center (abmp.com/learn).

At the tibiotalar joint, the concentrated weight of the entire body balances on the talus (blue). Surrounding this quarter-sized articulation, mechanoreceptor-rich structures send a stream of information about position, stresses, and movement to the brain, which coordinates the complex reflexes and muscular activity of balancing, standing, and moving. (Purple: toe flexor group. Brown: peroneal group. Dark green: Achilles and plantaris tendons. Orange: extensor group. Brown, tan, and green wrappings: skin, superficial and deep fascia, and retinacula.) Anatomy image courtesy Advanced-Trainings.com.

In the Tibiotalar Technique, the practitioner’s static pressure encourages the tibia to glide posteriorly (arrow, Image 4) on the talus, sending unfamiliar yet interesting sensory signals to the brain’s balance centers. When applied gently and patiently, this technique quiets, focuses, and calms the client’s autonomic nervous system. Anatomy image Sebastian Kaulitzki/123rf. Technique images courtesy Advanced-Trainings.com.

Hotline to the Brain

As an analogy, a hotline was set up directly linking the Pentagon and the Kremlin in 1963 at the height of the Cold War, so that crucial, disaster-averting communication could be prioritized. The tibiotalar joint can also be thought of as a kind of hotline to the brain because of its key role in disaster-averting (that is, fall-averting) balance. As hands-on therapists, we can imagine using this joint’s unique capacity for sensing and prioritizing to focus the brain’s attention and bringing the deep brain centers involved in balance online.

In the Tibiotalar Technique (sidebar page 83), we get the brain’s attention by moving the tibiotalar joint in unfamiliar yet nonthreatening ways. Then, we quiet the mind by waiting, relaxing, and breathing. To do this, we can either posteriorly translate (glide) the tibia on the talus (Images 2, 3, and 4), or we can gently but firmly roll it under the tibia with a slight passive dorsiflexion by gripping the talus with the web of the hand and posteriorly translating the talus in relationship to the tibia (shown in the accompanying video).

In either variation of the Tibiotalar Technique, we linger. And with sustained, sensitive pressure, we stimulate the mechanoreceptors that seem to quiet, focus, and calm the brain. This is why, for example, in the Advanced Myofascial Techniques series at Advanced-Trainings.com, we begin our whiplash protocol with this technique.

Understanding the Tibiotalar Technique will open multiple possibilities in your work, whether your goal is increased options for movement, refined proprioception, or calming and quieting the client’s nervous system.

Notes

1. Todd S. Ellenbecker, George J. Davies, and Jake Bleacher, “Proprioception and Neuromuscular Control,” in Physical Rehabilitation of the Injured Athlete, 4th ed., eds. James R. Andrews, Gary L. Harrelson, and Kevin E. Wilk (Philadelphia: Elsevier, 2012), 524–47, https://doi.org/10.1016/B978-1-4377-2411-0.00024-1.

2. Thanks to Jan Henry Sultan, Certified Advanced Rolfer and senior faculty at the Dr. Ida Rolf Institute of Structural Integration, for this concept and for the posterior-glide version of the Tibiotalar Technique.

3. The average width of the talar dome in a study of 26 health adults was 28.4 mm, and a US quarter-dollar coin has a diameter of 24.26 mm; Sorin Siegler et al., “New Observations on the Morphology of the Talar Dome and Its Relationship to Ankle Kinematics,” Clinical Biomechanics 29, no. 1 (January 2014): 1–6, https://doi.org/10.1016/j.clinbiomech.2013.10.009.