Introduction

Signs of Under-Activity and a Maladaptive Increase in Length: 

Overactive Synergists

Optimizing Motion (Best Practice)

Research Corner

Sample Activation Circuit

Tibialis Anterior Exercises (Activation)

NASM

ACSM

ProCert

AFAA

NCBTMB

CanFitPro

PTAGlobal

ISSA

REPS

REPSI

PACE

YOGA

WITS

CIMSPA

AUSPHYSIO

TPTA

NYPT

AOTA

Tibialis Anterior Exercises

Tibialis Anterior Activation

<p>This course describes tibialis <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> exercises (commonly referred to as tibialis <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> activation, <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> tibialis exercises, shin <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> strengthening, dorsiflexor <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> strengthening, ankle flexion exercises, and toe raises). Performing resisted dorsiflexion, with the addition of ankle inversion and toe flexion improves recruitment (isolation) of the tibialis <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> and may reduce recruitment of the commonly <a id="synergistic-dominance" data-tip="1647" target="_blank" href="/glossary-term/synergistic-dominance" class="glossary">over-active synergists</a>, extensor hallucis longus and extensor digitorum longus (Note, <a id="trigger-point" data-tip="1632" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger point</a> development and fatigue in these muscles may contribute to shin splints). The tibialis <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> is the primary dorsiflexor of the ankle joint, plays an important role in supination of the foot during weight bearing, and eccentric contraction during heel strike is essential for a smooth gait.</p>
<p>It is common to include these exercises in a program designed to address <a href="https://brookbushinstitute.com/video/overhead-squat-assessment-4-feet-flat-breakdown">feet flatten (pes planus)</a>; however, these exercises may also be recommended to reduce an asymmetrical weight shift, excessive forward lean, knees bow in (knee valgus), knees bow out (knee varus), and feet turn out. Addressing these signs has been correlated with improving and reducing the risk of shin splints, tibialis <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> pain, ankle injury, chronic ankle <a id="stability" data-tip="1193" target="_blank" href="/glossary-term/stability" class="glossary">instability</a>, Achilles tendinitis, plantar fasciitis, ankle pain and foot pain, and improving sports performance. Sports medicine professionals (personal trainers, fitness instructors, physical therapists, athletic trainers, massage therapists, chiropractors, occupational therapists, etc.) should add these exercises to their repertoire to improve the outcomes from their <a id="integration" data-tip="1473" target="_blank" href="/glossary-term/integration" class="glossary">integrated</a> exercise programs and therapeutic (rehabilitation) interventions.</p>
<h4><strong>Isolated Muscle Activation Exercises:</strong></h4>
<ul>
  <li><a href="https://brookbushinstitute.com/video/tibialis-anterior-isolated-activation">Tibialis </a><a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">Anterior</a> Isolated Activation (No Equipment)</li>
  <li><a href="https://brookbushinstitute.com/video/quick-tibialis-anterior-and-tibial-internal-rotator-activation">Tibialis </a><a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">Anterior</a> Activation and Progressions</li>
</ul>
<h4><strong>Reactive Muscle Activation Exercises:</strong></h4>
<ul>
  <li><a href="https://brookbushinstitute.com/video/tibialis-anterior-reactive-activation">Tibialis </a><a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">Anterior</a> Reactive Activations</li>
  <ul>
    <li>Heel Walks</li>
  </ul>
  <li><a href="https://brookbushinstitute.com/video/tibialis-anterior-reactive-activation-progressions">Tibialis </a><a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">Anterior</a> Reactive Activation Progressions</li>
  <ul>
    <li>Multiplanar Hops</li>
  </ul>
</ul>
<h4>Subsystem Integration Exercises:</h4>
<p>Last, it is important to <a id="integration" data-tip="1476" target="_blank" href="/glossary-term/integration" class="glossary">integrate</a> the increase in tibialis <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity into functional exercise. The Brookbush Institute accomplishes this with the intrinsic stabilization subsystem and the <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> oblique subsystem <a id="integration" data-tip="1472" target="_blank" href="/glossary-term/integration" class="glossary">integration</a>. Some example movements for these purposes include:</p>
<ul>
  <li><a href="https://brookbushinstitute.com/video/transverse-abdominis-tva-isolated-activation-quadruped">Quadrupeds (ISS)</a></li>
  <li><a href="https://brookbushinstitute.com/video/quadruped-crawl">Quadruped Crawl (ISS)</a></li>
  <li><a href="https://brookbushinstitute.com/video/row-and-progressions">Squat to Row (POS)</a></li>
  <li><a href="https://brookbushinstitute.com/video/step-up-to-row">Step Up to Row (POS)</a></li>
  <li><a href="https://brookbushinstitute.com/video/reverse-lunge-to-row-posterior-oblique-subsystem-progressions">Reverse Lunge to Row (POS)</a>
    <ul>
      <ul>
        <ul></ul>
      </ul>
    </ul>
  </li>
</ul>
<p><img alt="Isolated activation for the tibialis anterior muscle" title="Dr. Brent Brookbush demonstrating a tibialis anterior isolated activation" src="https://www.datocms-assets.com/25800/1645405076-quick-tibialis-anterior-and-tibial-internal-rotator-activation.png"></p>

Course Description: Tibialis Anterior Exercises (Activation)

<h3>Tibialis Anterior in Postural Dysfunction</h3>
<p>The <a href="https://brookbushinstitute.com/courses/tibialis-anterior">tibialis </a><a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> has a propensity to become inhibited and under-active (relatively weak during activity). This reduces our ability to eccentrically decelerate ankle plantar flexion and eversion, and maintain proper foot and arch alignment during daily activity and sport. This impaired function may result in <a id="dyskinesis" data-tip="1693" target="_blank" href="/glossary-term/dyskinesis" class="glossary">dyskinesis</a> (<a id="movement-impairment" data-tip="1802" target="_blank" href="/glossary-term/movement-impairment" class="glossary">movement dysfunction</a>) of the ankle, foot, and knee, and is often paired with over-activity of the gastrocnemius, soleus, <a href="https://brookbushinstitute.com/courses/extensor-hallucis-longus-and-extensor-digitorum-longus-fibularis-tertius">extensor hallucis longus and extensor digitorum longus</a>, the fibularis muscles, and/or the<a href="https://brookbushinstitute.com/courses/deep-longitudinal-subsystem"> Deep Longitudinal Subsystem (DLS)</a>. Tibialis <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> inhibition may reduce performance, increase the risk of future injury and dysfunction, and is correlated with pain and dysfunction of the lower extremity (knee and ankle joints).&#xA0;</p>
<ul>
  <li style="list-style-type: none;"></li>
</ul>

Introduction to Tibialis Anterior Exercises

<h3><a href="https://brookbushinstitute.com/courses/solutions-table-overhead-squat-assessment" target="_blank" rel="noopener"><strong>Overhead Squat Assessment:</strong></a></h3>
<ul>
  <li><a href="https://brookbushinstitute.com/video/overhead-squat-assessment-4-feet-flat-breakdown" target="_blank" rel="noopener">Feet Flatten</a> (Long/Under-active)</li>
  <li><a href="https://brookbushinstitute.com/video/overhead-squat-assessment-5-feet-turn-out-breakdown" target="_blank" rel="noopener">Feet Turn/Out</a> (Long/Under-active)</li>
  <li><a href="https://brookbushinstitute.com/video/overhead-squat-assessment-6-knees-bow-in-breakdown" target="_blank" rel="noopener">Knees Bow In</a> (Long Under-active)</li>
  <li><a href="https://brookbushinstitute.com/video/overhead-squat-assessment-7-knees-bow-out" target="_blank" rel="noopener">Knees Bow Out</a> (Long/Under-active)</li>
  <li><a href="https://brookbushinstitute.com/video/overhead-squat-assessment-8-excessive-forward-lean" target="_blank" rel="noopener">Excessive Forward Lean</a> (Long/Under-active)</li>
  <li><a href="https://brookbushinstitute.com/video/overhead-squat-assessment-15-sign-clusters-asymmetrical-weight-shift" target="_blank" rel="noopener">Asymmetrical Weight Shift</a> (Potentially long/under-active unilaterally)</li>
</ul>
<p style="padding-left: 200px;"><img title="An example of feet flatten which a common sign when tibialis anterior is weak (underactive)" src="https://www.datocms-assets.com/25800/1649862801-feet-flatten.jpg" width="232" height="307" alt="Feet flatten - notice the navicular drop and minimal arch of the foot"></p>
<h3><strong>Manual Muscle Testing for an Active Population (MMT):</strong></h3>
<ul>
  <li><a href="https://brookbushinstitute.com/video/tibialis-anterior-manual-muscle-testing-mmt-for-an-active-population" target="_blank" rel="noopener">Tibialis </a><a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">Anterior</a> MMT and Modifications:
    <ul>
      <li>A common result indicating dysfunction is <strong>strong with compensation</strong>. That is, the individual can resist considerable force, but does so with additional joint motion. The most common compensations include excessive toe extension and ankle eversion, implicating <a id="synergistic-dominance" data-tip="1643" target="_blank" href="/glossary-term/synergistic-dominance" class="glossary">synergistic dominance</a> of the <a href="https://brookbushinstitute.com/courses/extensor-hallucis-longus-and-extensor-digitorum-longus-fibularis-tertius" target="_blank" rel="noopener">extensor hallucis longus and extensor digitorum longus</a>. Note, eversion and dorsiflexion is a function of the <a href="https://brookbushinstitute.com/courses/extensor-hallucis-longus-and-extensor-digitorum-longus-fibularis-tertius" target="_blank" rel="noopener">extensor digitorum longus</a>. The <a href="https://brookbushinstitute.com/courses/extensor-hallucis-longus-and-extensor-digitorum-longus-fibularis-tertius" target="_blank" rel="noopener">extensor hallucis longus</a> is an invertor of the ankle.</li>
      <li>Provocative Testing for an Active Population: Can the individual maintain end range dorsiflexion and inversion with toes flexed against considerable resistance. This <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a> becomes more provocative if attempted at the new end range gained after techniques for plantar flexor: <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> and lengthening and <a href="https://brookbushinstitute.com/video/self-administered-ankle-mobilization" target="_blank" rel="noopener">ankle joint mobilization</a> have been completed.</li>
    </ul>
  </li>
</ul>
<h4><strong>Gait Impairment:</strong></h4>
<ul>
  <li>Gait impairment indicating <a href="https://brookbushinstitute.com/courses/tibialis-anterior" target="_blank" rel="noopener">tibialis anterior</a> under-activity can be thought of on a continuum. An inability to dorsiflex or a &quot;foot drop&quot; is always a sign of serious impairment; however, a foot slap that occurs only during running indicates a far less significant impairment. Note, even a small amount of dysfunction may result in pain and pathology in athletes who require high levels of neuromuscular control and eccentric force production during intense activity. The continuum below progresses from dysfunction during low intensity activities of daily living to dysfunction during higher intensity sporting activity; this continuum could also be thought of as progressing from &quot;most impairment&quot; to &quot;least impairment&quot;
    <ol>
      <li>Inability to dorsiflex in sitting</li>
      <li>Inability to dorsiflex during standing</li>
      <li>Foot drag during swing phase of gait</li>
      <li>Reduced clearance during swing phase</li>
      <li>Foot flop on heel strike</li>
      <li>Foot slap during heel strike</li>
      <li>Foot slap during heels strike when running</li>
      <li>Foot slap/loud landing during jumping</li>
    </ol>
  </li>
</ul>

Signs of Under-Activity& Length in Weak Tibialis Anterior Muscles

<p>Muscles that commonly become <a id="synergistic-dominance" data-tip="1649" target="_blank" href="/glossary-term/synergistic-dominance" class="glossary">synergistically dominant</a> when the <a href="https://brookbushinstitute.com/courses/tibialis-anterior" target="_blank" rel="noopener">tibialis anterior</a> is inhibited &#x2013; <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">Release</a> and stretch prior to activation, and cue joint motion to reciprocally inhibit these muscles during <a id="activation-technique" data-tip="1529" target="_blank" href="/glossary-term/activation-technique" class="glossary">activation exercise</a>.</p>
<ol>
  <li><a href="https://brookbushinstitute.com/courses/extensor-hallucis-longus-and-extensor-digitorum-longus-fibularis-tertius" target="_blank" rel="noopener">Extensor Hallicus Longus &amp; Extensor Digitorum Longus</a> (inhibit w/ toe flexion)
    <ol>
      <li><a href="https://brookbushinstitute.com/video/ehl-edl-release" target="_blank" rel="noopener">Release</a> (not easily <a id="release" data-tip="1253" target="_blank" href="/glossary-term/release" class="glossary">released</a> using self-administered techniques)</li>
      <li>Stretch</li>
    </ol>
  </li>
</ol>
<p><img src="https://www.datocms-assets.com/25800/1650477663-extensor-hallucis-longus.png" title="The muscles of the foot which include the extensor hallucis longus and extensor digitorum longus" alt="The extensor hallucus longus (EHL) and extensor digitorum longus (EDL)"></p>

