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Tibialis Anterior Audio

Integrated functional anatomy of the tibialis anterior. Attachments, nerves, palpation, joint actions, arthrokinematics, fascia, triggerpoints, the muscle's role in shin splints, running/sprinting mechanics, and behavior in postural dysfunction. Examples of common activation exercises, subsystems, and strength exercises of the tibialis anterior.

Tibialis Anterior

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This course describes the anatomy and integrated function of the tibialis anterior muscle (a.k.a. anterior tibialis, shin muscle, anterior leg muscle, ant tib, tib ant, or T.A. muscle). This muscle originates on the anterior side of the tibia, and the tibialis anterior tendon inserts (anterior tibialis insertion) on the medial and plantar surface of the foot (medial cuneiform and first metatarsal). The muscle is composed of a much larger percentage of type I muscle fibers than type II muscle fibers, and it is innervated by the deep fibular nerve. The tibialis anterior muscle lies within the anterior compartment, the tibialis anterior tendon crosses the ankle joints and transverse tarsal joints of the foot. Because of the superficial location of this muscle in the anterior compartment, a little resisted dorsiflexion will result in a visible contraction of the tibialis anterior on the shin, and tautness of the tibialis anterior tendon on the anterior side of the ankle.

This muscle is the primary dorsiflexor of the ankle, will contribute to the inversion of the ankle, and is an important supinator of the foot. This course also describes the role of the tibialis anterior on ankle (talocrural) joint arthrokinematics, fascial integration (plantar fascia and the medial longitudinal arch of the foot), postural dysfunction (e.g. pes planus), and subsystem integration (e.g. 

). For example, this course discusses the synergistic function of the tibialis with the tibialis posterior and flexor hallucis longus (FHL), and how this synergy affects the posterior glide of the talus during supination of the foot.

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 anterior 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 the treatment of tibialis anterior pain, pes planus (a.k.a. flat feet, flatfoot deformity, adult acquired flat foot, functional pes planus), tibialis anterior tendinopathy, shin splints (a.k.a. medial tibial stress syndrome), plantar fasciitis, Achilles tendonitis, and ankle impingement, and more serious injuries like tibialis anterior tendon tear, or muscle rupture. Further, this course aids in preparing for courses on tibialis anterior exercises and techniques for enhancing sports performance (e.g. ensuring ideal tibialis activity and strength for optimal foot and ankle joint stability, strength, power, and agility).

Tibialis Anterior Isolated Activation (Dorsiflexion and Inversion)

Cadaver dissection of the tibialis anterior muscle on the front side of the leg

 Course Description: Tibialis Anterior

 lower leg bone, 1726, from Latin tibia “shinbone,” also “pipe, flute” (originally one of bone), in which sense it originally came into English (1540s). Of unknown origin. The Latin plural is tibiæ. Related: Tibial. 

 1610s, Latin, literally “former,” comparative of ante “before” (see 

A cadaver dissection of the tibialis anterior, toe extensor muscles, and fibularis tertius

Cadaver Dissection of Anterior Compartment Muscles via http://www.rvuanatomy.com

Attachments & Innervation: Tibialis Anterior

Where is the Tibialis Anterior Located?

A drawing of tibialis anterior located on the front side of the shin

Palpating the Tibialis Anterior

Introduction to the Tibialis Anterior

Ankle: Primary dorsiflexor of the ankle and assists with inversion.

Actively involved in aiding forward translation of the knee (tibia on talus dorsiflexion) during the eccentric phase of closed chain activities, such as sitting, squatting, and jumping.

May have a moment arm for eversion when the ankle is in an everted position (14).

Foot: Dorsiflexion of the 1st metatarsal (acting across the tarsometatarsal joint) joint; contributing to forefoot supination.

Additional Note: The tibialis anterior is composed of predominately slow-twitch muscle fibers; with only 19 - 33% being fast-twitch fibers (16-19).

Note the fiber arrangement of the tibialis anterior on the lower leg

Tibialis Anterior via Gray's Anatomy: 20th Edition - http://up

 Ankle (tibiotalar joint), cuneonavicular, and 1st tarsometatarsal joints, and indirectly contributes to the stability of the talonavicular joint (24).

The functions above are of particular importance during gate (25). The tibialis anterior decelerates the passive plantarflexion moment created by body weight on the posterior surface of the calcaneus during heel strike (3). The activity of the tibialis anterior ensures a smooth "roll" of the foot from heel-strike to foot-flat. This is essential for optimal shock absorption and a smooth gate pattern. Dysfunction results in "foot-slap", named after the characteristic sound of the foot "slapping" the floor immediately following heel strike.

