0:04 This is Brent of the Brookbush Institute 0:06 bringing you tibialis posterior 0:08 activation- a muscle that has a 0:09 propensity to get long and underactive 0:11 in those individuals who have feet 0:13 flattened or feet turned out on that 0:15 overhead squat assessment, or those who 0:16 can't maintain their medial longitudinal 0:18 arch in standing single leg balance or 0:21 potentially during gait. I'm going to 0:22 have my friend, Melissa, come out. She's 0:24 going to help me demonstrate. Now I think 0:29 the hardest part of- the part of this 0:32 exercise where people get a little 0:33 confused is which direction should my 0:36 resistance actually pull. Alright, so we 0:38 need to remember that the tibialis 0:39 posterior does both plantar flexion and 0:41 inversion. So, we need something that 0:43 resists this way for plantar flexion. And 0:46 then inversion is kind of this inward 0:48 motion so that she shows the sole of her 0:51 foot inwards, so I need something that 0:53 pulls out that way a little bit. So, my 0:55 force should probably go out a little bit 0:57 of an angle over yonder, which is 1:00 actually pretty easy to create. If I 1:03 bring her foot in this way, I hook a band 1:06 around that back leg of the 1:10 plinth, I can then just take this band and 1:13 loop it through the handle, and then throw it 1:17 up over her foot. And now I have that nice 1:19 angle, out away from plantar flexion and 1:21 inversion. To prevent her from using her 1:24 adductors to maintain her leg in this 1:27 position, because the band kind of wants 1:28 to just take her and pull her out that 1:30 way, to keep her in this position, I'm 1:32 going to have her take this leg and cross it 1:36 over. Alright, so she's using this leg to 1:39 brace this leg, she doesn't have to come 1:41 up quite as high. If she didn't have quite as 1:43 much flexibility, we could try something 1:45 like that. Now we're all set up for 1:48 just band resisted tibialis posterior 1:51 activation. The next thing we have to 1:54 figure out is who are are overactive 1:57 synergists for the tibialis posterior, so 2:00 any muscle that has a propensity to become 2:02 long and under active, any prime mover. 2:04 And with the tibialis posterior being a very 2:06 important inverter, who's taking over for 2:08 this inhibition? Well, chances are it's 2:10 going to be the flexor hallucis longus, 2:11 the flexor digitorum longus, and our 2:14 fibularis or peroneal 2:15 muscles. The way we get our peroneal 2:17 muscles out is simply through inversion. 2:19 Our peroneals are everters, so we 2:21 don't have to do anything special there, 2:23 other than create this line of pull, 2:25 which we've already set up. The flexor 2:27 hallucis longus and the flexor digitorum 2:28 longus, well if they flex the toes, I can 2:32 reciprocally inhibit them using 2:35 extension of the toes. So, now what I'm 2:38 going to have her do is she's going to 2:40 point her foot going down and in a 2:44 little bit, right, while bringing her toes 2:47 up. Let's try that again. So you're 2:50 going to go down and in while bringing 2:52 your toes up. Good, and you can even give 2:54 a little cue, a cue that works really well. 2:57 If you put a little pressure on the ball 3:00 behind her big toe and go, "Here, press 3:03 right through here," she'll do a lot of 3:06 those things, the toes up, the 3:08 inversion, and plantar flexion naturally. 3:10 So, I'm just going to give her that 3:11 little tactile cue. There we go. And now 3:15 I want you to go back nice and slow for me. 3:17 Can you do that four second eccentric? 3:20 I'm going to have her out for two, hold 3:22 for two, and then back two, three, four. 3:27 Nice job. Now, I have to admit, guys, this 3:30 is a fairly low-level, fairly low 3:33 intensity posterior tib. activation 3:36 exercise. Generally, I don't need to use 3:39 this exercise. I can progress somebody to 3:41 our standing progressions for posterior 3:44 tibialis activation. But, this is an 3:46 important one to have in your arsenal, 3:48 because I guarantee, the longer you 3:50 practice, the longer you train, eventually 3:52 you're going to find somebody who can't 3:55 maintain the medial longitudinal arch of 3:57 their foot in standing even if you put 3:59 them there first. Or, maybe they've had 4:02 really painful plantar fasciitis, and 4:04 this is the only posterior tib. 4:07 activation exercise that doesn't cause 4:09 them further pain. It's also one of the 4:12 few exercises that's really easy to set 4:15 up at home. All they need is one of 4:17 these resistant bands, which is fairly 4:18 cheap. And this doesn't have to be done 4:20 on a plinth. Obviously, they could tie 4:22 this to 4:22 their bed or a heavy dining room table 4:27 or something to create this level of 4:29 resistance. So once again, guys, here's a quick 4:32 reviews on set up. Remember, we need to 4:38 create a resistance that pulls back and 4:41 that way a little bit, so I put 4:44 it on the back leg of the plinth. I then 4:46 took the band and just looped a little 4:50 section of the band through the handle. 4:53 That's important, guys, you want to create 4:54 a slipknot. Don't do this thing, where you 4:57 just slip the handle over the foot, 4:59 unless you want this to fly off and hit 5:00 somebody. Alright, so make sure you 5:02 create that little slip knot. Now, 5:05 to prevent her from using her adductors, 5:07 which are muscles that also have a 5:09 propensity to become a little overactive, and 5:11 we don't want to exacerbate dysfunction, 5:13 I'm going to have her use this leg and 5:17 create a brace. Are you nice and 5:20 comfortable? And then remember you can have 5:22 her push through the ball of her big toe 5:26 to stimulate flexion and inversion, and 5:30 we're going to make sure to reciprocally 5:31 inhibit her flexor hallucis longus and 5:34 her flexor digitorum longus by doing 5:36 big toe extension. Our common tempo 5:38 markings for activation exercise is a 4-2- 5:41 2 count. Since we're starting with the 5:43 concentric, we're going to go down for 5:44 two, hold for two, and then back for four. 5:48 Thank you, Melissa. I hope you guys enjoyed 5:51 the video. I look forward to seeing or 5:54 hearing about the results, the 5:56 outcomes, and all of the changes you guys 6:00 get in human movement. 6:08 you