<p><a id="optimal" data-tip="1571" target="_blank" href="/glossary-term/optimal" class="glossary">Optimal</a> neuromuscular activity (<a id="tone" data-tip="1639" target="_blank" href="/glossary-term/tone" class="glossary">tone</a>) and function is not only affected by the strength of individuals muscles, but <a id="optimal" data-tip="1571" target="_blank" href="/glossary-term/optimal" class="glossary">Optimal</a> length and activity of their functional antagonists and <a id="mobility" data-tip="1455" target="_blank" href="/glossary-term/mobility" class="glossary">mobility</a> of the joints they cross. It is recommended that the appropriate <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a>, lengthening and joint mobilization techniques are done prior to the activation and <a id="integration" data-tip="1472" target="_blank" href="/glossary-term/integration" class="glossary">integration</a> techniques discussed below.</p>
<ul>
  <li><strong>Release and Lengthening:</strong>
    <ul>
      <li><a href="https://brookbushinstitute.com/video/calf-and-fibularis-peroneal-active-release" target="_blank" rel="noopener">Plantar Flexors: Release</a></li>
      <li><a href="https://brookbushinstitute.com/video/fibularis-muscles-peroneals-sa-static-release" target="_blank" rel="noopener">Evertors: Release</a></li>
      <li><a href="https://brookbushinstitute.com/video/slant-board-calf-stretch">Plantar Flexors and Evertors: Lengthening</a></li>
    </ul>
    <a href="https://brookbushinstitute.com/video/slant-board-calf-stretch"> </a>
  </li>
  <li>Joint Mobilization:
    <ul>
      <li><a href="https://brookbushinstitute.com/video/self-administered-ankle-mobilization" target="_blank" rel="noopener">Ankle Joint</a></li>
    </ul>
  </li>
</ul>

<p>There is a scarcity of research on the relationship between <a id="movement-impairment" data-tip="1575" target="_blank" href="/glossary-term/movement-impairment" class="glossary">movement impairment</a> and <a href="https://brookbushinstitute.com/courses/tibialis-anterior" target="_blank" rel="noopener">tibialis anterior</a> dysfunction, and less on the effect <a id="specificity" data-tip="1224" target="_blank" href="/glossary-term/specificity" class="glossary">specific</a> interventions may have on <a href="https://brookbushinstitute.com/courses/tibialis-anterior" target="_blank" rel="noopener">tibialis anterior</a> function. This <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> is the primary dorsiflexor of the ankle, and is a powerful supinator of the forefoot (1); however, research has also suggested that the <a href="https://brookbushinstitute.com/courses/tibialis-anterior" target="_blank" rel="noopener">tibialis anterior</a> may contribute to eversion/pronation when the ankle is everted enough to move the <a href="https://brookbushinstitute.com/courses/tibialis-anterior" target="_blank" rel="noopener">tibialis anterior</a> tendon <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> to the center of the axis-of-rotation of the <a href="https://brookbushinstitute.com/courses/ankle-joint-talocrural-subtalar-tibiofibular-joints" target="_blank" rel="noopener">ankle</a> (2). Given the role the <a href="https://brookbushinstitute.com/courses/tibialis-anterior" target="_blank" rel="noopener">tibialis anterior</a> plays in ankle function, it is surprising that no research could be located looking specifically at the relationship between tibialis <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> function and ankle sprain, and only a single study on excessive eversion during gait (8). Despite a lack of direct correlations, indirect correlations can be made between <a href="https://brookbushinstitute.com/courses/tibialis-anterior" target="_blank" rel="noopener">tibialis anterior</a> function and lower extremity dysfunction via a handful of studies that noted relationships between lower extremity dysfunction/pathology and reductions in dorsiflexion, a reduction in talus <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a>, and/or flatfeet (3-7).</p>
<p>Two of these studies examined alterations in squat mechanics when dorsiflexion was reduced. The results indicated a decrease in sagittal plane motion at the ankle, but an increase in <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> displacement (frontal plane) of the knee (5, 6). In the one study on <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> knee displacement (functional valgus) that examined <a href="https://brookbushinstitute.com/courses/tibialis-anterior" target="_blank" rel="noopener">tibialis anterior</a> activity via EMG, the results are a bit puzzling, as activity of the <a href="https://brookbushinstitute.com/courses/tibialis-anterior" target="_blank" rel="noopener">tibialis anterior</a> was increased when compared to a control group, despite a decrease in dorsiflexion range of motion (7). It is almost as if the increase in <a href="https://brookbushinstitute.com/article/tibialis-anterior" target="_blank" rel="noopener">tibialis anterior</a> activity was an unsuccessful attempt by the human movement system to overcome a decrease in plantar flexor <a id="extensibility-2" data-tip="1308" target="_blank" href="/glossary-term/extensibility-2" class="glossary">extensibility</a>. Similar to the <a href="https://brookbushinstitute.com/courses/tibialis-posterior" target="_blank" rel="noopener">tibialis posterior</a>, the <a href="https://brookbushinstitute.com/courses/tibialis-anterior" target="_blank" rel="noopener">tibialis anterior</a> was also shown to have increased activity during gait in those that exhibited excessive eversion.</p>
<p>Two studies have considered the impact of ankle sprain on joint stiffness, specifically <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a> of the talus (3, 4). In one study it was found that normal arthorkinematics may not return, despite effective interventions to increase dorsiflexion (3), and the other study found that <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> talus <a id="glide" data-tip="1600" target="_blank" href="/glossary-term/glide" class="glossary">glides</a> decreased recovery time from acute ankle sprains (4). These two studies imply that ankle joint mobilization may be essential to <a id="optimal" data-tip="1571" target="_blank" href="/glossary-term/optimal" class="glossary">optimal</a> recovery from an ankle sprain and that normal arthorkinematics will not return with <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> and stretching techniques alone. Although the Brookbush Institute recommends the consideration of joint mobilizations for all <a id="movement-impairment" data-tip="1576" target="_blank" href="/glossary-term/movement-impairment" class="glossary">movement impairments</a>, we also hypothesize that the <a href="https://brookbushinstitute.com/courses/tibialis-anterior" target="_blank" rel="noopener">tibialis anterior</a> plays a special role in maintaining <a id="optimal" data-tip="1571" target="_blank" href="/glossary-term/optimal" class="glossary">optimal</a> talus <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a>. Below is a paragraph from the &quot;Arthrokinematics&quot; section of the article <a href="https://brookbushinstitute.com/courses/tibialis-anterior" target="_blank" rel="noopener">tibialis </a><a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a>.</p>
<p><strong>Tibiotalar Joint (Ankle):</strong> The talus is one of the few bones in the body without a single muscular attachment. Motion of the talus is dependent upon forces imparted by muscles that attach to the bones it articulates with. This includes the necessary <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a> of the talus on the tibia, essential to <a id="optimal" data-tip="1571" target="_blank" href="/glossary-term/optimal" class="glossary">optimal</a> dorsiflexion range of motion. The <a href="https://brookbushinstitute.com/courses/tibialis-anterior" target="_blank" rel="noopener">tibialis anterior</a> (and <a href="https://brookbushinstitute.com/courses/tibialis-posterior" target="_blank" rel="noopener">tibialis posterior</a>) may have the largest influence on <a id="arthrokinematics" data-tip="1701" target="_blank" href="/glossary-term/arthrokinematics" class="glossary">arthrokinematic motion</a> of the talus via the forces imparted on the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> cuneiform. The <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> and <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> force imparted by the tibialis <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> on the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> cuneiform is likely transferred through the navicular to impart a <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> and <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> force on the talar neck that results in <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a> and <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> tilt of the talus during dorsiflexion. It seems likely that <a id="synergistic-dominance" data-tip="1643" target="_blank" href="/glossary-term/synergistic-dominance" class="glossary">synergistic dominance</a> of the <a href="https://brookbushinstitute.com/courses/extensor-hallucis-longus-and-extensor-digitorum-longus-fibularis-tertius" target="_blank" rel="noopener">extensor hallucis longus and extensor digitorum longus</a>, and/or inhibition of the <a href="https://brookbushinstitute.com/courses/tibialis-anterior" target="_blank" rel="noopener">tibialis anterior</a> would not only contribute to excessive eversion and pronation of the ankle, but reduce the <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> force on the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> cuneiform, resulting in excessive <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a> (insufficient <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a>), limited dorsiflexion, and adaptive shortening of the <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> ankle capsule over-time.</p>
<p>Orthotics have proven ineffective for reducing the risk of occurrence of lower extremity dysfunction but may improve selective recruitment of the <a href="https://brookbushinstitute.com/courses/tibialis-anterior" target="_blank" rel="noopener">tibialis anterior</a> during exercise and functional tasks (9, 10). It is our view that orthotics may be used as an adjunct to corrective/therapeutic intervention, and should not be used in lieu of therapy or as a preventative measure. Although research regarding <a id="specificity" data-tip="1224" target="_blank" href="/glossary-term/specificity" class="glossary">specific</a> strengthening or activation could not be located, single leg <a id="balance" data-tip="1190" target="_blank" href="/glossary-term/balance" class="glossary">balance</a> and stabilization type exercise have been shown to increase <a href="https://brookbushinstitute.com/courses/tibialis-anterior" target="_blank" rel="noopener">tibialis anterior</a> activity (11, 12). It is our recommendation that <a id="specificity" data-tip="1224" target="_blank" href="/glossary-term/specificity" class="glossary">specific</a> strengthening/activation of the <a href="https://brookbushinstitute.com/courses/tibialis-anterior" target="_blank" rel="noopener">tibialis anterior</a> should precede stabilization type exercise in those exhibiting ankle impairment, in an attempt to optimize <a id="motor-unit" data-tip="1303" target="_blank" href="/glossary-term/motor-unit" class="glossary">motor unit</a> recruitment. Last, it is worth noting that research suggests that not only does a relationship between the ankle and hip exist, but <a href="https://brookbushinstitute.com/courses/tibialis-anterior" target="_blank" rel="noopener">tibialis anterior</a> strengthening and low back pain specifically (13, 14).</p>
<p><img title="A demonstration of ankle joint range of motion, including dorsiflexion, plantar flexion, inversion, and eversion" src="https://www.datocms-assets.com/25800/1650085746-ankle-joint-angle.jpeg" alt="Ankle joint range of motion demonstraed in a picture and illustration"></p>

Research On Tibialis Anterior Muscle Exercises

<ul>
  <li>Seated Dorsiflexion and Inversion</li>
  <li>Seated Resisted Dorsiflexion and Inversion</li>
  <li>Standing Toe Ups</li>
  <li>Quad sets with resisted dorsiflexion and inversion</li>
</ul>

Best Exercises For Tibialis Anterior Isolated Activation

<p><iframe src="//player.vimeo.com/video/82875971" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p>
<h4><strong>Equipment-Free, Variation: Standing Tibialis Anterior Activation:</strong></h4>
<ol>
  <li>Have your client or patient start in a standing position with a wall or something to hold onto in front of them.</li>
  <li>Have your client or patient turn their feet inward so that the fifth metatarsals (pinky toe) point straight ahead, squeeze the quads and lock the knees, squeeze the glutes and posteriorly tilt the pelvis if an <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> pelvic tilt is present, and <a id="drawing-in" data-tip="1806" target="_blank" href="/glossary-term/drawing-in" class="glossary">draw in</a>.</li>
  <li>Ask your client or patient to dorsiflex and invert both ankles while flexing the toes.
    <ul>
      <li>Note: I prefer a 2:4:2 count (E:I:C) on this exercise to emphasize increasing strength at the new end range (focus and &quot;max&quot; effort is important when no resistance is used) achieved with the ankle <a id="mobility" data-tip="1455" target="_blank" href="/glossary-term/mobility" class="glossary">mobility</a> exercises that preceded this activity.</li>
    </ul>
  </li>
  <li>Challenge yourself to lift the foot as high as you can off the floor.</li>
  <li>If more than 20 reps can be performed this exercise may be progressed by performing the steps above on one leg.</li>
</ol>
<h4>Progression:</h4>
<ul>
  <li>This exercise may be progressed from <a id="bilateral" data-tip="1552" target="_blank" href="/glossary-term/bilateral" class="glossary">bilateral</a> to unilateral</li>
</ul>
<h4>Common Mistakes:</h4>
<ul>
  <li>It is important that there is something stable in front of you to hold onto during the single-leg <a id="exercise-progression" data-tip="1184" target="_blank" href="/glossary-term/exercise-progression" class="glossary">progression</a> so that tibialis <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> activation and range of motion are the focus and not maintaining <a id="balance" data-tip="1190" target="_blank" href="/glossary-term/balance" class="glossary">balance</a>.</li>
</ul>

Standing Tibialis Anterior Activation (Equipment Free)

