0:00 This is Brent, coming at you with another activation video, we're doing Pes anserinus, 0:04 or tibial internal rotator activation. I'm actually really excited 0:08 about this one. I've been working at this for a long time, to come up with a 0:13 successful exercise that doesn't also gear up all of those overactive synergists 0:18 that can play a role in some of our postural dysfunction. My friend, Yvette, is 0:22 going to come out and help me demonstrate this exercise. I'm going to 0:26 show you both manual style techniques, as well as self-administered, or self 0:30 resisted techniques here. Now, if I want to get at the medial tibial rotators, 0:35 this is for everybody who has that dysfunction where their feet turn out, 0:40 right, which means their medial internal or tibial rotators would be long and 0:44 under active, or all of those individuals where their knees cave in, which is 0:49 relative tibial external rotation and femoral internal rotation, which means 0:54 once again these same muscles are long and under active. Now the hard part about 0:58 that is, all of these muscles are secondary muscles, they are two joint 1:02 muscles for the most part, and trying to get them recruited usually involves 1:07 potentially recruiting a lot of other muscles that could already be shortened, 1:12 overactive, in that same dysfunction. So, here's what we've got to do. We're going to 1:18 have to go ahead and get our patient or client in this long sit position to 1:23 start with. We're then going to go ahead and bend the leg to 90 degrees here, and 1:26 the first problem that I started to work out, was the fact that if 1:32 I wanted to get the gracilis active, I needed to find a way to do that without 1:36 getting the rest of the adductor complex active. That's actually not that hard to 1:42 drive out. All I have to do is make sure that I get a little bit of abduction, 1:48 alright, so if I resist here, and have Yvette push out towards me, boom, adductors are 1:54 now reciprocally inhibited. The next thing I have to do, is make sure biceps 2:00 femoris stays out, and TFL stays out. Well, that's actually not that hard to do 2:05 either because biceps femoris and TFL are tibial external rotators. So if I can 2:10 ensure that I'm doing tibial internal rotation, those guys will 2:14 automatically gear down. Now, the way to resist this becomes a little complicated, 2:20 but not unsolvable. We're going to go ahead and use the foot as a lever arm. 2:25 Now, to make sure that I'm getting tibial internal rotation, and not inversion, the 2:31 way we figured this out is by going into dorsiflexion. I posteriorally shift 2:36 the talis, kind of jam it into the mortise of the ankle, and now I can't get 2:41 any motion out of the ankle. So now we can use this as a nice firm lever, and if 2:46 I get her to internally rotate her tibia, I know that it's coming from tibial 2:51 internal rotation, and not inversion. Now what I'll go ahead and do with this 2:55 exercise is, since tibialis anterior is usually under active, the extensors 3:01 hallucis longus, and extensor digitorum longus is usually overactive, I'm going 3:05 to go ahead and have hear dorsiflex, but then bring down her toes, I can kill 3:09 two birds with one stone by activating tibialis anterior. Alright, so here's the 3:13 setup. We're at 90 degrees, roughly, of knee flexion. I'm in midline with the 3:19 hip, I don't want this position. If I put her here, this is the same position 3:23 as knees bow inward, so I've got her in this position, what I'm going to go ahead and 3:27 do is, I'm going to go ahead and bring my fingers underneath her heel, 3:32 because you can actually see me queue a little bit of extension too, to try to 3:36 further get TFL out of the mix, I'm then going to place my hand along this border 3:41 of her foot, so along that first ray, and then I'm going to place the palm 3:47 of my hand just outside of her knee. First thing I'm going to have Yvette do 3:51 is go ahead and push out against my hand a little bit, she doesn't have to kill me, 3:55 and then I can use whatever activation protocol you guys are comfortable with, 3:59 so you guys can use that 25, 50, 75, 100 protocol, you can use several isometric 4:06 holds, you could do isometric holds of the beginning range, end range, but at the end 4:09 of the day you're going to go, "go ahead and push out, alright, pull down, pull 4:14 your heel down and into the bench a little bit, down against my fingers, and 4:17 then I want you to internally rotate your foot against my forearm, 4:21 good, hold that, push, don't let it go, push out against this hand, push against 4:26 this arm, and relax". And then, for me, I'm going to keep ramping up the amount 4:34 of effort she's putting in, as long as I can maintain optimal form, and I'm sure, 4:40 and you guys can palpate to make sure, you can palpate here, making sure that 4:45 semitendinosus, membranosis, and gracilis are nice and active, and that 4:49 you actually have a little bit of a soft spot here, where that other adductor mass 4:53 is. Alright, so one more here, I have her dorsiflexed, toes down, have her push down her 5:00 heel into the table, good, push out here. I've got the inside of her foot braced, and 5:06 she's going to push into my forearm. Now, this doesn't have to be a manual 5:10 technique, she can do this on her own. All I've done here is wrapped a band around 5:16 the table leg, I'm going to go ahead and flip this around her foot this way, she 5:22 can scoot over a little bit to add a little bit more resistance, let's go down 5:27 just a little this way, good. So go ahead and dorsiflex, good, toes down, now I'm 5:34 going to have her use her hand to provide that abduction resistance to get 5:38 adductor's down. Alright, now all she has to do is, let's go ahead and do 15 slow reps, 5:43 of internal rotation, and there you guys go. You guys can see this is all tibial 5:51 internal rotation. Keep dorsiflex. Alright, I can actually see a little bit of her 5:56 tibial tuberosity, I don't know if you guys can see that in the camera. I can see a 6:00 little bit of a tibial crest moving inward. If I wanted to palpate here, I can 6:06 actually feel her semitendinosis, membranosis, and gracilis tendon, really, really 6:11 geared up. What we would hope to find, of course, is if we've done all of 6:16 our mobility work, we've done all of our release, stretching, joint mobilizations. 6:21 We've done our other activation work, and Yvette had feet turn out, then after doing 6:25 this exercise, we could have her redo whatever functional task assessment 6:30 we're doing, maybe like a squat assessment, and we 6:32 would see an improvement in her feet staying a little bit more in line. I hope 6:37 you enjoy this activation technique, You could see this as 6:42 somewhere between like a Pes anserinus activation, or a semimembranosus, 6:46 tendinosis, gracilis, and popliteus activation. I hope you get huge 6:50 results from this exercise. Talk with you soon.
