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Tibial external rotator muscle mobility. Tensor fascia latae (TFL),  vastus lateralis, and biceps femoris foam rolling and stretching. Release, lengthening, and manual stretching techniques for the tibial external rotators, TFL, quadriceps/quads, and hamstrings, plus a sample mobility program.

Tibial External Rotator: Release and Lengthening

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Brookbush Institute

I have almost completed my CPT certification and am half-way through the Human Movement certification to inform my massage practice. The different modalities of reading, watching audiovisual materials, and attending live or recorded webinars have been important to my learning style and for review.

Brookbush Institute has the most detailed, specific and effective tools for online learning for movement and/or bodywork professionals. I love the combination of the videos as well as the text available online.

I recently completed the CPT course. It was demanding yet practical. I would highly recommend it for anyone wanting an education about human movement.

I have my personal trainer certificate through here and am almost finished my human movement specialist certification. Overall, the education that Brookbush has packaged together for clinicians and trainers is invaluable. I am a physio assistant so coming from more of a rehab background I appreciate that this education has been beneficial both as a trainer and in a rehab setting. I love that I have been able to do all learning at my own pace and able to work around my schedule. Thank you for setting up this platform! Highly recommend :)

I have been a massage therapist for 10 yrs and I feel like all the “pieces” I’ve learned throughout the yrs have been put into place and can see the full picture. I am also a member to tons of great content since I love to learn! I plan to get my CPT through them as well.

I have been following Brent Brookbush for nearly a decade- back when I was a personal Trainer and now as a Physical Therapist. BBI is an incredible resource for any movement nerds and corrective exercise specialists! The information is thorough with multiple real world applications. I am looking forward to an in-person Manual Therapist course the second they do one a little bit closer to Virginia ;)

I have taken both the Human Movement Specialist and Certified Personal Trainer certificate programs and have found the value in understanding the how and ways the body moves and functions and from evidence, non-biased, outcome, conceptual, theoretical, and practical approach to helping my clients/patients look better, feel better, and move better.

Over the last years I've returned time and again to Brookbush Institute for stellar coursework as I've worked toward a Human Movement Specialist certification. (I'm currently ACE CPT, and in training with Anatomy Trains for Structural Integration Manual Therapy.) Every Brookbush Institute module is fantastic and each one includes detailed informational videos, written descriptions of how to-do, and, more importantly, why to-do!

I am a 70 yr old chiropractor and no other healthcare provider was able to come up with an exercise protocol particular to my structural and balances and muscle deficits and keep me in the game. And as for continuing education on human skeletal movement, the website is phenomenal full of great exercises for particular mechanical dysfunction.

The H.M.S. is the most valuable certificate I have earned and was a fraction of the the cost of my others. Define the best bang for your buck!

Brookbush is the most efficient Personal Training Certification I have ever come across. All the lessons are well thought out and very straight to the point.

I am getting my Master's degree in Kinesiology, and I would like to say that I have benefited greatly from the rich, comprehensive, well-documented scientific content of Brookbush Institute that links theory to practical applications. Proudly I've got my CPT certificate, and I am on my way to get my HMS certificate.

Having courses count towards different certifications makes it so users can transition seamlessly from one certification to another. In my case, going from earning the BI CPT to earning the BI HMS was an easy decision and I am proud to have earned both certifications. I have also had the pleasure of going to a Live HMS workshop that was well taught by Instructor Boettcher and that was excellent to see how the methods and techniques are implemented.



I have been a member of BBI for years and every course I have taken has been incredibly informative. I learn more from these courses than I do at local CEU courses for my PTA license. I also earned my CPT and HMS certifications through the platform. It was so convenient and the content was top notch! Forever member.

We learn principles in academia, we learn cool new modalities via whatever specialty certification, but BBI really concentrates on the nuances of passive treatment and they do a fantastic job. The format in which BBI instructs soft tissue specialists (DPTs, Chiros, ATs) like myself feels like almost like an apprenticeship. You get a thoroughly detailed explanation of the “why’s”, and a visual comprehension of how to apply. Personally, I believe application is where the good and the great are distinguished.

Brookbush has been incredibly helpful since I was in massage school and now as I’m in my career! I run my own practice and it gives me the resources I need to not only improve what I already know, but also help me navigate better, more efficient ways of treatment.