<p><iframe src="https://player.vimeo.com/video/108398950" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p>
<h4><strong>Resistance Band Seated Tibialis Anterior Activation:</strong></h4>
<ol>
  <li>Have your client or patient start in a &#x201C;long sit&#x201D; position (sitting on a floor or table with legs straight out, supporting the torso with a backrest, out-stretched arm, or down on elbows).</li>
  <li>Make a &quot;slip knot&quot; by running the resistance band through a handle creating a loop, and place the loop over the foot to be activated, closer to the ankle. Note: Do not simply slip your client&apos;s or patient&apos;s foot through the handle of the resistance band. This may result in the band slipping off during the exercise and potentially striking your patient/client in the face.</li>
  <li>Run the band around the bottom of the foot of the <a id="contralateral" data-tip="1549" target="_blank" href="/glossary-term/contralateral" class="glossary">contralateral</a> leg; this leg and foot will be the pulley and will allow your client or patient to create a <a id="proximal" data-tip="1564" target="_blank" href="/glossary-term/proximal" class="glossary">proximal</a> to <a id="distal" data-tip="1563" target="_blank" href="/glossary-term/distal" class="glossary">distal</a> direction of force.</li>
  <li>Ask your client or patient to hold the end of the band not attached to the foot tightly with both hands.</li>
  <li>Have your client or patient dorsiflex their ankle and flex the hip and knee of the <a id="ipsilateral" data-tip="1550" target="_blank" href="/glossary-term/ipsilateral" class="glossary">ipsilateral</a> leg until sufficient resistance has been reached, and have your patient/client &quot;hug&quot; that knee with heel on the floor.</li>
  <li>They are now in position to begin the exercise.</li>
  <li>Dorsiflex and invert the ankle while flexing the toes.
    <ul>
      <li>Note: I prefer a 2:4:2 count (E:I:C) on this exercise to emphasize strength at the new end range (achieved with the ankle <a id="mobility" data-tip="1455" target="_blank" href="/glossary-term/mobility" class="glossary">mobility</a> exercises that preceded this activity).</li>
    </ul>
  </li>
  <li>Adjust the resistance so that 12-20 reps may be performed with <a id="optimal" data-tip="1571" target="_blank" href="/glossary-term/optimal" class="glossary">optimal</a> <a id="posture" data-tip="1660" target="_blank" href="/glossary-term/posture" class="glossary">form</a>.&#xA0;</li>
</ol>
<h4>Progression:</h4>
<ul>
  <li>This exercise may be progressed by using a stronger band before moving on to the more challenging exercises discussed below.</li>
</ul>
<h4>Common Mistakes:</h4>
<ul>
  <li>Ensure&#xA0;that the target leg is stable. Clients or patients who do not use the opposite foot to affix the leg may <a id="compensation-pattern" data-tip="1697" target="_blank" href="/glossary-term/compensation-pattern" class="glossary">compensate</a> by using their <a href="https://brookbushinstitute.com/courses/adductors" target="_blank" rel="noopener">adductors</a> to maintain position. This could thwart attempts to correct <a id="movement-impairment" data-tip="1575" target="_blank" href="/glossary-term/movement-impairment" class="glossary">movement impairment</a> by exacerbating the commonly noted over-activity of the <a href="https://brookbushinstitute.com/courses/adductors" target="_blank" rel="noopener">adductors</a></li>
</ul>

Quick Tibialis Anterior and Tibial Internal Rotator Activation

<p>This technique is far easier to set-up and increases carry-over dramatically; however, you need access to a massage table or plint and a &quot;monster band&quot;.</p>
<p><iframe src="https://player.vimeo.com/video/104186038" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p>
<h4>Tibialis Anterior Activation on a Table (reinforcing Heel Strike Mechanics):</h4>
<ol>
  <li>Place the band over the foot, close to the ankle.</li>
  <li>Ask your client or patient to dorsiflex and invert the ankle while flexing the toes.
    <ul>
      <li>Note: I prefer a 2:4:2 count (E:I:C) on this exercise to emphasize increasing strength at the new end range achieved with the ankle <a id="mobility" data-tip="1455" target="_blank" href="/glossary-term/mobility" class="glossary">mobility</a> exercises that preceded this activity.</li>
    </ul>
  </li>
  <li>While performing step 3, you can reinforce &quot;heel strike synergy&quot; by cueing quadriceps activation (locking the knee) and <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> activation (pressing the heel into the table or a towel placed under the heel).</li>
  <li>Adjust the resistance so that 12-20 reps may be performed with <a id="optimal" data-tip="1571" target="_blank" href="/glossary-term/optimal" class="glossary">optimal</a> <a id="posture" data-tip="1660" target="_blank" href="/glossary-term/posture" class="glossary">form</a>.</li>
</ol>
<h4>Progression:</h4>
<ul>
  <li>This exercise may be progressed by using a stronger band</li>
</ul>
<h4>Common Mistakes:</h4>
<ul>
  <li>Trying to pull the band up with the whole leg: It is advisable to reinforce quadriceps activation (locking the knee) and <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> activation (pressing the heel into the table or a towel placed under the heel). Try to prevent the individual from using hip flexion and knee flexion to assist in pulling on the band, which may result in reinforcing compensation patterns that include <a href="https://brookbushinstitute.com/courses/tensor-fascia-latae-tfl" target="_blank" rel="noopener">tensor fasciae latae</a> or <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">biceps femoris</a> over-activity.</li>
</ul>

Tibialis Anterior Activation on a Table (reinforcing Heel Strike Mechanics)

<h4>Progressions:</h4>
<ol>
  <li>Single-Leg Balance</li>
  <li>Single-Leg <a id="balance" data-tip="1190" target="_blank" href="/glossary-term/balance" class="glossary">Balance</a> with Reach
    <ol>
      <li>Sagittal</li>
      <li>Frontal</li>
      <li>Transverse</li>
    </ol>
  </li>
  <li>Resisted Single-Leg Balance</li>
  <li>Resisted Single Leg <a id="balance" data-tip="1190" target="_blank" href="/glossary-term/balance" class="glossary">Balance</a> with Reach
    <ol>
      <li>Sagittal</li>
      <li>Frontal</li>
      <li>Transverse</li>
    </ol>
  </li>
  <li>Single-Leg Dead-lift Touchdown
    <ol>
      <li>Touch Knee</li>
      <li>Touch Shin</li>
      <li>Touch Toe</li>
      <li>Unstable</li>
    </ol>
  </li>
</ol>

Integrated Stabilization

<p><iframe src="//player.vimeo.com/video/76717841" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p>
<h4><strong>Single-leg Balance and Reach:</strong></h4>
<ol>
  <li>Explain to your client or patient the reason for performing single-leg <a id="balance" data-tip="1190" target="_blank" href="/glossary-term/balance" class="glossary">balance</a> and reach.</li>
  <li>Have the client or patient assume good form/posture: second toe pointing forward, hip, knee, and ankle in alignment, and pelvis is neutral.</li>
  <li>Instruct the client or patient to attain/maintain the median longitudinal arch of the foot throughout the exercise.</li>
  <li>Have the client or patient lift the foot of the non-target leg about an inch off the floor (leaning as little as they can). It may be helpful to cue the <a id="drawing-in" data-tip="1580" target="_blank" href="/glossary-term/drawing-in" class="glossary">drawing-in</a> maneuver, &quot;squeezing the glutes&quot;, and contracting the quadriceps.</li>
  <li>Maintain a single-leg stance for as long as good form/posture and the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> longitudinal arch of the foot can be maintained. A good goal of 1-2 minutes/leg.</li>
</ol>
<h4><strong>Progressions:</strong></h4>
<p><a id="exercise-progression" data-tip="1182" target="_blank" href="/glossary-term/exercise-progression" class="glossary">Progressions</a> are intended to challenge the client/patient&apos;s ability to maintain good form/posture and the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> longitudinal arch of the foot. When a reach is added you may either perform the exercise with a time goal, or using corrective exercise acute variables: 1-2 sets, 12 - 20 reps/set, with a 2:4:2 or 4:2:2 tempo.</p>
<ul>
  <li>Sagittal Plane Reach: Reaching the non-target leg forward or back.</li>
  <li>Frontal Plane Reach: Reaching the non-target leg laterally (a little extension bias may reduce TFL activity)</li>
  <li>Transverse Plane Reach: Reaching laterally and posteriorly with a combination of extension and external rotation.</li>
  <li>This exercise may be progressed by having the client or patient reach towards different targets (or numbers on a clock).</li>
</ul>
<h4><strong>Common Mistakes:</strong></h4>
<ul>
  <li>The most common mistake is to allow the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> longitudinal arch to collapse, or to allow for a significant lean. It is often assumed that the ability to <a id="balance" data-tip="1190" target="_blank" href="/glossary-term/balance" class="glossary">balance</a> on one leg is the goal; however, the <a id="optimal" data-tip="1571" target="_blank" href="/glossary-term/optimal" class="glossary">optimal</a> goal is to <a id="balance" data-tip="1190" target="_blank" href="/glossary-term/balance" class="glossary">balance</a> one leg for as long as good form/posture and the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> longitudinal arch of the foot can be maintained.</li>
</ul>

Single-leg Balance and Reach

<p><iframe src="//player.vimeo.com/video/82871943" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p>
<h4><strong style="font-size: 1em; letter-spacing: 0px;">Resisted Single-leg Balance and Reach:</strong></h4>
<p>This exercise is a <a id="exercise-progression" data-tip="1184" target="_blank" href="/glossary-term/exercise-progression" class="glossary">progression</a> of the Single-leg <a id="balance" data-tip="1190" target="_blank" href="/glossary-term/balance" class="glossary">Balance</a> and Reach described above, and uses identical cueing and variations. This <a id="exercise-progression" data-tip="1184" target="_blank" href="/glossary-term/exercise-progression" class="glossary">progression</a> adds <a id="a-band" data-tip="1347" target="_blank" href="/glossary-term/a-band" class="glossary">a band</a> or cable pulling in the frontal plane, toward the individual&apos;s stance leg (direction of pull is toward the leg on the ground). This increases the demand on the gluteus medius.</p>

Resisted Single-leg Balance and Reach

<p><iframe src="//player.vimeo.com/video/76719459" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p>
<h4><strong>Single-leg Touchdown:</strong></h4>
<ol>
  <li>Start with the client or patient assuming good standing form/posture.
    <ol>
      <li>2nd toe pointing forward and under the ASIS</li>
      <li>Ankles, knees, and hips in alignment</li>
      <li>Pelvis neutral (absence of <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> or <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> pelvic tilt)</li>
      <li>Torso, scapula, and head in neutral alignment</li>
      <li><strong>Note:</strong> It may be especially important throughout this exercise, to instruct the client or patient on the maintenance of the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> longitudinal arch of the foot.</li>
    </ol>
  </li>
  <li>Have the client or patient lift the foot of the non-target leg about an inch off the floor (leaning to the right or left as little as possible).</li>
  <li>Instruct the client or patient to maintain a soft knee in the target leg throughout the movement (this cue aids in optimizing recruitment of the glute complex and reducing reliance on the biceps femoris).</li>
  <li>While maintaining a neutral spine, have the client or patient use the hand opposite the target leg, to reach toward the toe of the target leg (reach down with the hand on the same side as the elevated leg). This results in some internal rotation and adduction of the hip and increases the load on the gluteus medius and gluteus maximus.</li>
  <li>Cue the client or patient to perform the <a id="drawing-in" data-tip="1580" target="_blank" href="/glossary-term/drawing-in" class="glossary">drawing-in</a> maneuver, squeeze the glutes, and &quot;thrust the hips forward&quot; to return to an upright position. (Note, &quot;hip thrust&quot; increases glute activation while decreasing reliance on the lumbar extensors.</li>
  <li>Have the client or patient perform a &#x201C;form/posture check&#x201D; and make any necessary adjustments.</li>
  <li>Repeat for the desired number of repetitions.</li>
</ol>
<h4><strong>Progressions: </strong></h4>
<ul>
  <li><strong>Exercise Regressions:</strong> Single-leg touchdown with non-target foot &#x201C;lightly touching&#x201D; the floor for additional <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a>.</li>
  <li><strong>Exercise Progressions:</strong> Increasing load, adding <a id="a-band" data-tip="1347" target="_blank" href="/glossary-term/a-band" class="glossary">a band</a> resistance for <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> pull on the pelvis, adding <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> loads or environments, incorporating scaption or curl-to-press for total-body (<a id="integration" data-tip="1473" target="_blank" href="/glossary-term/integration" class="glossary">integrated</a>) exercise <a id="exercise-progression" data-tip="1182" target="_blank" href="/glossary-term/exercise-progression" class="glossary">progressions</a>.</li>
</ul>
<h4><strong>Common mistakes: </strong></h4>
<ul>
  <li><strong>Reaching with the Wrong Hand:</strong> Reaching toward the foot with the hand on the same side as the stance leg may promote compensation (abduction and external rotation of the femur).</li>
</ul>
<ol>
  <ul>
    <li>
      <ul></ul>
    </li>
  </ul>
</ol>
<ul></ul>

Single-leg Deadlift Touchdown 

<h4>Progressions:</h4>
<ol>
  <li>Heel Walks</li>
  <li><a id="bilateral" data-tip="1552" target="_blank" href="/glossary-term/bilateral" class="glossary">Bilateral</a> Hops to Stabilization &#x2013; Land on heels softly</li>
  <li><a id="bilateral" data-tip="1552" target="_blank" href="/glossary-term/bilateral" class="glossary">Bilateral</a> Hops to Single Leg <a id="balance" data-tip="1190" target="_blank" href="/glossary-term/balance" class="glossary">Balance</a> &#x2013; Land on heels Softly</li>
  <li>Transverse Plane Hops to Single Leg <a id="balance" data-tip="1190" target="_blank" href="/glossary-term/balance" class="glossary">Balance</a> - Land on Heels Softly</li>
</ol>

