Why Osteopaths Sometimes Think in Analogies: The "Crank Handle" of the Foot and Lower Leg

When people imagine an osteopathic assessment, they often picture us looking for individual "out of place" joints or painful muscles. In reality, we spend much of our time trying to understand how parts of the body move together.
One of the ways I visualise movement in the lower leg and foot is by imagining a crank handle.

Looking for Smooth Motion
Imagine turning the handle of an old-fashioned machine. When everything is well lubricated and working properly, the movement feels smooth and continuous. If a bearing becomes stiff, or something starts resisting the motion, the handle no longer turns freely. I think about the foot and lower leg in a similar way.  When a patient is lying comfortably on the treatment couch, with the hip and knee bent to 90 degrees (rather like a Pilates tabletop position), I can gently introduce a rotational movement between the ball of the foot and the upper end of the fibula, just below the knee.  Rather than focusing on one single joint, I'm interested in how the whole system behaves.  Ideally, there is a smooth, easy "crank-like" quality to the movement.

What Might Disturb the Motion?
If that smooth movement is absent, several things might be contributing:

• A degree of stiffness in one or more joints of the foot.
• Reduced mobility at the ankle.
• Restriction around the superior tibiofibular joint (the small joint near the outside of the knee).
• Muscle tension or "guarding" within the calf muscles.

'Listening' to  where the movement is restricted  helps identify areas for manipulative therapy but the crank motion alos helps to integrate the movement  between those structures.

Movement Is Rarely About One JointOne of the fascinating things about the body is that movement is shared.
A limitation in one area may be compensated for elsewhere. Sometimes the site of pain isn't actually where the greatest restriction lies. Looking at movement patterns rather than isolated structures can therefore help us understand why symptoms have developed and what might be maintaining them.

A Similar Idea in the Arm
I use a similar mental model when assessing the forearm and wrist.
The "crank" is less obvious than in the lower limb, but the principle is the same. The hand, wrist, forearm and upper forearm should all contribute to a smooth, coordinated movement. When that quality is lost, it may suggest stiffness in one area or increased muscular tension elsewhere.

​Models, Not Mechanical Truths
These kinds of analogies are simply tools that help us organise information.
The body is wonderfully complex, and no single test or movement tells the whole story. But over the years I've found that thinking in terms of smooth, coordinated motion—rather than isolated parts—can be a useful way of understanding how people move and where treatment may be most helpful.

​Perhaps that's one of the reasons osteopathy appeals to me: we're not just interested in where something hurts, but in how the whole mechanism works together.

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