00:04 - 00:06This is Brent of the Brookbush
00:06 - 00:07Institute and in this video we're going to
00:07 - 00:10discuss tibialis posterior activation
00:10 - 00:13progression, specifically, the hardest
00:13 - 00:15tibialis posterior activation
00:15 - 00:17progression I have in my arsenal. Now,
00:17 - 00:19when I tried to create this exercise,
00:19 - 00:22realize I had three goals. I want to kind
00:22 - 00:25of explain how this happened. I wanted to
00:25 - 00:29try to find a way to get the line of
00:29 - 00:31pull of gravity to line up with the
00:31 - 00:35obliquity of the tibialis posterior, so I
00:35 - 00:37essentially wanted to be able to resist
00:37 - 00:41both plantar flexion and inversion.
00:41 - 00:44Second, I wanted to be able to
00:44 - 00:46reciprocally inhibit my overactive
00:46 - 00:48synergist just as I do on all of these
00:48 - 00:51activation techniques, so that I'm not
00:51 - 00:54reinforcing any of the movement
00:54 - 00:56dysfunction that's causing the
00:56 - 00:58individual's movement impairment or
00:58 - 01:02reducing their performance. Third, I
01:02 - 01:04wanted to try to take what we're doing
01:04 - 01:07at the foot and ankle and integrate it
01:07 - 01:10into a commonly used pattern,
01:10 - 01:12specifically, triple extension in this
01:12 - 01:15case, so that we have better carry over
01:15 - 01:17to functional activities. Now, I'm going
01:17 - 01:18to have my friend, Melissa, come
01:18 - 01:20out and she's going to help me demonstrate
01:20 - 01:25this exercise. Alright, so first things
01:25 - 01:26first, let's talk about the tibialis
01:26 - 01:30posterior anatomy. The insertion wraps
01:30 - 01:32around the medial side of the foot and
01:32 - 01:34then, actually, the origin is on the
01:34 - 01:37lateral side of the tibia. That creates
01:37 - 01:40this little diagonal here, this obliquity
01:40 - 01:43that comes out this way. So, how am I
01:43 - 01:46going to get that obliquity to line up
01:46 - 01:48with gravity, which pulls straight down?
01:48 - 01:51That's actually fairly easy. All I'll have to
01:51 - 01:55do is have Melissa lean over. So,
01:55 - 01:58if she leans into a wall, now gravity
01:58 - 02:02goes from lateral tibia right over the
02:02 - 02:04medial side of the foot so I have that
02:04 - 02:06nice line of pull. And if you guys think
02:06 - 02:10about her ankle coming straight up from
02:10 - 02:11this position,
02:11 - 02:13you can kind of see how not only is
02:13 - 02:16plantar flexion now resisted, but
02:16 - 02:18inversion as well. I can stimulate
02:18 - 02:20inversion a little bit more by having
02:20 - 02:23you bring your foot in so that pinkie toe
02:23 - 02:25is actually pointing forward, so just a
02:25 - 02:27little bit of tibial internal rotation
02:27 - 02:32there, guys. Now, step two: reciprocal
02:32 - 02:34inhibition of overactive synergists. The
02:34 - 02:36overactive synergists for my tibialis
02:36 - 02:39posterior are my flexor hallucis longus
02:39 - 02:41and flexor digitorum longus, i.e. my long
02:41 - 02:44toe flexors. If I want to inhibit toe
02:44 - 02:48flexors, I should probably just do toe
02:48 - 02:50extension, right? I'm going to lift my
02:50 - 02:52toes up, or ask her to lift her toes up.
02:52 - 02:54The other thing this does, which is real
02:54 - 02:56great for our athletes, is it starts
02:56 - 02:59teaching them to drive through the balls
02:59 - 03:01or just behind the balls of their feet,
03:01 - 03:05specifically, that first MTP, or just
03:05 - 03:07behind that first MTP, just behind the
03:07 - 03:10big toe. As soon as she lifted her
03:10 - 03:11toes, she should feel the balls of her
03:11 - 03:13feet kind of push into the ground a
03:13 - 03:15little bit which is a lot better than
03:15 - 03:17running off the toes, which is going to
03:17 - 03:19jack up all of those those toe flexors,
03:19 - 03:22which we already know are overactive
03:22 - 03:26synergies. Third, how do I get that
03:26 - 03:29integrated into the performance of the
03:29 - 03:32rest of the body? Well, I can definitely
03:32 - 03:34add it into my triple extension mechanic.