Reactive Activation

<p><iframe src="//player.vimeo.com/video/82876438" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p>
<h4><strong>Heel Walks:</strong></h4>
<ol>
  <li>As this exercise requires someone to walk on their heels it may be advisable to wear shoes or perform on a soft surface to prevent bruising over the tuberosity of the calcaneus.</li>
  <li>Instructor your client or patient to dorsiflex and invert their ankles while flexing their toes, resulting in the individual balancing on their heels.</li>
  <li>Ensure that the 5th metatarsal is pointing straight ahead (pinky toes forward) to reinforce inversion.</li>
  <li>When possible try to reinforce good <a id="posture" data-tip="1658" target="_blank" href="/glossary-term/posture" class="glossary">posture</a> and &quot;near&quot; normal walking mechanics (&quot;chest up&quot;, &quot;draw in&quot;, &quot;tuck your glutes&quot;, etc.)</li>
  <li>Perform 24 - 40 repetitions (steps), increasing stride length and speed to progress and increase intensity.</li>
</ol>
<h4>Progression:</h4>
<ul>
  <li>Speed, step length, and performing this exercise for time rather than reps (up to 2:00 minutes) are all means of progressing this exercise.</li>
</ul>
<h4>Common Mistakes:</h4>
<ul>
  <li>Pay careful attention to ensure your client or patient is &quot;walking&quot; on the <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> aspect of their calcaneus and not the outside of their foot (5th metatarsal).</li>
</ul>

Heel Walks 

<p><iframe src="//player.vimeo.com/video/76729346" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p>
<h4><strong>Hops to &quot;Heel-to-toe&quot; Landing to Stabilization:</strong></h4>
<ol>
  <li>Have your client or patient assume a semi-squat position.</li>
  <li>Set a conservative distance as a &quot;target&quot; or &quot;goal&quot;.</li>
  <li>Have your client or patient visualize landing on the heels and rolling to full foot on the floor, as softly as possible, maintaining the bottom position of the semi-squat after landing.</li>
  <li>Ask your client or patient to hop to the target softly.</li>
  <li>Land on the heels as softly as possible allowing your legs and the rolling motion of heel-to-toe to absorb the force.</li>
  <li>Hold the semi-squat position until you feel stable:</li>
  <li>Repeat for 12 to 20 repetitions.</li>
</ol>
<h4>Progression:</h4>
<ul>
  <li>This exercise may be progressed by hopping a greater distance, landing on a single leg, or hopping from one leg to another in the transverse plane.</li>
</ul>
<h4>Common Mistakes:</h4>
<ul>
  <li>The challenge is landing soft: Do not allow your patient/client to perform this exercise on a yoga mat, abmat, with soft-soled shoes etc., and ask them to remove headphones while performing the technique</li>
</ul>

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

<ol>
  <li>Side Step to <a id="balance" data-tip="1190" target="_blank" href="/glossary-term/balance" class="glossary">Balance</a> to Shoulder Series</li>
  <li>Frontal Plane Step-Up to <a id="balance" data-tip="1190" target="_blank" href="/glossary-term/balance" class="glossary">Balance</a> to Shoulder Series</li>
  <li><a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">Lateral</a> Lunge to <a id="balance" data-tip="1190" target="_blank" href="/glossary-term/balance" class="glossary">Balance</a> To Shoulder Series</li>
  <li>Single-Leg Touchdown w/ Scaption, or PNF Carry Away</li>
</ol>
<p><img src="https://www.datocms-assets.com/25800/1650477918-hop-down-to-single-leg-touchdown-to-balance.png" width="400" height="395" title="Dr. Brent Brookbush demonstrating a reactive activation for the tibialis anterior" alt="Hop down to single-leg touchdown to balance"></p>

Subsystem Integration

Tibialis Anterior Taping

<p>Perform each exercise for 10-20 reps with a weight that is challenging, but ensures that ideal <a id="posture" data-tip="1660" target="_blank" href="/glossary-term/posture" class="glossary">form</a> will be maintained. Perform in a circuit (without rest between exercises) 1-3 times through.</p>
<h4>Release and stretch short/hypertonic structures first:</h4>
<ol>
  <li><a href="https://brookbushinstitute.com/video/quick-tibialis-anterior-and-tibial-internal-rotator-activation" target="_blank" rel="noopener">Quick Tibialis </a><a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">Anterior</a> and Tibial Internal Rotator Activation (Isolated Activation)</li>
  <li><a href="https://brookbushinstitute.com/video/static-ball-bridge-with-trunk-rotation" target="_blank" rel="noopener">Static Ball Bridge with Trunk Rotation</a> (Core <a id="integration" data-tip="1472" target="_blank" href="/glossary-term/integration" class="glossary">Integration</a>)</li>
  <li><a href="https://brookbushinstitute.com/video/resisted-single-leg-balance-and-reach-with-progression" target="_blank" rel="noopener">Resisted Single-Leg </a><a id="balance" data-tip="1190" target="_blank" href="/glossary-term/balance" class="glossary">Balance</a> and Heel Touch to Step (<a id="integration" data-tip="1473" target="_blank" href="/glossary-term/integration" class="glossary">Integrated</a> Stabilization)</li>
  <li><a href="https://brookbushinstitute.com/video/tibialis-anterior-reactive-activation" target="_blank" rel="noopener">Heel Walks</a> (Reactive Activation)</li>
  <li><a href="https://brookbushinstitute.com/video/side-step-and-step-up-with-shoulder-series" target="_blank" rel="noopener">Side-Step to </a><a id="balance" data-tip="1190" target="_blank" href="/glossary-term/balance" class="glossary">Balance</a> to Scaption (Subsystem <a id="integration" data-tip="1472" target="_blank" href="/glossary-term/integration" class="glossary">Integration</a>)</li>
  <li><a href="https://brookbushinstitute.com/video/tibialis-anterior-activation-taping" target="_blank" rel="noopener">Tibialis </a><a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">Anterior</a> Activation Taping</li>
</ol>
<p style="padding-left: 80px;"><img title="Dr. Brent Brookbush demonstrating a dorsiflexion exercise for tibialis anterior activation" src="https://www.datocms-assets.com/25800/1650477364-tibialis-anterior-activation.png" alt="A tibialis anterior activation exercise using dorsiflexion and inversion"></p>

Sample Activation Circuit: Tibialis Anterior Exercises

<ol>
  <li>Klein, P., Mattys, S., &amp; Rooze, M. (1996). Moment arm length variations of selected muscles acting on talocrural and subtalar joints during movement: An in vitro study. <em>Journal of biomechanics</em>, <em>29</em>(1), 21-30.</li>
  <li>Lee, S. S., &amp; Piazza, S. J. (2008). Inversion&ndash;eversion moment arms of gastrocnemius and tibialis anterior measured in vivo. <em>Journal of biomechanics</em>, <em>41</em>(16), 3366-3370</li>
  <li>Denegar, C. R., Hertel, J., &amp; Fonseca, J. (2002). The effect of lateral ankle sprain on dorsiflexion range of motion, posterior talar glide, and joint laxity.<em>Journal of Orthopaedic &amp; Sports Physical Therapy</em>, <em>32</em>(4), 166-173</li>
  <li>Green, T., Refshauge, K., Crosbie, J., Adams, R. (2001). A Randomized Controlled Trial of a Passive Accessory Joint Mobilization on Acute Ankle Inversion Sprains. Physical Therapy, 2001. 81: 984-994</li>
  <li>Macrum et al. Effect of limiting ankle-dorsiflexion range of motion on lower extremity kinematics and muscle-activation patterns during a squat. <em>Journal of Sport Rehabilitation</em>, 2012, 21, Pg 144-150</li>
  <li>Bell DR, Padua DA. Influence of ankle dorsiflexion range of motion and lower leg muscle activation on knee vagus during a double legged squat. <em>J Athl Train 2007; 42 S84</em></li>
  <li>Padua, D. A., Bell, D. R., &amp; Clark, M. A. (2012). Neuromuscular characteristics of individuals displaying excessive medial knee displacement. <em>Journal of athletic training</em>, <em>47</em>(5), 525</li>
  <li>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. <em>Gait &amp; Posture</em>. 29-35</li>
  <li>V. M. Mattila, P.J Sillanpaa, T. Salo, H.-J. Laine, H Maenpaa, H. Pihlajamki. Can orthotic insoles prevent lower limb overuse injuries? A randomized-controlled trial of 228 subjects. Scand J Med Sci Sports 2011: 21: 804 &ndash; 808</li>
  <li>Murley GS, Landford KB, Menz HB, Bird AR: Effect of foot posture, foot orthoses and footwear on lower limb muscle activity during walking and running: a systematic review, <em>Gait Posture</em> 29:172-187, 2009</li>
  <li>Eils, E., and D. Rosenbaum. A multi-station proprioceptive exercise program in patients with ankle instability.Med. Sci. Sports Exerc., Vol. 33, No. 12, 2001, pp. 1991&ndash;1998</li>
  <li>Lemos T, Imbiriba LA, Vargas C, et al. (2015). Modulation of tibialis anterior muscle activity changes with upright stance width. <em>Journal of Electromyography and Kinesiology.</em> 168-174.</li>
  <li>Chon S, You JH, Saliba SA. (2012). Cocontraction of ankle dorsiflexors and transversus abdominis function in patients with low back pain. <em>Journal of Athletic Training.</em> 47(4): 379-389</li>
  <li>Souza, T. R., Pinto, R. Z., Trede, R. G., Kirkwood, R. N., &amp; Fonseca, S. T. (2010). Temporal couplings between rearfoot&ndash;shank complex and hip joint during walking. <em>Clinical biomechanics</em>, <em>25</em>(7), 745-748.</li>
</ol>

Bibliography

<p>© 2016 Brent Brookbush</p>
<p>Questions, comments, and criticisms are welcomed and encouraged </p>

Copyright

A-Band - Refers to the part of the muscle cell that looks darker under a microscope.  This area of the cell is darker due to parallel arrangement of thicker filaments (myosin) and overlap with the thinner filaments (actin).
<ul>
 	<li>As a muscle contracts, the A-band is where actin and myosin interact.</li>
</ul>
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

<strong>Accuracy</strong> - the proportion of individuals correctly identified by the test results.
<ul>
 	<li>For example, a special test with perfect accuracy would imply a test has 100% specificity, 100% sensitivity, 100% positive predictive value and 100% negative predictive values.</li>
</ul>

Action Potential - A rapid change in voltage, resulting in a wave of excitation, that may result in stimulation of a nerve or muscle cell.
<ul>
 	<li>In order for an action potential to be initiated, the resting membrane voltage must exceed the excitation threshold, which then results in a cascade of depolarization and the "wave of excitation." Any stimulus below that threshold will not result in an action potential, and a stimulus greater than the threshold will not increase a single action potential, but may result in additional action potentials.  In this way, the action potential functions more like an on/off switch (all or none), and less like a dimmer switch.</li>
</ul>

A single-joint movement pattern (most often) designed to load a specific under-active muscle(s), while minimizing the contribution of over-active synergists via specific cues/joint motions.
<ul>
 	<li style="text-align: left;">Activation techniques/exercises are performed with the intent of addressing a muscle exhibiting a reduction in activity (tone) as a result of, or contributing to postural dysfunction.</li>
 	<li style="text-align: left;">Activation techniques/exercises cannot be multi-joint movement patterns due to relative flexibility, altered reciprocal inhibition, and synergistic dominance resulting in compensation patterns.</li>
</ul>
Example, <a href="https://brentbrookbush.com/articles/corrective-exercise-articles/activation/gluteus-medius-activation-progression/" target="_blank">gluteus medius activation</a> involves resisted hip abduction while minimizing the contribution of the TFL via hip extension.

Active stretching is a term used to describe a stretch that involves an active contraction of opposing musculature to lengthen a muscle to its end range. Generally these stretches are held for 2-5 seconds and repeated for 8-15 repetitions.

<strong>Adenosine triphosphatase (ATPase):</strong> is the enzyme responsible for catalyzing (initiating and accelerating) the decomposition of ATP to ADP.
<ul>
 	<li>This dephosphorylation (breakdown) reaction releases energy for processes like muscular contraction.</li>
</ul>

<b>Adenosine triphosphate (ATP): </b>The molecule that functions as a universal energy-transfer molecule, providing most of the energy associated with muscular contraction and human movement. ATP is composed of an adenine group, a ribose group, and three molecules of inorganic phosphates.
<ul>
 	<li>Energy is provided when hydrolysis results in the cleaving of a phophate group; resulting in adenosine diphosphate, an inorganigic phosphate group, and energy.</li>
</ul>

<strong>Algometry</strong> - measuring the amount of pressure to result in sensitivity or pain, using an algometer.
<ul>
 	<li>Generally, research uses algometry to establish a minimum pain pressure threshold (PPT), in which a lower PPT implies more sensitivity and pain, and a higher PPT implies less sensitivity and pain. PPT is a common outcome measure in trigger point research.</li>
</ul>
<a href="https://brentbrookbush.com/wp-content/uploads/2019/07/Algometer.jpg"><img class="aligncenter  wp-image-140177" src="https://brentbrookbush.com/wp-content/uploads/2019/07/Algometer.jpg" alt="Image of an Algometer" width="500" height="333" /></a>

<span class="_Tgc"><b>All-or-none</b> <b>principle</b> - a nerve or muscle cell's response to a stimulus is independent of the strength of the stimulus. If that stimulus exceeds the threshold potential (threshold of an action potential), the nerve or muscle fiber will respond completely; otherwise, there is no response.</span>

Example, when a motor unit in the biceps brachii is stimulated it contracts the same way whether a 10 lb or 50 lb dumbbell is lifted.  It is actually the number of muscle cells and the size of the motor unit that determines force output.