Totally loving the convenience and affordability of this program with my crazy lifestyle! I feel like I am getting a quality education without a massive cost! My favorite part is the videos I can watch in the courses. I learn so much better that way. Once I really spent more time on the site, I figured out how to maneuver around a lot better! I enjoy the sense of humor, as well as the easy explanation, and short tests. And if I am really tired, I can have the computer read me the lessons. 😁

Challenging concepts are explained in very understandable terms without dumbing down the material, and I find this program to be superior in quality to other personal training programs.

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Human Movement Specialist

This course describes tibial external rotator release and lengthening, commonly referred to as tibial external rotator foam rolling, tibial external rotator foam rolling, tibial external rotator release with ball, tibial external rotator stretching, or knee mobility techniques. Although terms like muscle tightness, tight hips, tight tibial external rotators, tensor fascia lata (TFL) tightness, a tight biceps femoris (hamstring) muscle, etc., are commonly used, it may be more accurate to label these muscles as prone to over-activity (e.g. hypertonic, phasic). Performing tibial external rotator release and lengthening techniques to increase mobility prior to activation, integration, and strengthening techniques may significantly enhance rehabilitation and performance programs. In practice, the release of the tensor fascia latae (TFL), vastus lateralis, biceps femoris, and lateral gastrocnemius (calf), mobilizing the knee joint, and integrating a kneeling hip flexor stretch (TFL stretch), and modified calf stretch (gastrocnemius) is likely to improve knee mobility and improve the effectiveness of exercises like terminal knee extensions (TKE's), deadlift touchdowns, isolated tibial internal rotator activation, etc. Tibial external rotator over-activity has been correlated with altered lower extremity alignment, pronation distortion syndrome, knee bow in (knee valgus or functional valgus), an asymmetrical weight shift, loss of tibial internal rotator strength, and loss of vastus medialis obliquus (VMO), semitendinosus, and semimembranosus strength. Further, tibial external rotator over-activity has been correlated with knee pain, ankle pain, increased risk of future injury, and a loss of sports performance. Sports medicine professionals (personal trainers, fitness instructors, physical therapists, massage therapists, chiropractors, occupational therapists, athletic trainers, etc.) should consider adding these exercises to their repertoire to improve the outcomes of their integrated exercise programs and therapeutic (rehabilitation) interventions.

Vastus Lateralis Dynamic Release (Pin and Stretch)

Following release techniques, but before lengthening techniques, it may be beneficial to perform 

Self-administered Joint Mobilization Techniques: Lower Body

Slant Board Stretch (Lateral Gastrocnemius Stretch)

Human Movement Specialist (HMS) Certification

Pre-approved for Continuing Education Credits for:

Dr. Brent Brookbush demonstrating release of the vastus lateralis using a pin and stretch technique on a foam roller

Course Description: Tibial External Rotator: Release and Lengthening

Signs of over-actvity and adaptive shortening of tibial external rotators

Course Study Guide: Tibial External Rotator: Release and Lengthening

Lumbo Pelvic Hip Complex Dysfunction (LPHCD)

, Sacroiliac Joint Dysfunction (SIJD), and 

For a complete review of origin, insertion, innervation, action, integrated function, 

, motor behavior, subsystem involvement, and trigger points, please check out the Functional Anatomy & Human Movement Science of the:

A cadaver dissection of the TFL muscle and IT band running along the lateral side of the leg 

Introduction to Tibial External Rotator Release & Lengthening

, vastus lateralis (VL), iliotibial band (ITB) Complex:

The iliotibial band is an often misunderstood connective tissue (fascial) structure. Although this structure does not contract, develop trigger points (a muscular phenomenon), and is unlikely to become "tight" or adaptively shortened, many practitioners prescribe techniques specific to the iliotibial band (ITB). A more sound approach to hypothesized ITB issues would be addressing the commonly over-active muscles that invest in this complex fascial sheath. The 

 uses the iliotibial band as a tendon, and the vastus lateralis (VL) has fascial slips that invest into the ITB. These fascial slips of the VL extend above the hip implying a role resisting adduction, and the distal slips create a fascial network that invests in several structures of the lateral knee implying a role in resisting tibial internal rotation. Relative to movement impairment, the TFL/VL/ITB complex implies that VL release should be included when over-activity of the tibial external rotators (and potentially hip flexors) is suspected.

Note on Integrated Functional Anatomy of Tight Tibial External Rotators and The IT Band

Dr. Brent Brookbush demonstrating feet turn out during an overhead squat assessment

Dr. Brent Brookbush performing goniometric assessment for hip external rotation in supine (with hip and knee at 90°/90°) with a patient.

