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Tibialis posterior exercises for improving movement dysfunction, posture, Achilles tendinitis, plantar fasciitis, knee pain, ankle pain and sports performance. Great ankle plantar flexion and inversion exercises, hopping, and calf raise variations for the tibialis anterior.

Tibialis Posterior Exercises (Activation)

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

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

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

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

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

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

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

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

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

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

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

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

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



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

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

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

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

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

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This course describes tibialis posterior exercises, commonly referred to as tibialis posterior activation. Performing plantar flexion of the ankle exercises, with the addition of ankle inversion and toe extension improves recruitment (isolation) of this important muscle. The tibialis posterior is the primary supinator of the foot, primary invertor of the ankle, and a strong plantar flexor of the ankle joint. It is common to include these exercises in a program designed to address 

; 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 chronic ankle instability, Achilles tendinitis, plantar fasciitis, ankle pain, and foot pain, and improving sports performance. Movement professionals (personal trainers, physical therapists, athletic trainers, massage therapists, chiropractors, occupational therapists, etc.) should consider adding these exercises to their repertoire with the intent of improving patient/client outcomes from their integrated exercise programs and therapeutic (rehabilitation) interventions.

Bilateral Standing Tibialis Posterior Activation

Unilateral Standing Tibialis Posterior Activation

Last, it is important to integrate the increase in tibialis posterior muscle activity into functional exercise. The Brookbush Institute accomplishes this with intrinsic stabilization subsystem and posterior oblique subsystem integration. Some example movements for these purposes include:

A tibialis posterior activation exercise with a miniband

Course Description: Tibialis Posterior Exercises (Activation)

Tibialis posterior exercises (activation) study guide introduction

Study Guide: Tibialis Posterior Activation (Exercises)

Introduction

Tibialis Posterior in Postural Dysfunction and Movement Impairment

 has a propensity to become inhibited and under-active (relatively weak during activity). This reduces our ability to eccentrically decelerate ankle dorsiflexion and eversion, and maintain proper foot and arch alignment during daily activity and sport. This impaired function may result in dyskinesis (movement dysfunction) of the ankle, foot, and knee, and is often paired with over-activity of the gastrocnemius, soleus, 

flexor hallucis longus and flexor digitorum longus

. Tibialis posterior 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).

Signs of Under-Activity and a Maladaptive Increase in Length

Dr. Brent Brookbush demonstrating the feet turn out sign commonly seen with lower leg dysfunction

Signs Of Under-Activity & Length In Weak Tibialis Posterior Muscles

Introduction to Tibialis Posterior Exercises

Overactive Synergists

Muscles that commonly become synergistically dominant when the 

 is inhibited – Release and stretch prior to activation, and cue joint motion to reciprocally inhibit these muscles during activation exercise.

Flexor Hallicus Longus & Flexor Digitorum Longus

 (included in lower leg release below - trigger points are deep to the 

Fibularis Muscles a.k.a. Peroneals (inhibit w/ inversion)

The lower leg muscles and connective tissue, including tibialis posterior, soleus, gastrocnemius, the toe extensors and toe flexors

Optimizing Motion (Best Practice)

Optimal neuromuscular activity (tone) and function is not only affected by the strength of individuals muscles but optimal length and activity of their functional antagonists and mobility of the joints they cross. It is recommended that the appropriate release, lengthening and joint mobilization techniques are done prior to the activation and integration techniques discussed below.

Research Corner

There is a considerable amount of research on the relationship between movement impairment and 

 dysfunction, as well as activation and strengthening of the 

 and its effect on the quality of human movement. The tibialis posterior is the primary invertor of the ankle, and a powerful supinator of the forefoot (1, 2). Not surprisingly, research has linked weakness and/or dysfunction of the 

 (including tibialis posterior tendinopathy) to "flat feet" (9-12); however, weakness/fatigue does not seem to be related to calcaneus valgus (17). Although the 

 was not used in these research studies, "

" is a commonly noted sign that can likely be attributed to 

 weakness and over-activity of the fibularis muscles (9).