&nbsp;

The transition period between eccentric load and concentric contraction during a repetition of an exercise.  This term is most often used in reference to power/plyometric exercises, in which a shorter amortization phase is believed to be beneficial.  The shorter amortization phase may better use the stored energy from the elastic deformation of connective tissue and enhance synchronization of myotatic (stretch) reflex with maximum voluntary contraction.

Example, the athlete was cued to spend as little time as possible in the bottom of their squat stance (the amortization phase) during a set of box jumps.

Muscles that oppose the prime mover and synergists for a given joint action.

That is, all the muscles that can perform the opposing joint action.

Example: The triceps and anconeus are antagonists during elbow flexion.

An anatomical direction; toward the front

Example, the face is on the <em>anterior</em> aspect of the head

<strong>Appendicular Skeleton</strong> - referring to the bones the bones of the arms and legs, as well as the bones that support them. This includes the pelvis, clavicle and scapula. There are approximately 126 bones in the appendicular skeleton.
<ul>
 	<li>Etymology - Appendicular, as in appendage, "that which is appended to something as a proper part," 1640s, from <a class="crossreference" href="https://www.etymonline.com/word/append?ref=etymonline_crossreference">append</a> + <a class="crossreference" href="https://www.etymonline.com/word/-age?ref=etymonline_crossreference">-age</a>. - <a href="https://www.etymonline.com/word/appendage" target="_blank" rel="noopener">Etymology Online</a></li>
</ul>
"Appendicular skeleton" is a label referring to a set of bones whose function is distinct from the bones of the "<a href="https://brentbrookbush.com/glossary/axial-skeleton/" target="_blank" rel="noopener">axial skeleton</a>".

A reflexive decrease in muscle activity due to joint dyskinesis.
For example, a reduction in deep cervical flexor activity as a result of cervical spine dyskinesis.

<strong>Arthrokinematic Motion</strong> - Small amplitude motions between bone surfaces at a joint.  The arthrokinematic motions are roll, glide (slide or translation), spin, compression and distraction (traction). Arthrokinematic motions accompany osteokinematic motions to maintain joint congruence.
<ul>
 	<li>Example, arthrokinematic motion of the talus includes posterior glide on the tibia during ankle dorsiflexion.</li>
</ul>
Synonyms include: arthrokinematics, passive accessory motion, joint play and component motion

&nbsp;

<strong>Assessment</strong><em> -</em> is the act of assessing, i.e. determining the importance, size, or value of -

In most cases, the results of an assessment are compared to normative data. If the individual exhibits values that are within normal parameters, it may be assumed that the aspect of health or motion assessed is not contributing to the patient's complaint, symptoms or movement impairment. If the results fall outside of normal parameters, it may indicate that the aspect of health or motion assessed is contributing to, or being affected by the patient/client's complaint, symptoms, or movement impairment. In some cases, the results of an assessment are compared to an "ideal model." In this case, deviations from the ideal are noted as potential issues. For example, deviations noted in the <a title="Introduction to the Overhead Squat Assessment" href="https://brentbrookbush.com/online-courses/articles/assessment/introduction-overhead-squat-assessment/" target="_blank">Overhead Squat Assessment</a> are compared to an "ideal model" of posture and motion.

Assessments used by human movement professionals can be divided into three broad categories:
<ul>
 	<li><strong>"Clear" the Patient/Client for Intervention</strong> - These are tests, assessments and evaluations used to determine if a patient/client's issue may improve given the assessing professional's scope, skills, abilities and willingness to treat that individual.
<ul>
 	<li>For example, many of the special tests used in orthopedic medicine assist in determining the level of pathology or likelihood of a particular diagnosis. Certain issues and diagnoses are beyond the scope of the human movement professional, and are better treated by diagnostic professionals in the medical community (physicians, podiatrists, surgeons, etc.). A <em>Calf Squeeze (Thompson) Test</em> is one example, in which a positive sign may indicate a rupture of the Achilles tendon that may be better treated via surgical intervention.</li>
</ul>
</li>
 	<li><strong>Highlight Contraindications - </strong>Tests, assessments and evaluations used to stratify risk or preclude a professional from addressing certain tissues, motions or using a particular technique.
<ul>
 	<li>For example, the Vertebral Artery Test (VBI) is often used to determine if high velocity thrust mobilizations (manipulations) are safe for a patient with cervical dysfunction.</li>
</ul>
</li>
 	<li><strong>Refine Exercise/Intervention Selection</strong>: Tests, assessments and evaluations used to assist the professional in determining which techniques, modalities and exercises will best address a patient/client's complaints or desired goals.
<ul>
 	<li>Most movement assessments fall into this category. For example, a positive <a href="https://brentbrookbush.com/vimeo_videos/elys-test-rectus-femoris-flexibility-assessment/" target="_blank">Ely's Test</a> may indicate a need to release and/or lengthen the <a href="https://brentbrookbush.com/articles/anatomy-articles/muscular-anatomy/rectus-femoris/" target="_blank">rectus femoris</a>.</li>
</ul>
</li>
</ul>
Note: An assessment, or assessment result, may fall into more than one category. For example, although goniometry is an assessment most often used to <em>Refine Exercise/Intervention Selection</em>, if a range of motion is significantly altered, with an abnormal end-feel, and/or causes the patient or client/pain, the individual may need to be referred to a physician for further testing and <em>Clearance</em> to resume rehab activities.  Further, that same patient may return to the human movement professional with a list of <em>Contraindicated Activities</em> from the physician. - <em>"When in doubt, refer out!"</em>

<strong>Axial Skeleton</strong> - referring to the bones of the head, neck, trunk and spinal column (does not include pelvis). There are approximately 80 bones in the axial skeleton.
<ul>
 	<li>Etymology - Axial, as in "axis", referring to "imaginary motionless straight line around which a body (such as the Earth) rotates," from Latin <span class="foreign">axis</span> "axle, pivot, axis of the earth or sky" - <a href="https://www.etymonline.com/word/axis" target="_blank" rel="noopener">Etymology Online</a></li>
</ul>
"Axial skeleton" is a label referring to a set of bones whose function is distinct from the bones of the "<a href="https://brentbrookbush.com/glossary/appendicular-skeleton/" target="_blank" rel="noopener">appendicular skeleton</a>".

<strong>Balance</strong> - The ability to maintain a body’s center of mass over its base of support. Balance can be static or dynamic.
<ul>
 	<li>For example, maintaining balance is harder on one leg because the center of mass must stay over a much smaller base of support.</li>
</ul>

A ball and socket joint (also called a spheroid joint or spheroidal joint) is a synovial joint in which the rounded or spherical end of one bone fits into a cup-like depression of another bone. The distal bone is capable of motion around an indefinite number of axes, which have one common center. Examples include the hip and shoulder (glenohumeral joint)

<strong>Base of support (BoS)</strong> - refers to the area beneath an object or person, and the area within the perimeter created by every point of contact that the object or person makes with the supporting surface. This may include the <a href="https://brentbrookbush.com/articles/anatomy-articles/muscular-anatomy/gluteus-maximus/" target="_blank" rel="noopener">glutes</a> of someone sitting on a chair, or the back of someone leaning against a wall.
<ul>
 	<li>For example, during a single leg balance the BoS is the area of the foot in contact with the surface; however, when a person is standing on two feet, the BoS is the area of both feet and the surface between them.</li>
</ul>

Pertaining to both sides

Example, bilateral rows are performed with both arms at the same time.

<strong>Case-control Study</strong> - a particular form of retrospective study that samples a matched group of people who have, and do not have the outcome being studied. A case-control study is a quasi-experimental design, often used in medicine to aid in determining potential contributing factors (cannot determine causality). In this study type exposure is the dependent variable and outcome is independent.
<ul>
 	<li>Example, in this retrospective case-control, medical records were investigated for trends correlated with cervical pain (1).
<ol>
 	<li>Mäkela, M., Heliövaara, M., Sievers, K., Impivaara, O., Knekt, P., &amp; Aromaa, A. (1991). Prevalence, determinants, and consequences of chronic neck pain in Finland. <i>American journal of epidemiology</i>, <i>134</i>(11), 1356-1367.</li>
</ol>
</li>
</ul>

An anatomical direction; toward the tail, relative to humans this term is often used to refer to "in the direction of the tale (toward the feet)".

Example, to release the trapezius muscle the therapist used a force directed<em> caudally</em>.

<strong>Center of mass (CoM)</strong> - an object's mean position of mass; that is, a point that is perfectly surrounded by an equal amount mass in all directions.

<b>Center of gravity (CoG)</b> - point where <b>gravity</b> appears to act. Since the human body is so small compared to the earth, we can assume gravity acts uniformly on the body, and that CoG and CoM are the same.
<ul>
 	<li>Example, the CoM of the human body while lying down or standing straight up is close to our navel. However, it is possible that during a resistance exercise, the combination of the body's weight and the weight of the resistance will place the combined CoM outside the body. For example, during the mid-portion of a <a href="https://brentbrookbush.com/vimeo_videos/back-squat/" target="_blank" rel="noopener">back squat</a> the CoM would be several anterior to the naval.</li>
</ul>

An anatomical direction; toward the head (synonym: cranial)

Example, hip pain was felt with any force directed <em>cephalad</em>.

<strong>Cohort Study</strong> - a particular form of longitudinal study that samples a cohort (a group of people who share a defining characteristic), performing a cross-section at intervals through-out a period of time. A cohort study is a quasi-experimental design often used in medicine to aid in determining etiology or a cause-and-effect relationship. In this study type exposure is the independent variable and outcome is dependent.
<ul>
 	<li>Example, the study by Cholewicki et al. (1) investigated Yale Varsity Athletes (the cohort) with 2 and 3 year follow up (longitudinal design) and found that trunk muscle response time to off-loading was predictive of future low back injury.</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/core/increased-trunk-muscle-latency-may-cause-rather-than-result-from-low-back-pain/" target="_blank" rel="noopener noreferrer">Cholewicki, J., Silfies, S., Shah, R., Greene, H., Reeves, N. Alvi, K., Goldberg, B. (2005). Delayed trunk muscle reflex responses increase the risk of low back injuries. Spine. 30(23), 2614-2620</a></li>
</ol>

<strong>Comparable Sign:</strong> A combination of pain, stiffness and/or spasm during examination that is comparable to the patients symptoms.
<ul>
 	<li>One common error made during evaluation with special tests is attention given to any discomfort or pain, rather than attempting to identify the pain/discomfort related to the patient's complaint (concordant/comparable sign). Many special tests purposefully test tissue limits and are at least mildly uncomfortable in every individual. Basing your assessment on positive tests that resulted in "concordant/comparable signs" will improve your chances of arriving at the correct diagnosis.</li>
</ul>

An alternative movement pattern that has been adopted to compensate for dysfunction/impairment in the human movement system.
Example: A lack of calf extensibility may limit dorsiflexion, leading to the knees bowing inward (functional valgus) and excessive forward lean of the torso during a squat.

An arthrokinematic motion - the approximation of joint surfaces; that is, a force that directs one bone surface into another resulting in a reduction in intra-articular volume. Although widely thought of as a "destructive force", it is likely best to consider compression as a naturally occurring, stabilizing force. Any arthrokinematic force in excess (spin, glide, roll, traction) may be viewed as potentially deleterious.

For example, during a squat the femoral head is compressed into the acetabulum by muscular forces, bodyweight and any additional external load.

<strong>Concave (Concavity)</strong> - Having an outline or surface curved like the interior surface of a bowl or sphere - to cave-in or curve inward.
<ul>
 	<li>Example, the internal surfaces of the pelvis is concave, holding some of the bodies viscera.</li>
</ul>

<strong>Concordant Sign</strong> - The patient's specific pain, symptom or complaint.<span style="color: #ff0000;"> </span>
<ul>
 	<li>One common error made during evaluation with special tests is attention given to any discomfort or pain, rather than attempting to identify the pain/discomfort related to the patient's complaint (concordant/comparable sign). Many special tests purposefully test tissue limits and are at least mildly uncomfortable in every individual. Basing your assessment on positive tests that resulted in "concordant/comparable signs" will improve your chances of arriving at the correct diagnosis.</li>
</ul>

<strong>Conductivity</strong>: Stimulation results in more than a local effect (1).
<ul>
 	<li>For example, in a muscle cell the stimulation of a motor endplate results in a change in cell membrane polarity that rapidly propagates (is conducted) along the entire length of the muscle cell, stimulating all sacromere.</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

A condyloid joint (also called condylar, bicondylar, ellipsoid, or ellipsoidal) is an ovoid articular surface, or condyle, that is received into an elliptical cavity.  These joints permit movement in two planes.  Examples include the knee, metacarpophalangeal joints and metatarsophalangeal joints.

Connective Tissue Cell - One of the four basic types of animal tissue, consisting mostly fibers and ground substance.  These cells are specialized to binds organs together, holds them in place, protect them from external forces, and may fill space in the body's cavities.