Dr. Brent Brookbush demonstrating Ober's test, a positive test indicates a short and overactive tensor fascia latae (TFL)

Movement Assessments

Dr. Brent Brookbush

Optimizing Motion to Prevent Knee Pain

Signs of Over-Activity and Adaptive Shortening

Several texts have noted the propensity of the muscles addressed in this article to become over-active and short (1-5, 14). Further, many of these texts recommend techniques similar to those described in this article. Recently, more research has been done to investigate the relative activity of muscles as it relates to movement impairment, specifically knee valgus. In one study, functional knee valgus was found to be an indicator of relative over-activity of the 

However, in another study by Bell et al., an exercise intervention including release and lengthening of the 

 was found to be effective in reducing functional knee valgus (8)

 In a study by Hasegawa et al. stretching the 

 also resulted in a relative increase in 

Two studies showed an increase in hamstring extensibility (

) when foam rolling was done prior to stretching (9, 11). Further, release and stretching of the calf complex (

) has been shown to be more effective than stretching alone for increasing range of motion, and potentially rehabilitation from plantar heel pain (12, 13). 

Although there are no studies specifically investigating the effect of self-administered release techniques on the 

, all of the research we are currently aware of shows self-administered release is effective for increasing range of motion, without reducing force output (9 - 13), and release and stretching is more effective for increasing ROM than either technique alone (11-13).

Research Corner

Vastus Lateralis Release: Static --> Dynamic

Biceps Femoris Release: Static --> Dynamic

Tensor Fasciae Latae Stretch: Static --> Active --> Dynamic

Vastus Lateralis: No stretching techniques, presumed to be lengthened during Tensor Fasciae Latae Stretching

Manual Stretch for TFL: Thomas Test Stretch for Hip Flexors

Techniques and Progressions

Tensor Fascia Latae (TFL) Self-administered Static Release

Release Techniques: Tensor Fascia Latae

Vastus Lateralis Self-administered Static Release

Vastus Lateralis Self-administered Dynamic Release

Release Techniques: Vastus Lateralis

Biceps Femoris Self-Administered Static Release

Biceps Femoris Self-administered Dynamic Release

Release Techniques: Bicep Femoris

Lateral Gastrocnemius Self-administered Static Release

Lateral Gastrocnemius Self-administered Active Release

Release Techniques: Lateral Gastrocnemius

Kneeling Hip Flexor Self-administered Static Stretch (TFL/VL/ITB Complex)

Active Hip Flexor Stretch (TFL/VL/ITB Complex)

Dynamic Hip Flexor Stretch (Upright Lunge Series)

Lengthening Techniques: Hip Flexor Complex

Biceps Femoris (Self-administered) Active Stretch

Dynamic Biceps Femoris Stretch

Lengthening Techniques: Biceps Femoris

Lateral Gastrocnemius Self-Administered Static Stretch

Lateral Gastrocnemius Slant Board Stretch

Lateral Gastroc Active Stretch

Dynamic Calve Stretch

Lengthening Techniques: Gastrocnemius

Manual Hip Flexor Stretch/Thomas Test Position (Pectineus and Adductor Stretch)

Manual Gastrocnemius and Soleus Stretch

Dynamic Stretching Series for Lower Leg Dysfunction (TFL, Biceps Femoris, and Calves)

Additional Stretching Techniques

Tensor Fasciae Latae (TFL) and Gluteus Minimus Static Manual Release

Mobility Program: Self-administered Techniques

Tensor Fascia Latae (TFL) Self-administered Release

Biceps Femoris Dynamic Release (Pin and Stretch)

Lateral Gastrocnemius Dynamic Release (Pin and Stretch)

Sample Programs

Phillip Page, Clare Frank, Robert Lardner, 

Assessment and Treatment of Muscle Imbalance: The Janda Approach

NASM Essentials of Corrective Exercise Training

Diagnoses and Treatment of Movement Impairment Syndromes,

Mauntel, T., Begalle, R., Cram, T., Frank, B., Hirth, C., Blackburn, T., & Padua, D. (2013). The effects of lower extremity muscle activation and passive range of motion on single leg squat performance. 

Journal Of Strength And Conditioning Research / National Strength & Conditioning Association

Padua, D. A., Bell, D. R., & Clark, M. A. (2012). Neuromuscular characteristics of individuals displaying excessive medial knee displacement. 

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. 