Feet flatten, notice the navicular drop, indicating a lengthened tibialis posterior

Those with foot/ankle dysfunction often exhibit excessive eversion and a reduction in the ability to decelerate pronation (feet flatten), and paradoxically, an increase in 

 activity (3, 4, 5). This may imply that the uncommon combination of release and activation techniques may be appropriate for addressing this muscle. However, given the deep location of the 

, it is likely that release would be limited to manual techniques. Foot/ankle dysfunction may lead to more than foot/ankle pathology as a relationship does exist between excessive eversion and an increase in hip internal rotation (6). Orthotics have proven ineffective for reducing the risk or occurrence of lower extremity dysfunction, but may improve selective recruitment of the 

 during exercise and functional tasks (7, 15, 17). It is our view that orthotics may be used as an adjunct to corrective/therapeutic intervention, but should not be used in lieu of therapy or as a preventative measure.

Activation/strengthening exercises for the 

 have been found to have a positive impact on lower extremity motion and the risk of injury (8). To date, research has highlighted the importance of inversion/adduction during tibialis posterior activation and the potential benefit of training that focuses on eccentric loading (14, 16)

Research on Tibialis Posterior Muscle Exercises

Seated Band Resisted Plantar Flexion and Inversion

Seated "Pigeon Toed" Calf Raise with Band Resisted Inversion

Standing "Pigeon Toed" Calf Raise with Band Resisted Inversion Leaning

Dr. Brent Brookbush demonstrating a tibialis posterior activation exercise

Standing "Pigeon Toed" Calf Raise with Band Resisted Inversion

Leaning Single Leg Calve Raise

Best Exercises for Tibialis Posterior Isolated Activation

Single-leg Balance and Reach

Resisted Single-leg Balance and Reach

Single-leg Deadlift Touchdown

Integrated Stabilization

Step Back to Soft Landing

Step Forward to Soft Landing

Hop Down to Stabilization

Reactive Activation

Frontal Plane Step-Up to Balance to Shoulder Series

Lateral Lunge to Balance To Shoulder Series

Single-Leg Touchdown w/ Scaption, or PNF Carry Away

Dr. Brent Brookbush demonstrating a lateral lunge with dumbbells

Side Step to Balance to Shoulder Series

Subsystem Integration

Sample Activation Circuit

38 yo male, history of ankle sprains and shin splints when volume of exercise increases.

 The most common compensations include: excessive toe flexion -implicating dominance of the 

lexor hallucis longus, flexor digitorum longus, and/or excessive eversion implicating dominance of the fibularis (peroneals) muscles.

Extensor Hallucis Longus and Extensor Digitorum Longus Manual Static Release

Gastrocnemius and Soleus Manual Static Release

Ankle (Talus) Manual Joint Mobilization - Anterior to Posterior

Talonavicular and Cuneonavicular Joint Manipulations

Mobility Program: Self-administered Techniques

Gastrocnemius and Soleus Self-Administered Manual Static Release

Fibularis Self-Administered Static Manual Release

Plantar Flexors and Evertors: Lengthening

 Light to Moderate (60 - 85% of 1-RM), focus on form and ROM

 Circuit training, 1 min rest between exercises

 5 - 15 minutes (excluding mobility interventions)

Standing “Pigeon-toed” Calf Raise with Band Resisted Inversion

Dr. Brent Brookbush demonstrating a sagittal plane hop down to stabilization

Sample Activation Circuit: Tibialis Posterior Exercises

Klein, P., Mattys, S., & Rooze, M. (1996). Moment arm length variations of selected muscles acting on talocrural and subtalar joints during movement: An in vitro study. 

Kamiya T, Uchiyama E, Watanabe K, Suzuki D et al. (2012). Dynamic effect of the tibialis posterior muscle on the arch of the foot during cyclic axial loading. 

Yao K, Yang TX, Yew WP. (2015). Posterior tibialis tendon dysfunction: overview of evaluation and management. Orthopedics. 38(6): 385-391.

Chang, R., Kent-Braun, JA., Hamill, J. Use of MRI for volume estimation of tibialis posterior and plantar intrinsic foot muscles in healthy and chronic plantar fasciitis limbs. 