Example, the body's muscles are enclosed in durable connective tissue sheets known as the "epimysium", "perimysium", and "endomysium," which and in support and transmitting force.
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

<strong>Contractility: </strong>The ability to shorten (1).
<ul>
 	<li><strong>Contractility</strong>: Muscle cells are unique in the amount they can shorten when stimulated; this is this largerly due to the highly organized and unique arrangement of myofilaments (actin and myosin).</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

Pertaining to the opposite side

Example, the external oblique muscle performs contralateral rotation; rotation to the opposite side.

<strong>Convex (Convexity)</strong> - Having an outline or surface curved like the exterior of a circle or sphere - to bulge or curve outward.
<ul>
 	<li>Example, the top of your head is shaped by the convex exterior surface of your skull.</li>
</ul>

<strong>Correlational Research</strong> - Non-experimental <a href="https://www.questionpro.com/blog/what-is-research/">research</a> method in which the statistical relationship between two variables is investigated.
<ul>
 	<li>In this research by Kwon et al., a correlation was noted between a decrease in extensibility during a hamstring length test (goniometry) and current knee pain (1).</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/knee/correlation-patellofemoral-pain-syndrome-pfps-hamstring-activity/" target="_blank" rel="noopener">Kwon O, Yun M, and Lee W. (2014). Correlation between intrinsic patellofemoral pain syndrome in young adults and lower extremity biomechanics. <em>J. Phys. Ther. Sci. </em>26: 961-964</a></li>
</ol>

<strong>Counter-nutation</strong> - posterior rotation of sacrum relative to ilium, and/or anterior rotation of ilium relative to sacrum.
<ul>
 	<li>The pelvic floor muscles are examples of muscle that may counter-nutate the sacrum.</li>
</ul>
[caption id="attachment_126335" align="aligncenter" width="400"]<a href="https://brentbrookbush.com/wp-content/uploads/2018/10/Nutation.png"><img class=" wp-image-126335" src="https://brentbrookbush.com/wp-content/uploads/2018/10/Nutation.png" alt="Nutation and Counter-nutation of the Sacroiliac Joint" width="400" height="967" /></a> Nutation and Counter-nutation of the Sacroiliac Joint[/caption]

&nbsp;

<strong>Crossover (Study) Design</strong> - A type of longitudinal, repeated measures quasi-experimental design in which each group receives both treatments, but at different times. It is named "crossover" due to the patients "crossing-over" to the other treatment or sham group after a specified period of time.
<ul>
 	<li>This type of study has the advantage of every individual serving as their own control, which may reduce the influence of confounding variables.</li>
 	<li>Unfortunately, the design itself introduces the chances that anyone receiving the experimental variable in the first period will continue to be effected in the second period.</li>
</ul>
In a study by Senna et al., a cross-over design was used to investigate the difference load made on inter-set rest intervals (1).
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/strength-training-research-corner/heavy-vs-light-load-single-joint-exercise-performance-with-different-rest-periods/" target="_blank" rel="noopener">Senna, G.W., Rodrigues, B.M., Sandy, Scudese, Bianco, A, &amp; Dantas, E.H.M. (2017). Heavy vs light load single-joint exercise performance with different intervals. <em>Journal of Human Kinetics, 58, 197-206.</em> </a></li>
</ol>

Cross-sectional Study - a research design that involves gathering data from a population or representative subset at a specific point in time.
<ul>
 	<li>Example, the study by Karimi-Mobarake et al.(1) investigated the prevalence of genu varum and genu valgum among school children 7-11 years old in Iran.</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/knee/low-prevalence-of-genu-varum-and-valgum-among-elementary-school-children/" target="_blank" rel="noopener noreferrer">Karimi-Mobarake, M., Kashefipour, A., Yousfnejad, Z. The prevalence of genu varum and genu valgum in primary school children in Iran 2003-2004. (2005) <em>Journal of Medical Science</em> 5(1). 52-54</a></li>
</ol>

<strong>Cytokine</strong> - A broad and loose category of small proteins that act through receptors, and are especially important to immune function (inflammation).
<ul>
 	<li>Cytokines include substances such as interferon, interleukin, and growth factors, which are secreted by certain cells of the immune system and have an effect on other cells. Their definite distinction from hormones is a topic of continued research.</li>
</ul>
&nbsp;

Dependent variable - in research, this is the variable that is changed by the independent variable, most often this is the "outcome" of the study.
<ul>
 	<li>Example, in the study by Cleland et al. (1), the independent variable is "thoracic manipulation," and the dependent variable is "lower trapezius muscle strength."</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/short-term-effects-lower-thoracic-manipulation-lower-trapezius-muscle-strength/" target="_blank" rel="noopener noreferrer">Cleland J, Selleck B, Stowell T, Brown L, Alberini S, St. Cyr H, Caron T. Short-term Effects of Thoracic Manipulation on Lower Trapezius Muscle Strength. <em> Journal of Manual &amp; Manipulative Therapy</em>. 2004; 12(2): 82-90</a></li>
</ol>

An anatomical direction; further from the trunk or center of the body

Example, the foot is at the <em>distal</em> end of the leg.

An arthrokinematic motion - a <span class="_Tgc">force applied to a body part that may result in the separation of joint surfaces, a reduction in intra-articular pressure, and/or an increase in intra-articlar space.</span>

For example, to hang from one's hands (i.g. in preparation for a pull-up) results in a traction force on the glenohumeral joint (shoulder).

An anatomical term of location; back or upper surface

Example, shoe laces may compress tissues on the <em>dorsal</em> surface of the foot

The "drawing-in" maneuver is a common cue used during exercise and rehabilitation programs. A light contraction of the <a href="https://brentbrookbush.com/articles/muscular-anatomy/transverse-abdominis/" target="_blank" rel="noopener">transverse abominis</a> (and potentially the entire <a href="https://brentbrookbush.com/articles/corrective-exercise-articles/core-subsystems/intrinsic-stabilization-subsystem/" target="_blank" rel="noopener">intrinsic stabilization subsystem</a>) achieved by gently pulling the lower abdominal region away from one's waist band. This should have minimal effect on breathing, and should not be confused with a maximal contraction of the <a href="https://brentbrookbush.com/articles/muscular-anatomy/transverse-abdominis/" target="_blank" rel="noopener">transverse abdominis</a> resulting in a "vacuum pose".
<ul>
 	<li>Research often refers to this maneuver as the "abdominal drawing-in maneuver"; abbreviated ADIM.</li>
</ul>
Development and introduction of this cue into practice is based on the pivotal research and resulting text:
<ol>
 	<li>Carolyn Richardson, Paul Hodges, Julie Hides. Therapeutic Exercise for Lumbo Pelvic Stabilization – A Motor Control Approach for the Treatment and Prevention of Low Back Pain: 2nd Edition (c) Elsevier Limited, 2004</li>
</ol>

Faulty or abnormal movement; an<span class="_Tgc"> alteration of normal kinematics.</span>

For example, joint stiffness or a reduction in arthrokinematics motion that results in limited osteokinematic range of motion - inadequate inferior glide of the femoral head resulting in limited abduction of the hip.

The seeping into, or abnormal collection of fluid in a body cavity.

For example, knee effusion describes swelling within the knee joint.

Note: the word "effusion" is used differently in medicine than it is used in reference to the movement (seeping out) of liquids and gases, for example in chemistry.

&nbsp;

A trait of body tissues that allows a tissue to return to its resting length or state after deformation or stretch.
Example:  Muscle is elastic tissue; many muscles will return to their resting length after being stretched to 150% of that length without any appreciable change in tissue quality.

<strong>Elasticity</strong>: Elasticity refers to the ability of a cell to return to its resting length after being stretched/lengthened.
<ul>
 	<li>Note: this term is often confused with extensibility. Elasticity is not the ability to stretch; it is the ability to return to normal length after being stretched. Muscle tissue, connective tissue and even nerve tissue have varying levels of elasticity.</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

Epithelial cell - One of the four basic cell types, found lining the body's cavities, blood vessels, organs and constitutes most gland tissue.  These cells are specialized to aid with absorption, secretion, or act as a barrier from foreign objects.
<ol>
 	<li>Saladin, K. S., &amp; Miller, L. (1998). <i>Anatomy &amp; physiology</i>. New York (NY): WCB/McGraw-Hill.</li>
</ol>

<strong>Equilibrium</strong> - a state in which opposing forces or influences are balanced.
<ul>
 	<li>For example, to maintain a neutral trunk while pushing or pulling a weight in one hand, your core musculature must balance the force by creating an equal amount of force in the opposite direction.</li>
</ul>

The study of causation, or origination. The word is commonly used in the medical professions, where it may refer to the study of why things occur, or the reason behind why things act a certain way.

For example, the etiology of low back pain is a complex subject, with multiple contributing factors and various structures implicated.

<div class="gs_citr" tabindex="0"><strong>Evidence-based medicine (practice)</strong> is the integration of best research evidence with clinical expertise and patient(client) values (2)."</div>
<ul>
 	<li class="gs_citr" tabindex="0">...the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients (clients).  It involves the integration of at least (a) clinical expertise/expert opinion, (b) external scientific evidence, and (c) client/patient/caregiver perspectives to provide high-quality services reflecting the interests, values, needs, and choices of the individuals we serve (1).</li>
</ul>
&nbsp;
<ol>
 	<li id="gs_cit1" class="gs_citr" tabindex="0">Sackett, D. L., Rosenberg, W. M., Gray, J. M., Haynes, R. B., &amp; Richardson, W. S. (1996). Evidence based medicine: what it is and what it isn't. <i>Bmj</i>, <i>312</i>(7023), 71-72.</li>
 	<li class="gs_citr" tabindex="0">Sackett D et al. Evidence-Based Medicine: How to Practice and Teach EBM, 2nd edition. Churchill Livingstone, Edinburgh, 2000, p.1</li>
</ol>

<strong>Excitability:</strong> The ability of a cell to <span class="hvr">change</span> in <span class="hvr">membrane</span> <span class="hvr">conductance</span> as a <span class="hvr">response</span> to <span class="hvr">stimulation.
</span>
<ul>
 	<li><span class="hvr">For example, muscle cells are specialized to react to a change in membrane potential with contraction, where as nerve cells are specialized to propagate a change in membrane potential along there axons and communicate that message to other tissues via neurotransmitters.
</span></li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

<strong>Excitation threshold:</strong> The level that a depolarization must reach for an action potential to occur.
<ul>
 	<li>The excitation threshold is a contributing factor to the "all-or-none" response of muscle and nerves cells to a stimulus.</li>
</ul>

<strong>Exercise Progression</strong> - Modification of an exercise with the intent of promoting adaptation by increasing demand. This can be accomplished by increasing reps, load, tempo, range of motion, complexity, and/or challenge to an individual's stability.
<ul>
 	<li>Because load, reps, tempo and complexity are often explicitly noted, the term "exercise progression" is most often used throughout Brookbush Institute (BI) content to refer to an exercise, or series of exercises that make it harder to maintain stability with good form.
<ul>
 	<li>Sample Exercise Progression: <a href="https://brentbrookbush.com/vimeo_videos/kneeling-chop-pattern/" target="_blank" rel="noopener">Kneeling Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/static-standing-chop-pattern/" target="_blank" rel="noopener">Standing Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/single-leg-chop-pattern/" target="_blank" rel="noopener">Single-leg Chop</a></li>
</ul>
</li>
</ul>

<strong>Exercise regression</strong> - The opposite of progression; that is, modification of an exercise with the intent of reducing demand. This can be accomplished by decreasing reps, load, tempo, range of motion, complexity, and/or challenge to an individual's stability. Generally, regressions are used to modify an exercise to the client's current level of ability, with the intent of improving form, motor learning and retention.
<ul>
 	<li>Because load, reps, tempo and complexity are often explicitly noted, the term "exercise regression" is most often used throughout Brookbush Institute (BI) content to refer to an exercise or series of exercises that make it easier to maintain stability with good form.
<ul>
 	<li>Sample Exercise Regression: <a href="https://brentbrookbush.com/vimeo_videos/single-leg-chop-pattern/" target="_blank" rel="noopener">Single-leg Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/static-standing-chop-pattern/" target="_blank" rel="noopener">Standing Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/kneeling-chop-pattern/" target="_blank" rel="noopener">Kneeling Chop</a></li>
</ul>
</li>
</ul>

<strong>Experimental Research</strong> - Studies in which the researchers introduce the variable to be studied, with the intent of observing the outcome. This is different than observational research which observes the effect of a variable already present. Many texts also assert that experimental research should include randomization and ideally a control group, as is seen in Randomized Control Trials. Studies in which the variable is introduced by the researchers, but participants are not randomized may be considered Quasi-experimental research.
<ul>
 	<li>In this study by Esformes, the experimental variable was squat depth and the outcome measures observed were various performance measures related to power (1).</li>
</ul>
<ol>
 	<li><a href="https://brookbushinstitute.com/article/back-squat-depth-lower-body-post-activation-potentiation/" target="_blank" rel="noopener">Esformes, J., &amp; Bampouras, T. (2013). Effect of back squat depth on lower-body postactivation potentiation. <em>Journal of Strength and Conditioning Research, 27</em>(11), 2997-3000.</a></li>
</ol>
&nbsp;

<strong>Extensibility</strong>: The ability of a cell to be stretched or lengthened without damage (1).
<ul>
 	<li>For example, most cells would rupture with even a modest stretch, but muscles can stretch up to 3 times their contracted length.</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

<strong>False Negative </strong>- the proportion of negatives in a group that were assessed incorrectly (assessed as negative when the patient was actually positive)
<ul>
 	<li>Test Results: Although most tests/assessments result in either a positive or negative, the accuracy of a test is dependent on the number  of positives and negatives that are correct. Therefore, when the accuracy of a test is determined, their are 4 possible results, because a positive or negative result could be right (true) or wrong (false).</li>
</ul>

<strong>False Positive </strong>- the proportion of positives in a group that were assessed incorrectly (assessed as positive when the patient was actually negative)
<ul>
 	<li>Test Results: Although most tests/assessments result in either a positive or negative, the accuracy of a test is dependent on the number  of positives and negatives that are correct. Therefore, when the accuracy of a test is determined, their are 4 possible results, because a positive or negative result could be right (true) or wrong (false).</li>
</ul>

The function of fascia is to transmit force, provide support, and protect tissues. Fascia can effect motion by:
Transmitting force from one or more muscles (example: the thoracolumbar fascia)
Restricting motion in cases of adaptive shortening and/or adhesion to proximal structures (example: iliotibial band in cases of lower-leg dysfunction)
Elastic recoil after stretching can contribute to force production (example: plyometric exercise)

Note: There is evidence that fascia may house more receptors related to human movement than other tissues. In this way fascia may act as a motherboard for the nervous system

The fascial system does not contract or develop trigger points, and its capacity to adapt to stretching and or strengthening exercise is limited, especially when compared to the adaptive capacity of muscle tissue.