03:34 - 03:37if you think about how she's pushing
03:37 - 03:39into the wall, right, I can have her use
03:39 - 03:43her glute to extend and even abduct a
03:43 - 03:44little bit. I want you to actually-
03:44 - 03:46we're going to use your forearm
03:46 - 03:48here, have you post up against the wall, and
03:48 - 03:50have this pushing against the wall. This
03:50 - 03:51isn't a stability exercise. I don't want
03:51 - 03:54her back and forth this way. I don't
03:54 - 03:56want her to feel unstable. I want her to
03:56 - 03:59feel nice and stable as she pushes into
03:59 - 04:00the wall. She's going to squeeze her
04:00 - 04:04glute, squeeze her quad, so now we
04:04 - 04:06have that triple extension. And now as
04:06 - 04:09soon as I ask her to do a calf raise, we
04:09 - 04:13can see that's on a diagonal but close
04:13 - 04:16to the same mechanics she's going to use
04:16 - 04:19to either push off and run or do a
04:19 - 04:23lateral step if she's, let's say guarding
04:23 - 04:26somebody and has to move laterally, or if
04:26 - 04:28she was a basketball player, give a
04:28 - 04:30little crossover. Alright, so she's going
04:30 - 04:34to push up into a calf raise, drive
04:34 - 04:38through her glute and her quad, making
04:38 - 04:39sure she stays internally rotated a
04:39 - 04:44little bit here, and back down. So just
04:44 - 04:45getting her to do a calf raise first is
04:45 - 04:47the first thing I want to do. Now I'm
04:47 - 04:49going to start trying to perfect this a
04:49 - 04:51little bit. Make sure that the individual
04:51 - 04:53is going into plantar flexion and
04:53 - 04:56inversion. What you will find is that some
04:56 - 04:58individuals will start to collapse.
04:58 - 05:00They'll start to let their body rotate
05:00 - 05:02in this way, but that's what the arm is here
05:02 - 05:04for. We need to keep her nice and
05:04 - 05:06straight this way, so that this stays
05:06 - 05:08plantar flexion and inversion and
05:08 - 05:09doesn't become plantar flexion and
05:09 - 05:12eversion as she tries to find a way to
05:12 - 05:14kind of get back into this position,
05:14 - 05:15which, maybe, was her compensation
05:15 - 05:19pattern. Alright, up again, making sure
05:19 - 05:21her toes are coming up, or she's at least
05:21 - 05:24trying to pull her toes up. The other
05:24 - 05:26mistake you'll see, although Melissa's
05:26 - 05:27being a lot better on this particular
05:27 - 05:31take up this video, if she goes up, a lot
05:31 - 05:33of people will just flop back down.
05:33 - 05:37I'd like to concentrate on eccentric
05:37 - 05:39control, especially since overpronation
05:39 - 05:41is a lot of times what I'm using this
05:41 - 05:44for, which is the inability to be
05:44 - 05:46eccentrically control flat-footedness. I
05:46 - 05:49want her to go up as high as she can, hold,
05:49 - 05:51make sure all this is tight, give her a
05:51 - 05:53little posture check at the top, and then
05:53 - 05:57a four-second eccentric- two, three, four.
05:57 - 06:01Good. Back up.
06:01 - 06:06Make sure you're staying straight this way. Back down. Now,
06:06 - 06:09with this leg she's being a little lazy.
06:09 - 06:11We do have a couple choices with this
06:11 - 06:14other leg. We can leave it on
06:14 - 06:15the floor. If this is the first time,
06:15 - 06:17maybe, I'm doing this progression, and I'm
06:17 - 06:19progressing from a two-footed
06:19 - 06:22tibialis posterior activation exercise,
06:22 - 06:25then maybe I want her to just- I'm going to
06:25 - 06:27give her this kickstand of just allowing
06:27 - 06:29the ball of her foot to stay on the
06:29 - 06:31floor so that she's not lifting quite so
06:31 - 06:33much weight with this leg.
06:33 - 06:36That's okay. I'm okay with
06:36 - 06:38that initially, but then as she gets
06:38 - 06:40better, I want her to pull this leg up.
06:40 - 06:42I'm even going to have her dorsiflex an
06:42 - 06:44invert so that I'm reinforcing triple
06:44 - 06:46flexion mechanics on this side, triple
06:46 - 06:48extension mechanics on this side. You
06:48 - 06:50guys can see how the carryover and
06:50 - 06:51transfer would happened there to some of
06:51 - 06:55her other athletic activities. Good, back
06:55 - 06:59up and back down. Let's show everybody
06:59 - 07:02what it looks like from the other side.
07:03 - 07:07Lean over. Oh, good, Alright, so she's
07:07 - 07:09going to post up against the wall here.
