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