<strong>Fibromyalgia</strong> - A loosely defined diagnosis that is associated with a combination of widespread pain <i>in combination with</i> 2) tenderness at 11 or more of the 18 specific tender point sites. Consideration may also be given to the presence of psychosocial stressors and inflammatory disease in the patients history. Newer research suggests that fibromyalgia may be at least in part due to central sensitization of myofascial pain, often associated with trigger points (1 - 4).
<ol>
 	<li>Wolfe, F. (2018). Fibromyalgia Syndrome and Fibromyalgia Syndrome Criteria: Problems in Definition and Validity. <i>Fibromyalgia Syndrome and Widespread Pain: From Construction to Relevant Recognition</i>.</li>
 	<li>Wolfe, F., Smythe, H. A., Yunus, M. B., Bennett, R. M., Bombardier, C., Goldenberg, D. L., ... &amp; Fam, A. G. (1990). The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. <i>Arthritis &amp; Rheumatism: Official Journal of the American College of Rheumatology</i>, <i>33</i>(2), 160-172.</li>
 	<li>Alonso-Blanco, C., Fernandez-de-las-Penas, C., Morales-Cabezas, M., Zarco-Moreno, P., Ge, H. Y., &amp; Florez-García, M. (2011). Multiple active myofascial trigger points reproduce the overall spontaneous pain pattern in women with fibromyalgia and are related to widespread mechanical hypersensitivity. <i>The Clinical journal of pain</i>, <i>27</i>(5), 405-413.</li>
 	<li>Staud, R., Nagel, S., Robinson, M. E., &amp; Price, D. D. (2009). Enhanced central pain processing of fibromyalgia patients is maintained by muscle afferent input: a randomized, double-blind, placebo-controlled study. <i>PAIN®</i>, <i>145</i>(1-2), 96-104.</li>
</ol>
&nbsp;

Muscles that act to reduce or prevent movement at proximal joints to improve force transmission.
Example: The muscles of the core are important fixators; reducing motion of the spine/trunk to enhance force transmission between the extremities and environment.

An increase in joint stability via compressive forces resulting from muscular contraction and increased tension in fascial structures (1,2).
<ul>
 	<li>This term is most often used in reference to core intrinsic stabilizers, the thoracolumbar fascia and the sacroiliac joint; however, force closure and form closure have been mentioned in the literature referring to other joints.</li>
 	<li>Related term: Form closure</li>
</ul>
<ol>
 	<li>Andry Vleeming, Vert Mooney, Rob Stoeckart. Movement, Stability &amp; Lumbopelvic Pain: <a class="glossaryLink " title="Glossary: Integration" href="https://brentbrookbush.com/glossary/integration/" target="_blank" rel="noopener noreferrer" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Integration&lt;/div&gt;&lt;div class=glossaryItemBody&gt;Making a whole of parts.&lt;br /&gt;&lt;br /&gt;Example, The Brookbush Institute uses an integrative approach to explaining and addressing human movement.&lt;/div&gt;">Integration</a> of Research and Therapy. (c) 2007 Elsevier Limited</li>
 	<li id="gs_cit1" class="gs_citr" tabindex="0">Vleeming, A., Pool-Goudzwaard, A. L., Stoeckart, R., van Wingerden, J. P., &amp; Snijders, C. J. (1995). The Posterior Layer of the Thoracolumbar Fascia| Its Function in Load Transfer From Spine to Legs. <i>Spine</i>, <i>20</i>(7), 753-758.</li>
</ol>

The relative contribution of joint shape and structure to the stability of a joint (1,2).
<ul>
 	<li>This term is most often used in reference to the "rough" articulating surfaces of the sacroiliac joint and the wedge shape of the sacrum; however, force closure and form closure have been mentioned in the literature referring to other joints.</li>
 	<li>Related term: Force closure</li>
</ul>
<ol>
 	<li>Andry Vleeming, Vert Mooney, Rob Stoeckart. Movement, Stability &amp; Lumbopelvic Pain: <a class="glossaryLink " title="Glossary: Integration" href="https://brentbrookbush.com/glossary/integration/" target="_blank" rel="noopener noreferrer" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Integration&lt;/div&gt;&lt;div class=glossaryItemBody&gt;Making a whole of parts.&lt;br /&gt;&lt;br /&gt;Example, The Brookbush Institute uses an integrative approach to explaining and addressing human movement.&lt;/div&gt;">Integration</a> of Research and Therapy. (c) 2007 Elsevier Limited</li>
 	<li id="gs_cit1" class="gs_citr" tabindex="0">Vleeming, A., Pool-Goudzwaard, A. L., Stoeckart, R., van Wingerden, J. P., &amp; Snijders, C. J. (1995). The Posterior Layer of the Thoracolumbar Fascia| Its Function in Load Transfer From Spine to Legs. <i>Spine</i>, <i>20</i>(7), 753-758.</li>
</ol>

An arthrokinematic motion - linear motion across a joint surface parallel to the plane of the adjacent joint surface, just as your posterior moves relative to a "slide" in a park.

For example, the glide of facet joint in the spine during spinal flexion and extension, or the posterior glide of the humeral head that must accompany anterior roll to maintain congruence with glenoid fossa during shoulder horizontal adduction.

A plane joint (also called an arthrodial joint, gliding joint or plane articulation) is a synovial joint which allows only gliding movement in the plane of the articular surfaces. The opposed surfaces of the bones are flat or almost flat, with movement generally limited by tight capsules and ligaments. Plane joints are numerous, are most often small, and allow very little motion.  Examples include the carpal joints of the wrist, the tarsal joints of the ankle, and the facet joints of the spine.

"...refers to the measurement of angles, in particular the measurement of angles created at human joints by the bones of the body (1).

&nbsp;
<ol>
 	<li>Cynthia C. Norkin, D. Joyce White. Measurement of Joint Motion: A Guide to Goniometry 3rd Edition. Copyright (C) 2003 by F.A. Davis Company</li>
</ol>

Ground reaction force (GRF) - The force exerted by the ground on the body in contact with it.

For example, when a runner's foot strikes the ground with a force equal to the mass of the individual times their acceleration due to gravity, momentum and muscular exertion, the ground exerts an equal and opposite force on the runner's foot.
<ul>
 	<li>GRF is often measured in research studies using force plates as a means of quantitatively measuring the force generated by an individual.</li>
</ul>

<strong>H-Band</strong> - Refers to the central zone of a sarcomere that looks lighter under a microscope.  This area of the sarcomere is a lighter portion of the A-band where there is no overlap between the thinner filaments (actin), and the thicker filaments (myosin).
<ul>
 	<li>Example, when a muscle contracts, actin and myosin cross-bridging occurs in the region of the A-band until the H-band is reached where no overlap occurs.</li>
</ul>
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

A hinge joint (also called a ginglymus) is a synovial joint in which the articular surfaces fit one another in a way that only permits motion in one plane. Examples include the elbow, the knee (unless considered a condyloid joint) and the interphalangeal joints.

Holism (holistic) (<em>biological holism</em>) - (from Greek <i>holos</i> "all, whole, entire") is the idea that systems and their properties should be viewed as wholes, not just as a collection of parts.
<ul>
 	<li>Summarized by Aristotle in his "Metaphysics": "The whole is more than the sum of its parts". However, the term "holism" was introduced into language by the South African statesman Jan Smuts as recently as 1926. (Smuts J. C. 1987 [1926]. <em class="EmphasisTypeItalic ">Holism and evolution</em>. Cape Town: N &amp; S Press.)</li>
</ul>
Example: The Brookbush Institute promotes a holistic approach to human movement science, in which the muscular, fascial, articular and neural systems are not viewed as separable and all proximal segments are considered.

<strong>Hormone: </strong>Chemical messengers produced by the endocrine system, transported via tissue fluids such as blood, to stimulate cells to "act."
<ul>
 	<li>Example: Growth hormone is secreted by the pituitary gland in the brain; stimulating growth, cell reproduction and cell regeneration in certain types of cells</li>
</ul>
The English physician E. H. Starling discovered in collaboration with the physiologist W. M. Bayliss secretin, the first hormone, in 1902. (1).
<ol>
 	<li>Henriksen, J. H., &amp; de Muckadell, O. S. (2000). Secretin, its discovery, and the introduction of the hormone concept. <i>Scandinavian journal of clinical and laboratory investigation</i>, <i>60</i>(6), 463-472.</li>
</ol>

A range of motion achieved by the patient/client that is more than normal.
<ul>
 	<li>Note: Both hyper-mobility and hypo-mobility may adversely affect motion and may lead to deleterious effects on joints and soft tissue over time. There is no evidence to suggest that more or less flexibility than normal is beneficial.</li>
</ul>
Example: If an individual can place their forehead on their knees they are likely hypermobile at one, if not several joints

Example 2: 110° of shoulder external rotation would be considered hyper-mobile.

<strong>Hyperplasia</strong> is an increase in organic tissue size due to an adaptive increase in the number of cells per organ.
<ul>
 	<li>Although muscle hyperplasia has been noted in some animals, human muscle tissue does not seem to have this adaptive ability.</li>
</ul>

A condition of excessive tone of the skeletal muscles; increased resistance of muscle to passive stretching.  May be related to increased neural drive, synergistic dominance, trigger points, reflexive over-activity, and/or muscle length.
Example:  Individuals who exhibit ankle eversion and abduction during an overhead squat assessment likely have hypertonic fibularis (peroneal) muscles.

<strong>Muscular hypertrophy</strong> is an increase in muscle mass/size due to increase in the volume and cross-sectional area (CSA) of individual muscle cells. The increase in cross-sectional area can be attributed to an an increase in contractile proteins and structural elements (myofibrillar hypertophy), as well as an increase in glycogen storage and elements related to metabolism (sarcoplasmic hypertophy). Hypertrophy is an adaptation of both cardiac and skeletal muscle fibers in response to progressive increases in workload.
<ul>
 	<li>Note: Hypertrophy is not hyperplasia. Hyperplasia is an increase in muscle size due to an adaptive increase in the number of muscle fibers/cells per muscle. This type of adaptation does not occur in human muscle tissue.</li>
</ul>

A range of motion achieved by a patient/client that is less than normal.
<ul>
 	<li>Note: Both hyper-mobility and hypo-mobility may adversely affect motion and may lead to deleterious effects on joints and soft tissue over time. There is no evidence to suggest that more or less flexibility than normal is beneficial.</li>
</ul>
Example: If the end range of shoulder external rotation is reached and measured as 75° during goniometric assessment, the client/patient is exhibiting hypomobility of the glenohumeral joint (shoulder).

Hypothesis - a proposed explanation for a phenomenon; "scientific hypotheses" are generally constructed in a way that is testable or falsifiable.
<ul>
 	<li>Example: The hypothesis, "excessive knee valgus may be correlated with future knee pain and injury," has been the subject of several studies published over the last decade.</li>
</ul>

Diminished tone of skeletal muscles; diminished resistance of muscles to passive stretching.   May be related to inhibition, reciprocal inhibition, arthrokinematics inhibition and/or  increased resting length of muscle.
Example:  If your knees cave (hip adduction) during a squat or leg-press it is likely that your gluteus medius is hypotonic.

