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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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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.

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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.



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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.

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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)

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

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 

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

Introduction to Tibial External Rotator Release & Lengthening

 Although this course addresses muscles that "externally rotate the tibia;" excessive tibial external rotation may result in compensation at the hip and ankle.

"Rule #3 of Brent's Rules of Human Movement Science"

"The motion of a bone is relative to the bones it approximates."

Tibial external rotation is relative femoral internal rotation

Tibial external rotation, combined with femoral internal rotation approximates the lateral knee (valgus force), resulting in "

If the foot remains fixed and the tibia cannot rotate enough to compensate for the restriction; the femur will internally rotate to pick up the slack. Further, the approximation of structures in the lateral knee (the outside of the knee being pinched together by the biceps femoris and TFL/VL/ITB complex) will force the knee to deflect inward - aka. femoral internal rotation and adduction.

: Short and Over-active Tibia External Rotators

: Short and over-active Tibia External Rotators on the side opposite the shift

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

: <35 - 45° – Short and Over-active Tibia External Rotators (via arthrokinematic dyskinesis)

: <35 - 45° – Short and Over-active Tibia External Rotators

Hip Internal Rotation in Supine (with hip and knee at 90°/90°)

: < 35 - 45° – Short and Over-active Tibia External Rotators (via arthrokinematic dyskinesis)

Hip External Rotation in Supine (with hip and knee at 90°/90°)

: < 35 - 45° – Short and Over-active Tibia External Rotators

 (90°/90°) > 0 - 20° Short and Over-active 

Note: Although tibial internal rotation would be the most direct method for assessing optimal ROM of these muscles, clinically I have found this goniometric assessment highly unreliable.

FADIR Test (video coming soon) - Indicative of Short and Overactive 

 and potentially the Vastus Lateralis via the Iliotibial Band

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 

 were not examined in this study (7). 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

Release Techniques

Tensor Fascia Latae (TFL) Self-administered Static Release

Tensor Fascia Latae

Vastus Lateralis Self-administered Static Release

Vastus Lateralis Self-administered Dynamic Release

Vastus Lateralis

Biceps Femoris Self-Administered Static Release

Biceps Femoris Self-administered Dynamic Release

Bicep Femoris

Lateral Gastrocnemius Self-administered Static Release

Lateral Gastrocnemius Self-administered Active Release

Lateral Gastrocnemius

Lengthening Techniques

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)

Hip Flexor Complex

Biceps Femoris (Self-administered) Active Stretch

Dynamic Biceps Femoris Stretch

Biceps Femoris

Lateral Gastrocnemius Self-Administered Static Stretch

Lateral Gastrocnemius Slant Board Stretch

Lateral Gastroc Active Stretch

Dynamic Calve Stretch

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

Perform each technique with accuracy (ex. hold until release for static techniques, 10-15 repetitions for active techniques at a 2:2:2 count, etc.). Progress the flexibility routine as trigger points are reduced, techniques are mastered, and optimal flexibility is attained (generally over the course of weeks). This can be accomplished by adding additional release techniques, and/or replacing static stretches with active and eventually dynamic stretches.

Lateral Gastroc Static Release (progress to 

Activate and Integrate Under-active Structures specifically the 

Sample Mobility Program and Progressions

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

Introduction to Tibial External Rotator Release & Lengthening
1 Sub Section

Signs of Over-Activity and Adaptive Shortening
1 Sub Section

Research Corner

Techniques and Progressions

Release Techniques

Tensor Fascia Latae
1 Sub Section

Vastus Lateralis
2 Sub Sections

Bicep Femoris
2 Sub Sections

Lateral Gastrocnemius
2 Sub Sections

Lengthening Techniques

Hip Flexor Complex
3 Sub Sections

Biceps Femoris
2 Sub Sections

Gastrocnemius
4 Sub Sections

Additional Stretching Techniques
3 Sub Sections

Sample Mobility Program and Progressions

Bibliography

Related Courses:

Comments

Guest

Tibial External Rotator: Release and Lengthening

Related Courses:

Course Description: Tibial External Rotator: Release and Lengthening

Introduction to Tibial External Rotator Release & Lengthening1 Sub Section

Signs of Over-Activity and Adaptive Shortening1 Sub Section

Research Corner

Techniques and Progressions

Release Techniques

Tensor Fascia Latae1 Sub Section

Vastus Lateralis2 Sub Sections

Bicep Femoris2 Sub Sections

Lateral Gastrocnemius2 Sub Sections

Lengthening Techniques

Hip Flexor Complex3 Sub Sections

Biceps Femoris2 Sub Sections

Gastrocnemius4 Sub Sections

Additional Stretching Techniques3 Sub Sections

Sample Mobility Program and Progressions

Bibliography

Related Courses:

Comments

Guest

Introduction to Tibial External Rotator Release & Lengthening
1 Sub Section

Signs of Over-Activity and Adaptive Shortening
1 Sub Section

Tensor Fascia Latae
1 Sub Section

Vastus Lateralis
2 Sub Sections

Bicep Femoris
2 Sub Sections

Lateral Gastrocnemius
2 Sub Sections

Hip Flexor Complex
3 Sub Sections

Biceps Femoris
2 Sub Sections

Gastrocnemius
4 Sub Sections

Additional Stretching Techniques
3 Sub Sections