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, 

Souza, T. R., Pinto, R. Z., Trede, R. G., Kirkwood, R. N., & Fonseca, S. T. (2010). Temporal couplings between rearfoot–shank complex and hip joint during walking. 

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 – 808

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

Basmajian JV, Stecko G. The role of muscles in arch support of the foot. J Bone Joint Surg 1963;45A: 1184-90

Mizel MS, Temple HT, Scranton PE II, Gellman RE, Hecht PJ, Horton GA, et al. Role of the peroneal tendons in the production of the deformed foot with posterior tibial tendon deficiency.

Dyal CM, Feder J, Deland JT, Thompson FM. Pes planus in patients with posterior tibial tendon insufficiency: asymptomatic versus symptomatic foot. Foot Ankle Int 1997;18: 85-8.

Mosier SM, Pomeroy G, Manoli A II. Pathoanatomy and aetiology of posterior tibial tendon dysfunction. Clin Orthop Rel Res 1999;365:12-22.

Pohl MB, Rabbito M, Ferber R. The role of tibialis posterior fatigue on foot kinematics during walking. Journal of Foot and Ankle Research 2010 

Kulig, K., J. M. Burnfield, S. M. Requelo, M. Sperry, and M. Terk. Selective Activation of Tibialis Posterior: Evaluation by Magnetic Resonance Imaging. Med. Sci. Sports Exerc., Vol. 36, No. 5, pp. 862–867, 2004.

Alvarez R., Marini A, Schmitt C, Saltsman C. Stage I and II Posterior Tibial Tendon Dysfunction Treated by a Structured Nonoperative Management Protocol: An Orthosis and Exercise Program Foot Ankle Int January 2006 27: 2-8

Kulig K, Lederhaus E, Reischl S, Arya S, Bashfor G. Effect of Eccentric Exercise Program for Early Tibialis Posterior Tendinopathy Foot & Ankle International September 2009 vol. 30 no. 9 877-885

Kulig K, Burnfeld JM, Reischl S, Requejo SM, Blanoc CE, Thordarson DB. Effect of foot orthoses on tibialis posterior activation in persons with pes planus. Medicine and Science in Sports and Exercise 2005, 37(1):24-29

Bibliography

Questions, comments, and criticisms are welcomed and encouraged

Tibialis Posterior Exercises (Activation)

Related Courses:

Course Description: Tibialis Posterior Exercises (Activation)

Study Guide: Tibialis Posterior Activation (Exercises)

Introduction to Tibialis Posterior Exercises
1 Sub Section

Overactive Synergists

Optimizing Motion (Best Practice)

Research on Tibialis Posterior Muscle Exercises

Best Exercises for Tibialis Posterior Isolated Activation
4 Sub Sections

Integrated Stabilization
3 Sub Sections

Reactive Activation
3 Sub Sections

Subsystem Integration
3 Sub Sections

Sample Activation Circuit: Tibialis Posterior Exercises

Bibliography

Related Courses:

Comments

Guest

Tibialis Posterior Exercises (Activation)

Related Courses:

Course Description: Tibialis Posterior Exercises (Activation)

Study Guide: Tibialis Posterior Activation (Exercises)

Introduction to Tibialis Posterior Exercises1 Sub Section

Overactive Synergists

Optimizing Motion (Best Practice)

Research on Tibialis Posterior Muscle Exercises

Best Exercises for Tibialis Posterior Isolated Activation4 Sub Sections

Integrated Stabilization3 Sub Sections

Reactive Activation3 Sub Sections

Subsystem Integration3 Sub Sections

Sample Activation Circuit: Tibialis Posterior Exercises

Bibliography

Related Courses:

Comments

Guest

Introduction to Tibialis Posterior Exercises
1 Sub Section

Best Exercises for Tibialis Posterior Isolated Activation
4 Sub Sections

Integrated Stabilization
3 Sub Sections

Reactive Activation
3 Sub Sections

Subsystem Integration
3 Sub Sections