The tibialis anterior is the primary dorsiflexor of the ankle and has two or three synergists: the 

extensor hallucis longus (EHL) and the extensor digitorum longus (EDL) (and fibularis tertius)

. Often, the EHL and EDL will become synergistically dominant for an inhibited tibialis anterior in those individuals with over-active plantar flexors (altered reciprocal inhibition).

The tibialis anterior is a synergist for inversion of the ankle and supination of the foot - the 

 being the prime mover (3, 10). Other invertors of the ankle include the 

flexor hallucis longus (FHL), and flexor digitorum longus (FDL)

 and according to some texts the medial gastrocnemius.

The tibialis anterior has a propensity toward under-activity; perhaps due to altered reciprocal inhibition as a result of over-active plantar flexors - gastrocnemius and/or soleus. Generally, this inhibition is compensated for by over-activity/synergistic dominance of the long toe extensors - 

extensor hallucis longus and extensor digitorum longus and potentially fibularis tertius

The tibialis anterior, toe extensors, connective tissue and bones of the foot and ankle

Arthrokinematics

Tibialis Anterior Muscle Actions

My Fascial Hypothesis: Large fascial sheaths not only play a role in the transmission of mechanical force but may also play a role in dictating the function of muscular synergies. This is likely caused by reducing or increasing 

 of invested musculature via reflex arcs formed between mechanoreceptors embedded in the connective tissue and the attached musculature. In this way, my view of fascia differs slightly from noted expert on the subject Tom Myers. I think of these large fascial sheaths (specifically the thoracolumbar fascia, iliotibial band, and abdominal fascial sheath) as nature's “motherboard.” A place for mechanical information to be communicated to the 

. Despite having a slightly different philosophy it does not change the fact that fascia plays an important communicative role in the human body and we have Tom Myers to thank for his work.

Image of the fascial system of the body connecting muscles

Iliotibial Band and the Tibialis Anterior?

 (Review of the lower portion of the Spiral Line (6))

The iliotibial band (and lateral intermuscular septum) creates a complicated network that invests in several structures distally:  

Lateral retinaculum and the patellar tendon

The lateral collateral ligament at the knee

And possibly a continuation to the tibialis anterior (although I doubt it)

The potential communicating synergies that may arise from this fascial network are staggering and could be the subject of an article unto themselves (and likely will be). But I doubt the tibialis anterior is part of this communicating synergy (this is a point where Tom Myers (6) and I differ in opinion). Although there may be a connection between the ITB, the lateral retinaculum of the knee, and the tibialis anterior, or potentially the 

 tendon and the tibialis anterior, this fascial connection is not continuous unless including periosteum, which is adhered to bone and is unlikely to transmit mechanical force. Further, it is far more likely that the ITB and biceps femoris invest into the superficial sheath of fascia that covers the tibialis anterior (anterior crural fascia), and not into tendon or fibers of the tibialis anterior muscle itself.

The connective tissue surrounding the knee joint including the IT band, quadriceps, and tibialis anterior

Note the complexity of the fascial system at the lateral knee - http://www.aafp.org/afp/2007/0115/afp20070115p194-f1.jpg

Tibialis Anterior and Extensor Hallucis Longus (EHL):

Much of the lateral border of the tibialis anterior is abutted by the EHL, and fascia arising from the EHL forms a retinaculum between the two muscles. Both muscles are powerful dorsiflexors and aid in the inversion of the ankle. During gait, the tibialis anterior and EHL have similar spikes in activity and may play similar roles (10).

The Plantar Surface of the Navicular and Medial Cuneiform:

The fascial networks on the plantar surface of the foot are complex and deserve further consideration relative to myofascial synergies. Given the fascial density, complex attachments on the plantar surface of the navicular and cuneiform, and variations in tendon attachment of the tibialis anterior occurring in better than 20% of the population (15), the relationship between the insertion of the tibialis anterior, 

 and fibularis longus is worth consideration. These three muscles play significant roles in superior glide and rotation of the 1st metatarsocuneiform joint and cuneonavicular joint, supination, and pronation of the forefoot and may be responsible for controlling posterior glide and tilt of the talus on the tibia (see arthrokinematics above). The tibialis anterior and fibularis longus are often given credit for creating a fascial sling or "stirrup", via their tendons, that supports the medial longitudinal arch during gait. It may be interesting to investigate whether tension results in transmission of force through this fascial network and the stimulation of receptors that contributes to an increase or decrease in activity of these muscles during functional tasks (standing posture, single-leg stance, gait, etc.)

Subsystems

Facial Integration

adaptive lengthening and relative under-activity (3, 11);

 however, a compensatory increase in activity during functional tasks may lead to symptoms generally associated with over-activity and overuse (7).

 the tibialis anterior plays no significant role.

