Tibialis Posterior

This course describes the anatomy and integrated function of the tibialis posterior muscle (a.k.a. post tib, tib post, deep calf muscle, tibial posterior muscle, or posterior tibialis muscle). This muscle is located deep to the calf muscle and posterior compartment, in the deep posterior compartment, and the tibialis posterior tendon courses posterior to the medial malleolus and underneath the foot (near the posterior tibial artery, and tendons of the long toe flexors). The muscle is composed primarily of type II muscle fibers (based on animal studies) and crosses both the ankle joint and foot joints.

The tibialis posterior is the primary invertor of the ankle, will contribute to plantar flexion of the ankle, and is a supinator of the foot (tarsal joints). Further, the tibialis posterior will eccentrically decelerate dorsiflexion, eversion, and pronation (as seen in adult-acquired flatfoot, or flatfoot deformity). This course also describes the role of the tibialis posterior in ankle (talocrural) joint arthrokinematics, fascial integration (Achilles tendon), postural dysfunction, and subsystem integration. Additionally, the location of the tibialis posterior is discussed relative to the anterior tibial artery, posterior tibial artery, fibular artery, sciatic nerve, tibial nerve, common fibular nerve, deep fibular nerve, and the fascial sheaths that comprise the deep posterior compartment, including the interosseus membrane and transverse intermuscular septa.

Sports medicine professionals (personal trainers, fitness instructors, physical therapists, massage therapists, chiropractors, occupational therapists, athletic trainers, etc.) must be aware of the integrated function of the tibialis posterior for the detailed analysis of human movement, and the development of sophisticated exercise programs and therapeutic (rehabilitation) interventions. Further, this course is essential knowledge for future courses discussing injury prevention and physical rehabilitation including pes planus (a.k.a. flat feet, flatfoot deformity, adult acquired flat foot, functional pes planus), tibialis posterior tendinopathy, (a.k.a. posterior tibial tendonitis, posterior tendinopathy, tibialis posterior tendon inflammation, tibial tendon dysfunction, tendon tears, tendon sheath damage), and surgical interventions (tendon tear repair, deep posterior compartment release, tibial tendon dysfunction surgery, tendon transfers). Tibialis posterior exercises and techniques are also introduced in this course (e.g. tibialis posterior activation, integration, and strengthening.)

Brookbush Institute’s most recommended techniques for the Tibialis Posterior (see videos below):

• Activation: Tibialis Posterior Isolated Activation (Plantarflexion and Inversion)
• Activation: Tibialis Posterior Reactive Activation
• Subsystem Integration: Single-leg Touchdown with Posterior Pull

Caption: Tibialis posterior in a cadaver dissection