Sullivan, K.M., Silvey, D.B.J., Button, D.C., Behm, D.G. (2013). Roller-massager application to the hamstrings increases sit-and-reach range of motion within five to ten seconds without performance impairments. 

International Journal of Sports Physical Therapy

Halperin, I., Aboodarda, S.J., Button, D.C., Andersen, L.L., Behm, D.G. (2014). Roller massager improves range of motion of plantar flexor muscles without subsequent decreases in force parameters. 

The International Journal of Sports Physical Therapy. 9(1):

Mohr, A. R., Long, B. C., & Goad, C. L. (forthcoming 2014). Foam Rolling and Static Stretching on Passive Hip Flexion Range of Motion. 

Skarabot, J., Beardsley, B., Stim, I. (2015). Comparing the effects of self-myofascial release with static stretching on ankle range of motion in adolescent athletes. 

International Journal of Sports Phyiscal Therapy.

Renan-Ordine, R., Alburquerque-Sedin, F., De Souza, E.P.R., Cleland, J.A., Fernandez-De-La-Penas, C. (2011) Effectiveness of myofascial trigger point manual therapy combined with a self-stretching protocol for the management of plantar heel pain: A randomized controlled trial. Journal of Orthopaedic & Sports Medicine

Tateuchi, H., Taniguchi, M., Mori, N., Ichihashi, N. Balance of hip and trunk muscle activity is associated with increased anterior pelvic tilt during prone hip extension (2013) 

Journal of Electromyography and Kinesiology

Hasegawa, K. T., Hori, S., Tsujita, J., & Dawson, M. L. (2001). Effects of Stretching Exercises on Vastus Medialis and Vastus Lateralis.Medicine & Science in Sports & Exercise, 33(5), S10.

Bibliography

Questions, comments, and criticisms are welcomed and encouraged

Tibial External Rotator: Release and Lengthening

Related Courses:

Course Description: Tibial External Rotator: Release and Lengthening

Course Study Guide: Tibial External Rotator: Release and Lengthening

Introduction to Tibial External Rotator Release & Lengthening

Note on Integrated Functional Anatomy of Tight Tibial External Rotators and The IT Band

Signs of Over-Activity and Adaptive Shortening
2 Sub Sections

Research Corner

Techniques and Progressions

Release Techniques: Tensor Fascia Latae
1 Sub Section

Release Techniques: Vastus Lateralis
2 Sub Sections

Release Techniques: Bicep Femoris
2 Sub Sections

Release Techniques: Lateral Gastrocnemius
2 Sub Sections

Lengthening Techniques: Hip Flexor Complex
3 Sub Sections

Lengthening Techniques: Biceps Femoris
2 Sub Sections

Lengthening Techniques: Gastrocnemius
4 Sub Sections

Additional Stretching Techniques
3 Sub Sections

Sample Programs

Bibliography

Related Courses:

Comments

Guest

Tibial External Rotator: Release and Lengthening

Related Courses:

Course Description: Tibial External Rotator: Release and Lengthening

Course Study Guide: Tibial External Rotator: Release and Lengthening

Introduction to Tibial External Rotator Release & Lengthening

Note on Integrated Functional Anatomy of Tight Tibial External Rotators and The IT Band

Signs of Over-Activity and Adaptive Shortening2 Sub Sections

Research Corner

Techniques and Progressions

Release Techniques: Tensor Fascia Latae1 Sub Section

Release Techniques: Vastus Lateralis2 Sub Sections

Release Techniques: Bicep Femoris2 Sub Sections

Release Techniques: Lateral Gastrocnemius2 Sub Sections

Lengthening Techniques: Hip Flexor Complex3 Sub Sections

Lengthening Techniques: Biceps Femoris2 Sub Sections

Lengthening Techniques: Gastrocnemius4 Sub Sections

Additional Stretching Techniques3 Sub Sections

Sample Programs

Bibliography

Related Courses:

Comments

Guest

Signs of Over-Activity and Adaptive Shortening
2 Sub Sections

Release Techniques: Tensor Fascia Latae
1 Sub Section

Release Techniques: Vastus Lateralis
2 Sub Sections

Release Techniques: Bicep Femoris
2 Sub Sections

Release Techniques: Lateral Gastrocnemius
2 Sub Sections

Lengthening Techniques: Hip Flexor Complex
3 Sub Sections

Lengthening Techniques: Biceps Femoris
2 Sub Sections

Lengthening Techniques: Gastrocnemius
4 Sub Sections

Additional Stretching Techniques
3 Sub Sections