Lumbo Pelvic Hip Complex Dysfunction (LPHCD)

Unilateral maladaptive changes in length or activity of any muscle in the lower leg may result in an asymmetrical weight shift during the 

. Although it is generally assumed that an asymmetrical weight shift is the result of LPHC or SIJD dysfunction, further assessment using the 

Overhead Squat Assessment with Modification

 or Goniometry will aid in differentiation and pinpointing the source of movement impairment.

Lower leg dysfunction is most often driven by a lack of dorsiflexion and/or excessive eversion/pronation. This implies that the tibialis anterior has adaptively lengthened, and lacks the adequate activity and strength to dorsiflex the foot, as well as eccentrically decelerate plantar flexion and eversion. This may be due to altered reciprocal inhibition as a result of over-activity of the plantar flexors (gastrocnemius and/or 

, and evertors (fibularis muscles) and/or arthrokinematic restrictions resulting from a decrease in posterior glide of the talus and increased resistance or loss of range of motion during dorsiflexion. Generally, inhibition of the tibialis anterior is compensated for by over-activity/synergistic dominance of the long toe extensors - 

extensor hallucis longus (EHL) and extensor digitorum longus (EDL) and potentially fibularis tertius

. Trigger point development and over-use often lead to symptoms emanating from the anterior compartment that are attributed to the tibialis anterior but are likely associated with the 

The behavior of the tibialis anterior in those exhibiting dysfunction is a bit puzzling. EMG studies have shown over-activity in individuals who excessively pronate and/or lack optimal dorsiflexion during squatting (20, 21). This implies that despite an increase in length and signs of decreased strength (excessive plantar flexion, eversion, and pronation), activity actually increases. It may be that the increase in activity is compensatory for over-activity in the much larger and stronger plantar flexors, or that the relative increase in length caused by excessive pronation increases muscle spindle activity and results in reflexive over-activity (myotatic/stretch reflex). This may imply that in some cases of long-standing dysfunction, over-use, trigger point development, the aforementioned increased activity, and pain may provide a rationale for releasing the tibialis anterior (along with plantar flexors) before attempting activation and integration techniques.

Manual muscle testing (MMT) will often show this muscle to be strong (5/5), but this is often a false finding. The tibialis anterior is often inhibited, deconditioned, and weak in the dorsiflexion range of motion that has been lost. My challenge to the reader is to test dorsiflexion during your initial assessment, and then use your release, mobilization, and lengthening techniques to regain dorsiflexion. Test the tibialis anterior again in the new range of motion, and you will likely find a significant weakness.

 the tibialis anterior has a propensity to become 

, implying that this muscle would benefit from techniques for 

. Based on a few studies mentioned above (20, 21), 

release of the tibialis anterior may be beneficial

 for those who are experiencing pain originating from this muscle, but assessment of trigger point development and over-activity in the 

 should likely occur before release techniques for the tibialis anterior are included in a corrective intervention. Further, the discussion above on 

 implies that ankle mobilization and first ray mobilization may assist in optimizing activity, length, and function. Note: Self-administered ankle mobilization is demonstrated below; manual techniques should be performed by qualified licensed professionals only.

Knee Pain (Patellar tendonitis, iliotibial band friction syndrome, etc.)

MTSS (Medial Tibial Stress Syndrome) (27)

Transverse tarsal and tarsometatarsal joint dysfunction

Signs of Altered Length/Tension and Tone:

Asymmetrical Weight Shift: Long/Under-active on side of dysfunction

: < 20° (Active Assisted Range of Motion)

Altered reciprocal inhibition of tibialis anterior due to plantar flexor adaptive shortening and over-activity.

Palpation and Tibialis Anterior Trigger Points:

Referral Pain will concentrate on the anteromedial aspect of the ankle, and on the dorsal and medial surfaces of the great toe. A spill-over pattern may radiate from the active trigger point, down over the shin to the anteromedial ankle (8, 28).

As trigger points have been correlated with motor points, it may be worth reviewing this study by Alberto et al. (23) and comparing the Travell and Simons (8) trigger point sites to motor point locations - Atlas of the muscle motor points for the lower limb: implications for electrical stimulation procedures and electrode positioning.