07:09 - 07:11Make sure that she's perpendicular to
07:11 - 07:14the wall. I don't want her- what tends
07:14 - 07:15to happen to people is they start
07:15 - 07:17falling in this way. That's what this
07:17 - 07:19arm is for. No need to turn this into a
07:19 - 07:20stability exercise. I have other
07:20 - 07:23exercises, I have other techniques that I
07:23 - 07:25can use to start working on her stability
07:25 - 07:27and balance. This is just tibialis
07:27 - 07:30posterior activation. Turn this foot in
07:30 - 07:33a little bit. Because you're so
07:33 - 07:35advanced, we're going to go ahead and
07:35 - 07:38lift this leg up, dorsiflex, reinforce
07:38 - 07:40that triple flexion mechanic. Let's
07:40 - 07:42reinforce this triple extension mechanic,
07:42 - 07:44squeeze your glute, no anterior pelvic
07:44 - 07:46tilt, little tuck under if we need to
07:46 - 07:49drawn in, quad tight, drive through
07:49 - 07:51the ball of your foot, ankle straight up.
07:51 - 07:53Alright, so that time you kind of turned
07:53 - 07:56out on me and then caved in, so let's
07:56 - 07:58step out just a little bit from the wall.
07:58 - 08:04Good. Drive into the wall. There you go.
08:04 - 08:08Just giving individuals the
08:08 - 08:10cue to push a little bit into the wall
08:10 - 08:11sometimes helps. Sometimes that will help
08:11 - 08:14get their ankle to go up and out rather
08:14 - 08:16than cave in.
08:17 - 08:20Good.
08:25 - 08:29Getting tired? Good deal. Alright, so
08:29 - 08:32before we we wrap this video up, I do
08:32 - 08:34want to give you guys a closer look at
08:34 - 08:36what's happening to Melissa's feet.
08:36 - 08:40Once again, guys, just to go over the
08:40 - 08:41position of the feet, make sure
08:41 - 08:44she's slightly internally rotated, pinkie
08:44 - 08:46toe pointing straight ahead, we don't
08:46 - 08:48need crazy internal rotation just a
08:48 - 08:51little bit, we want toes up, driving
08:51 - 08:53through the full ball of the foot. From
08:53 - 08:56big toe all the way to little toe,
08:56 - 08:58just behind the ball of her foot is
08:58 - 09:00driven hard into the ground. And then
09:00 - 09:02you're going to watch the lateral
09:02 - 09:04malleolus to see if it goes up and out
09:04 - 09:07just a little bit as we try to stimulate
09:07 - 09:10both plantar flexion and inversion to
09:10 - 09:12make sure that we are getting as much
09:12 - 09:15positive activity as we possibly can. So
09:15 - 09:18there you go, guys. That's the hardest
09:18 - 09:20tibialis posterior activation
09:20 - 09:23progression I have in my arsenal. Any
09:23 - 09:26athlete who comes to me with any sign of
09:26 - 09:28foot, ankle, or lower extremity
09:28 - 09:30dysfunction, anybody with feet
09:30 - 09:34turn out, feet flat, or knees cave in that
09:34 - 09:36overhead squat assessment, anybody who's
09:36 - 09:39lacking dorsiflexion, anybody who has
09:39 - 09:42that functional flat foot or pes planus,
09:42 - 09:44those individuals who as soon as they
09:44 - 09:47take shoes off and step barefoot, you watch
09:47 - 09:49the medial longitudinal arch collapse,
09:49 - 09:53their goal- this exercise. In fact, not
09:53 - 09:57just this exercise. I want to see 20 reps
09:57 - 10:00at a 4-2-2 count, that's eccentric,
10:00 - 10:02isometric, concentric, so we're really
10:02 - 10:06focused on that eccentric deceleration
10:06 - 10:10before every lower extremity workout.
10:10 - 10:12That's part of their corrective exercise
10:12 - 10:15program, integrated warm-up, movement prep,
10:15 - 10:17whatever you want to call it. In fact, I'm
10:17 - 10:18going to take this one step farther.
10:18 - 10:21Forget just my athletes. I want to see
10:21 - 10:26how many of you can maintain 20
10:26 - 10:29repetitions at a 4-2-2 count with
10:29 - 10:33perfect form. Toes up, glutes tight, quads
10:33 - 10:34tight,
10:34 - 10:37no speeding up the tempo to get through
10:37 - 10:39the set faster. I look forward to hearing
10:39 - 10:41about your outcomes. I look forward to
10:41 - 10:43seeing how this exercise affects you
10:43 - 10:45personally. I can't wait to see you guys
10:45 - 10:49send me those videos of proof of you
10:49 - 10:52doing this exercise. I hope you enjoyed it.