Name: Tibial Internal Rotator Activation
Uploaded: 2023-04-26T01:02:06.000Z
Duration: 6 min 55 s
Description: Loosen up tight muscles with this quick video on Tibial Internal Rotator activation! Learn easy moves to reduce pain and tension and relieve tightness in your legs.

English captions

https://stream.mux.com/XcFp6Vf15ouvPqWvl8CPgRjZtpVR4Xm601ZAXs02nLHSw.m3u8

Loosen up tight muscles with this quick video on Tibial Internal Rotator activation! Learn easy moves to reduce pain and tension and relieve tightness in your legs.

Introduction to Pes Anserinus Activation

Identifying and Addressing Tibial Rotator Dysfunction

Exercise Setup and Positioning for Activation

Techniques for Effective Tibial Internal Rotation

Self-Administered Activation Techniques

Evaluating Improvements Through Functional Assessment

Tibial Internal Rotator Activation

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

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