Trigger point development and over-use often lead to symptoms emanating from the anterior compartment that are attributed to the tibialis anterior but are likely associated with the 

Postural Dysfunction and the Tibialis Anterior

Tibialis Anterior Manual Muscle Testing (MMT) for an Active Population

Equipment-Free, Variation: Standing Tibialis Anterior Activation

Resistance Band Seated Tibialis Anterior Activation

Heel Walks

Hops to "Heel-to-toe" Landing to Stabilization

Tibialis Anterior Kinesiology Taping

The ankle joint with connective tissues, bones, and muscles labeled

Self-administered Ankle Mobilization: Anterior to Posterior Mobilization with Dorsiflexion

Exercises and Techniques for the Tibialis Anterior

Phillip Page, Clare Frank, Robert Lardner, 

Assessment and Treatment of Muscle Imbalance: The Janda Approach 

NASM Essentials of Corrective Exercise Training

NASM Essentials of Personal Training: 4th Edition

Diagnoses and Treatment of Movement Impairment Syndromes,

David G. Simons, Janet Travell, Lois S. Simons, 

Travell & Simmons’ Myofascial Pain and Dysfunction, The Trigger Point Manual, Volume 1. Upper Half of Body: Second Edition

Joint Structure and Function: A Comprehensive Analysis: Fifth Edition

Florence Peterson Kendall, Elizabeth Kendall McCreary, Patricia Geise Provance, Mary McIntyre Rodgers, William Anthony Romani

Manipulative Therapy: Musuloskeletal Medicine

Lee, S. S., & Piazza, S. J. (2008). Inversion–eversion moment arms of gastrocnemius and tibialis anterior measured in vivo. 

Luchanscky E., Paz Z: Variations in the Insertion of the Tibialis Anterior Muscle. 

Henriksson-LArsen K: Distribution, number and size of different fiber types in whole cross-sections of female m tibialis anterior. An enzyme histochemical study. 

Henrisson-LArsen K, Friden J, Wretling ML, Distribution of the fibre sizes in human skeletal muscle. An enzyme histochemical study in m tibialis anterior. 

Henriksson-Larsen KB, Lexell J, Sjostrom M: Distribution of different fibre types in human skeletal muscle. I. Method for preperation and analysis of cross-section of whole tibialis anterior. 

Helliwell TR, Coakley J, Smith PEM, et al.: The Morphology and morphometry of the normal human tibialis anterior muscle. 

Gray ER: The Role of leg muscles in variations of the arches in normal and flat feet. 

Dell DR, Padua DA. Influence of ankle dorsiflexion range of motion and lower leg muscle activation on knee vagus during a double legged squat. 

Bell, D. R., Oates, D. C., Clark, M. A., & Padua, D. A. (2013). Two-and 3-dimensional knee valgus are reduced after an exercise intervention in young adults with demonstrable valgus during squatting. 

Alberto B, Oprandi G, Lanfranco F, Allasia S, Maffiuletti N, Minetto M, Atlas of the muscle motor points for the lower limb: implications for electrical stimulation procedures and electrode positioning

Lemos T, Imbiriba LA, Vargas C, et al. (2015). Modulation of tibialis anterior muscle activity changes with upright stance width. 

Journal of Electromyography and Kinesiology. 

Wang R, Gutierrez-Farewik EM. (2011). The effect of subtalar inversion/eversion on the dynamic function of the tibialis anterior, soleus, and gastrocnemius during stance phase of gait. 

Zuil-Escobar JC, Martinez-Cepa CB, Martin-Urrialde JA, et al. (2015). Prevalence of myofascial trigger points and diagnostic criteria of different muscles in function of the medial longitudinal arch. 

Archives of Physical Medicine and Rehabilitation. 

Rathleff MS, Samani A, Olesen CG, et al. (2011). Inverse relationship between the complexity of midfoot kinematics and muscle activation in patients with medial tibial stress syndrome.

 Journal of Electromyography and Kinesiology

Chon S, You JH, Saliba SA. (2012). Cocontraction of ankle dorsiflexors and transversus abdominis function in patients with low back pain. 

Bibliography

Questions, comments, and criticisms are welcome and encouraged

Tibialis Anterior

Related Courses:

Course Description: Tibialis Anterior

Introduction to the Tibialis Anterior
3 Sub Sections

Tibialis Anterior Muscle Actions
1 Sub Section

Facial Integration
1 Sub Section

Postural Dysfunction and the Tibialis Anterior

Exercises and Techniques for the Tibialis Anterior
7 Sub Sections

Bibliography

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Comments

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Tibialis Anterior

Related Courses:

Course Description: Tibialis Anterior

Introduction to the Tibialis Anterior3 Sub Sections

Tibialis Anterior Muscle Actions1 Sub Section

Facial Integration1 Sub Section

Postural Dysfunction and the Tibialis Anterior

Exercises and Techniques for the Tibialis Anterior7 Sub Sections

Bibliography

Related Courses:

Comments

Guest

Introduction to the Tibialis Anterior
3 Sub Sections

Tibialis Anterior Muscle Actions
1 Sub Section

Facial Integration
1 Sub Section

Exercises and Techniques for the Tibialis Anterior
7 Sub Sections