<strong>I-Band</strong> - Refers to the part of the muscle cell that looks lighter under a microscope.  This area of the cell is lighter due to parallel arrangement of thinner filaments (actin), and no overlap with the thicker filaments (myosin).
<ul>
 	<li>As a muscle contracts, the I-bands will decrease in width and move closer to one another.</li>
</ul>
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

Independent variable - in research, this is the variable or phenomenon being manipulated in the study.
<ul>
 	<li>Example, in the study by Ghanbari et al. (1), the independent variable is "knee joint mobilization", the dependent variable is "quadriceps muscle strength."</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/effect-knee-joint-mobilization-quadriceps-muscle-strength/" target="_blank" rel="noopener noreferrer">Ghanbari A. and Kamalgharibi S. (2013). Effect of knee joint mobilization on quadriceps muscle strength. <em>International Journal of Health and Rehabilitation Sciences</em>. 2(4): 186-191</a></li>
</ol>

An anatomical direction; toward the bottom (below)

Example, the mouth is <em>inferior</em> to the eyes

A reduction in neural drive, muscular activity, and or force output due to altered neuromuscular reflex.  Alterations in neuromuscular reflex may occur due to increases in muscle length (hypothesis: increased excitation threshold), altered reciprocal inhibition in response to increased antagonist tone, and or alterations in joint motion (arthrokinematics inhibition).

Making a whole of parts.

Example, The Brookbush Institute uses an integrative approach to explaining and addressing human movement.

<strong>Intermuscular Coordination</strong> - Optimal timing and motor unit recruitment of agonists, antagonists, synergists, neutralizers, stabilizers and fixators.

<strong>Example: Role of Muscles during Hip Extension</strong>
<ul>
 	<li><strong><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Prime Mover" href="https://brentbrookbush.com/glossary/prime-mover/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Prime Mover&lt;/div&gt;The muscle most responsible for a joint action under load -&lt;br /&gt;&lt;br /&gt;That is, the muscle that can produce the most force for a given joint action. Often this term is used synonymously with the term agonist. The prime mover as defined above, may or may not be the most active muscle for a joint action during activities of daily living.&lt;br /&gt;&lt;br /&gt;Example: the gluteus maximus is the most powerful hip extensor and therefore the prime mover; however, the hamstrings are likely the most active hip extensors during low level activities like walking or standing.">Prime Mover</a>:</strong>  <a href="https://player.vimeo.com/external/82855344.hd.mp4?s=54c3e7d98fb9d4e0af8d282c85ba9b3e">Gluteus maximus</a></li>
 	<li><strong><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Synergists" href="https://brentbrookbush.com/glossary/synergists/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Synergists&lt;/div&gt;Muscles that assist the prime mover in performing a joint action.&lt;br /&gt;&lt;br /&gt;That is, all muscles that can perform a joint action that are not the prime mover, are termed synergists.&lt;br /&gt;Example: The rectus abdominis is the prime mover of spinal flexion. All other muscles that can perform spinal flexion are synergists including – external obliques, internal obliques and psoas.">Synergists</a>:</strong> <a href="https://brentbrookbush.com/articles/muscular-anatomy/biceps-femoris/">Biceps femoris (long head)</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/semitendinosus-and-semimembranosus/">semitendinosus, semimembranosus</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/adductors/">posterior head of adductor magnus</a></li>
 	<li><strong><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Antagonist" href="https://brentbrookbush.com/glossary/antagonists/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Antagonist&lt;/div&gt;Muscles that oppose the prime mover and synergists for a given joint action.&lt;br /&gt;&lt;br /&gt;That is, all the muscles that can perform the opposing joint action.&lt;br /&gt;&lt;br /&gt;Example: The triceps and anconeus are antagonists during elbow flexion.">Antagonists</a>:</strong> <a href="https://brentbrookbush.com/articles/muscular-anatomy/psoas/">Psoas</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/iliacus/">iliacus</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/tensor-fascia-latae-tfl/">tensor fascia latae</a> (TFL),<a href="https://brentbrookbush.com/articles/muscular-anatomy/rectus-femoris/"> rectus femoris</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/adductors/">anterior adductors (especially pectineus)</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/sartorius/">sartorius</a></li>
 	<li><strong><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Neutralizer" href="https://brentbrookbush.com/glossary/neutralizers/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Neutralizer&lt;/div&gt;Muscles that oppose unwanted joint motions created by the prime mover and/or synergists, and/or muscles that prevent unwanted ancillary motion.&lt;br /&gt;Example: The teres minor and infraspinatus neutralize the internal rotation force created by the pectoralis major during horizontal adduction of the shoulder.">Neutralizers</a>:</strong> <a href="https://brentbrookbush.com/articles/muscular-anatomy/gluteus-minimus/">Gluteus minimus</a> and <a href="https://brentbrookbush.com/articles/muscular-anatomy/gluteus-medius/">anterior fibers of gluteus medius</a> neutralize external rotation force of <a href="https://brentbrookbush.com/articles/muscular-anatomy/gluteus-maximus/">gluteus maximus</a></li>
 	<li><strong><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Stabilizer" href="https://brentbrookbush.com/glossary/stabilizers/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Stabilizer&lt;/div&gt;Muscles whose primary role is to improve arthrokinematics by maintaining optimal alignment of joint surfaces.&lt;br /&gt;&lt;br /&gt;Most often these muscles are the most intrinsic muscles of a joint, have a larger percentage of Type I muscle fibers and are rich in proprioceptors.&lt;br /&gt;Example: The muscles of the rotator cuff act as stabilizers for most shoulder motions.">Stabilizers</a>:</strong> <a href="https://brentbrookbush.com/articles/muscular-anatomy/deep-rotators-of-the-hip/">Deep rotators of hip</a></li>
 	<li><strong><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Fixator" href="https://brentbrookbush.com/glossary/fixators/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Fixator&lt;/div&gt;Muscles that act to reduce or prevent movement at proximal joints to improve force transmission.&lt;br /&gt;Example: The muscles of the core are important fixators; reducing motion of the spine/trunk to enhance force transmission between the extremities and environment.">Fixators</a>: </strong><a href="https://brentbrookbush.com/articles/core-subsystems/intrinsic-stabilization-subsystem/">Intrinsic stabilization subsystem</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/rectus-abdominis/">rectus abdominis</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/internal-obliques/">internal</a> and <a href="https://brentbrookbush.com/articles/muscular-anatomy/external-obliques/">external obliques</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/quadratus-lumborum/">quadratus lumborum</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/erector-spinae/">erector spinae</a></li>
</ul>
&nbsp;

Example from: <a href="https://brentbrookbush.com/articles/anatomy-articles/introduction-to-functional-anatomy/kinesiology-of-the-hip/" target="_blank" rel="noopener">Introduction to Functional Anatomy: Kinesiology of the Hip</a>

Intramuscular coordination refers to the coordinated recruitment of motor units within a single muscle. This concept is used to explain increases in maximal strength and power; however, the coordinated and sequential recruitment of motor units is also essential to strength endurance and smooth coordinated motion.  Related terminology may include; motor unit recruitment, preferential recruitment, rate coding, sequence, etc..

Example: It is hypothesized that the "shaking" noted during a novice exercisers attempt at an activity like the <a href="https://brentbrookbush.com/vimeo_videos/ball-crunch-and-progressions/" target="_blank">stability ball crunch</a> may be due to relatively poor intramuscular coordination. Rather than smooth, sequential firing of rectus abdominis motor units, groups of motor units turn on and off in an uncoordinated manner.

Pertaining to the same side

Example, the quadratus lumborum performs ipsilateral flexion; lateral flexion toward the same side as the muscle.

An <strong>isoform</strong>, or variant, is a member of a set of similar proteins, that originate from the same gene, or gene family.<sup id="cite_ref-2" class="reference"></sup>
<ul>
 	<li>Example, the variations in myosin heavy chain proteins (MHC I, MHC IIA, MHC IIB/X) that contribute to the characteristic differences between muscle fiber types.</li>
</ul>

“The Prime Assumption”
Everything crossing a joint will influence joint motion during every joint action.

A concept that has expanded over the past several decades to describe the integration of 4 body systems (muscle, joints, fascia and nerves), as well as, the coordinated function of various body segments (e.g. hip, knee and ankle) to produce motion. Kinetic referring to motion, and chain being an analogy for the interdependent link between systems.

Example, the posterior <em>kinetic chain</em>, refers to the integrated function of nerves, muscles, fascia and joints on the posterior side of the body.

The concept of the kinetic chain was originally adapted from the work of a mechanical engineer named Franz Reuleaux (Kinematics of Machinery (1875)) by Dr. Arthur Steindler in 1955 (Steindler A: Kinesiology of the Human Body. Springfield, IL, Charles C. Thomas Co.. 1955).

<strong>Latent Trigger Point</strong> - A myofascial trigger point that is not painful at rest, only painful when palpated, and may or may not exhibit a characteristic referral pain pattern when palpated.  Latent trigger points do result in an acute point of sensitivity, in a taut band of muscle, and may restrict range of motion (1).

Note: Based on the clinical experience, the Brookbush Institute suggests that latent trigger points (sometimes refereed to as Tender Points) are more common than active trigger points. Further, they are likely addressed more often than trigger points; being the intended target of many soft-tissue mobility techniques.
<ol>
 	<li>David G. Simons, Janet Travell, Lois S. Simons, <em>Travell &amp; Simmons’ Myofascial Pain and Dysfunction, The Trigger Point Manual, Volume 1. Upper Half of Body: Second Edition</em>,© 1999 Williams and Wilkens</li>
</ol>

An anatomical direction; further from the midline

Example, the anterior deltoid is <em>lateral</em> to the pectoralis major

<strong>Length/Tension Relationship</strong> - The amount of force generated by a muscle is dependent on sarcomere length.
<ul>
 	<li>The ability of sarcomere to maximally produce force occurs when sarcomere length results in optimal overlap between actin and myosin. Stretching a sarcomere decreases overlap between actin and myosin filaments and reduces force production (1-3). When length is less than optimal, actin from opposite ends overlap and interfere with cross-bridging, and myosin filament are compressed as they contact the the Z-disk also reducing force (4)</li>
</ul>
<ol>
 	<li>Gordon, A. M., Huxley, A. F., &amp; Julian, F. J. (1966). The variation in isometric tension with sarcomere length in vertebrate muscle fibres. <i>The Journal of physiology</i>, <i>184</i>(1), 170-192.</li>
 	<li>Edman, K. A. P. (1966). The relation between sarcomere length and active tension in isolated semitendinosus fibres of the frog. <i>The Journal of Physiology</i>, <i>183</i>(2), 407-417.</li>
 	<li>Lieber, R. L., Loren, G. J., &amp; Friden, J. (1994). In vivo measurement of human wrist extensor muscle sarcomere length changes. <i>Journal of neurophysiology</i>, <i>71</i>(3), 874-881.</li>
 	<li>Lieber, R. L. (2002). <i>Skeletal muscle structure, function, and plasticity</i>. Lippincott Williams &amp; Wilkins.</li>
</ol>
&nbsp;

<span class="_Tgc"><strong>Levels of Evidence</strong> - Relative to evidence-based practice, levels of evidence are an attempt to describe the strength of the results measured in a clinical trial or research study.  Note: levels of evidence do not supersede the critical evaluation of an experienced professional, and should be viewed as guidelines - a meta-analysis may be poorly constructed (Level IA), and a comparative study (Level III) may employ new technologies and a strong methodology.
</span>

The Levels of Evidence used by the Brookbush Institute, as described by Shekelle et al.(1):
<ul>
 	<li class="p1">IA - Evidence from meta-analysis of randomized controlled trials</li>
 	<li class="p1">IB - Evidence from at least one randomized controlled trial</li>
 	<li class="p1">IIA - Evidence from at least one controlled study without randomization</li>
 	<li class="p1">IIB - Evidence from at least one other type of quasi-experimental study</li>
 	<li class="p1">III - Evidence from non-experimental descriptive studies, such as comparative studies, correlation studies, and case-control studies</li>
 	<li class="p1">IV - Evidence from expert committee reports or opinions or clinical experience of respected authorities, or both</li>
</ul>
<ol>
 	<li>Shekelle, P. G., Woolf, S. H., Eccles, M., &amp; Grimshaw, J. (1999). Developing clinical guidelines. <i>Western Journal of Medicine</i>, <i>170</i>(6), 348.</li>
</ol>

<strong>Likelihood Ratios</strong> - Likilihood ratios are used for assessing the value of performing a diagnostic test. They use sensitivity and specificity to determine whether a test result usefully changes the practitioner's chance (probability) of reaching the correct assessment. Calculation of likelihood ratios is based on Baye's theorem.
<ul>
 	<li><strong>Positive Likelihood Ratio (LR+)</strong> - The ratio of a positive test result in people with the pathology to a positive test result in people without the pathology.</li>
 	<li><strong>Negative Likelihood Ratio (LR-)</strong> - The ratio of a negative test result in people with the pathology to a negative test result in people without the pathology.</li>
</ul>

Longitudinal Study - a research design that involves observing the same variables, several times over a period of time.
<ul>
 	<li>Example, the study by Hewett et al. (1) is a type of longitudinal study called a "cohort study." This study investigated whether excessive knee valgus during landing was a predictor of knee injury risk in adolescent females over the course of a season.</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/knee/research-review-increased-valgus-during-landing-predicts-acl-injury-in-adolescent-female-athletes/" target="_blank" rel="noopener noreferrer">Hewett, T. E., Myer, G. D., Ford, K. R., Heidt, R. S., Colosimo, A. J., McLean, S. G., &amp; Succop, P. (2005). Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes A prospective study. The American journal of sports medicine, 33(4), 492-501</a></li>
</ol>

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