Thanks for your question. As you know the tibialis posterior muscle from the interosseous membrane, lateral part of the posterior surface of the tibia, and superior two-thirds of the medial surface of the fibula. It travels between the flexor digitorum longus and flexor hallucis longus to insert into the tuberosity of the navicular, cuneiforms, cuboid, and the bases of the 2-4th metatarsals.
The function of the tibialis posterior is one of ankle plantar flexion, calcaneal inversion and plantar flexion as well as stabilization (through compression) of the first ray complex (talus, medial cuneiform, navicular and base of the first metatarsal). It acts additionally to help decelerate subtalar pronation. Further stabilization of the midfoot comes from smaller tendon slips inserting onto the other cuneiforms, metatarsals, the cuboid and the peroneus longus tendon.
The more common problems that can occur with the tibialis posterior complex are those of muscular strain, tendonitis, tendon insufficiency (stretch) and partial or complete tears. Excessive or prolonged pronation causes excessive dorsiflexion of the distal first ray complex, increased pronatory effects, and as discussed above, dysfunction of the 1st MPJ joint. The dorsiflexed 1st toe will compromised the efficiency of the windlass mechanism which “winds up” the plantar fascia, properly positions the paired sesamoids, and thus limit effective dorsiflexion of the 1st MPJ. This dorsiflexion of the first ray requires the tibialis posterior to undergo excessive eccentric load for a longer period of time, thus placing more stress on the tendon and muscle belly.
Clinically we find that more people are flexor driven. Therefore we work quite a bit with increasing extensor function, thus a lot of our rehab protocals involve strengthing Anterior Tib as opposed to Posterior Tib. To this one must ask what is your criterior for strengthening the posterior tib, if over pronation or navicular drop has led you to this conclusion then you may want to reexamine the clinical findings for what muscles may actually be involved.
That being said, there times when it is clinically necessary to strengthen the Posterior Tibialis muscle and we like the following exercises
1. Single Leg Balance with Arch Supports:
Begin standing on one foot. Attempt to raise the medial longitudinal arch and hold in tact while maintaining the body stable over the foot.
2. Single Leg Balance with Arm Swings
Perform the exercise above and add to it multi planar arm swings while maintaining medial arch integrity and balance. Cross body arm swings that generate torso rotation, and simulated axe and pitching motion with each arm are effective motions to use.
3. Seated Forefoot Adduction and Inversion
This exercises utilizes some sort of resistive device such as a theraband that will wrap around the forefoot to attach somewhere lateral to the body creating lateral resistance. while stabilizing the ipsilateral knee with the contralateral hand the exercise is performed by adducting the forefoot against resistance towards the midline.
4. Inverted Calf raises
This exercise is performed standing. it should be started as a double support exercise and can be transitioned into a single support for added challenge. the exercise is performed by performing a standard calf raise with or with out Y-axis resistance and adding an inverted moment at the apex of the raise and then lowering back down.
5. Closed Chain Unilateral Supination
Standing on one leg on a step with the knee slightly flexed and the medial border of the foot over the edge of the step. Exercise is performed by lowering and lifting the arch from pronation to supination.
6. Now perform the sequence with appropriate arch intergrity WITHOUT the arch supports
These exercises should get you started. Good luck and let us know if you have any other questions.
The Gait Guys
In this great little slow mo video we see some things. Do you ? … The Perfect Runner.
1. First clips….. awesome toe extension through the entire swing phase all the way into early contact phase. You have read here before on our blog entries how critical toe extension is for stable and optimal arch contruction prior to foot loading. Suboptimal arch height can mean that pronation loading occurs in a suboptimal foot tripod posturing and can mean difficulties controlling the normal end point where pronation should stop and convert back into supination to ensure rigid toe off. (It is kind of like two runners in a 100m sprint. One starts at the line off the blocks and the other gets to start 1 second earlier 10 meters back from the line and gain speed towards the line before the gun goes off. This is what it is like to start pronation prematurely, or with a suboptimal arch, the starting line where things are fair to all parts has been moved. The foot (the other guy in the race) doesnt have a chance. Maybe a bad example but you catch the drift we’re surfin’ here.) Back to our point, Niobe has great running form and great technicals. Great midfoot strike, yes a little forefoot here but that is what happens when you are barefoot naked on hard surfaces. You have to get good form before you can clean up the technicals. We spend alot of time on the technicals of running once form is clean. It is what makes the difference between 2nd place and a winner. And it is these little things that mushroom into nagging injuries over time. We cannot express enough how important toe extension range and strength is for proper foot function and a strong neutral foot tripod. We rarely have to address long toe flexor strength, short flexor strength yes, but not long. Toe curls, towel scrunches, picking up stuff is not on our list of homework.
2. Second clip. He is skirting the issue of cross over without going too far. He could do a bit better but all in all pretty decent.
3. Emmanual Pairs, big dude ! No cross over. Awesome form.
4. Krysha Bailey. Long jumper. As with all sprinters, no cross over, beautiful form.
Just some easy topics and viewing for a Saturday blog post.
Have a good day brethren !
Shawn and Ivo
Friday Follies. Time to revisit George Costanza’s strength shoe !
thanks for the idea RC !
During a recent trip to the zoo with the family, I noticed this young lady walking in front of me (yes, We ALWAYS have a camera with us and YES, We ALWAYS look at everyone’s gait and YES, we really are that geeky).
Watch the clip a few times and note these points about the gal on the left; keep in mind, she could have hip or muscle pathology as well
- notice the subtle toeing in (decreased progression angle) of the feet, most likely due to internal tibial torsion
- notice how she doesn’t have her shoes tied; this would necessitate her clenching or clawing her toes to keep her shoes from falling off. This inhibits the activity of the glutes and causes her to have to extend from the hams and lumbar spine; as a result, note how straight she keeps her legs when ambulating
- there is little to no ankle rocker; she goes from heel rocker to forefoot rocker
- premature heel rise
- due to the lack of hip extension and decreased activity of glute max, note how she “rotates” around each leg
- how about that cross over gait?
- tie your shoes
- 1 legged standing exercises, being careful to keep hips level and not have a pelvic shift
- walk with toes up or slightly extended during all phases except for that brief moment during midstance where you need the toes for balance and ground purchase
- shuffle exercises to engage glute max
- never wear pants that are sooooo tight that you cannot generate normal fluid gait
Ivo and Shawn…The Gait Geeks…We leave no gait unanalzed…even at the zoo. Watch it; we may have YOU on film!