0:04 This is Brent of the Brookbush 0:06 Institute and in this video we're going to 0:07 discuss tibialis posterior activation 0:10 progression, specifically, the hardest 0:13 tibialis posterior activation 0:15 progression I have in my arsenal. Now, 0:17 when I tried to create this exercise, 0:19 realize I had three goals. I want to kind 0:22 of explain how this happened. I wanted to 0:25 try to find a way to get the line of 0:29 pull of gravity to line up with the 0:31 obliquity of the tibialis posterior, so I 0:35 essentially wanted to be able to resist 0:37 both plantar flexion and inversion. 0:41 Second, I wanted to be able to 0:44 reciprocally inhibit my overactive 0:46 synergist just as I do on all of these 0:48 activation techniques, so that I'm not 0:51 reinforcing any of the movement 0:54 dysfunction that's causing the 0:56 individual's movement impairment or 0:58 reducing their performance. Third, I 1:02 wanted to try to take what we're doing 1:04 at the foot and ankle and integrate it 1:07 into a commonly used pattern, 1:10 specifically, triple extension in this 1:12 case, so that we have better carry over 1:15 to functional activities. Now, I'm going 1:17 to have my friend, Melissa, come 1:18 out and she's going to help me demonstrate 1:20 this exercise. Alright, so first things 1:25 first, let's talk about the tibialis 1:26 posterior anatomy. The insertion wraps 1:30 around the medial side of the foot and 1:32 then, actually, the origin is on the 1:34 lateral side of the tibia. That creates 1:37 this little diagonal here, this obliquity 1:40 that comes out this way. So, how am I 1:43 going to get that obliquity to line up 1:46 with gravity, which pulls straight down? 1:48 That's actually fairly easy. All I'll have to 1:51 do is have Melissa lean over. So, 1:55 if she leans into a wall, now gravity 1:58 goes from lateral tibia right over the 2:02 medial side of the foot so I have that 2:04 nice line of pull. And if you guys think 2:06 about her ankle coming straight up from 2:10 this position, 2:11 you can kind of see how not only is 2:13 plantar flexion now resisted, but 2:16 inversion as well. I can stimulate 2:18 inversion a little bit more by having 2:20 you bring your foot in so that pinkie toe 2:23 is actually pointing forward, so just a 2:25 little bit of tibial internal rotation 2:27 there, guys. Now, step two: reciprocal 2:32 inhibition of overactive synergists. The 2:34 overactive synergists for my tibialis 2:36 posterior are my flexor hallucis longus 2:39 and flexor digitorum longus, i.e. my long 2:41 toe flexors. If I want to inhibit toe 2:44 flexors, I should probably just do toe 2:48 extension, right? I'm going to lift my 2:50 toes up, or ask her to lift her toes up. 2:52 The other thing this does, which is real 2:54 great for our athletes, is it starts 2:56 teaching them to drive through the balls 2:59 or just behind the balls of their feet, 3:01 specifically, that first MTP, or just 3:05 behind that first MTP, just behind the 3:07 big toe. As soon as she lifted her 3:10 toes, she should feel the balls of her 3:11 feet kind of push into the ground a 3:13 little bit which is a lot better than 3:15 running off the toes, which is going to 3:17 jack up all of those those toe flexors, 3:19 which we already know are overactive 3:22 synergies. Third, how do I get that 3:26 integrated into the performance of the 3:29 rest of the body? Well, I can definitely 3:32 add it into my triple extension mechanic. 3:34 if you think about how she's pushing 3:37 into the wall, right, I can have her use 3:39 her glute to extend and even abduct a 3:43 little bit. I want you to actually- 3:44 we're going to use your forearm 3:46 here, have you post up against the wall, and 3:48 have this pushing against the wall. This 3:50 isn't a stability exercise. I don't want 3:51 her back and forth this way. I don't 3:54 want her to feel unstable. I want her to 3:56 feel nice and stable as she pushes into 3:59 the wall. She's going to squeeze her 4:00 glute, squeeze her quad, so now we 4:04 have that triple extension. And now as 4:06 soon as I ask her to do a calf raise, we 4:09 can see that's on a diagonal but close 4:13 to the same mechanics she's going to use 4:16 to either push off and run or do a 4:19 lateral step if she's, let's say guarding 4:23 somebody and has to move laterally, or if 4:26 she was a basketball player, give a 4:28 little crossover. Alright, so she's going 4:30 to push up into a calf raise, drive 4:34 through her glute and her quad, making 4:38 sure she stays internally rotated a 4:39 little bit here, and back down. So just 4:44 getting her to do a calf raise first is 4:45 the first thing I want to do. Now I'm 4:47 going to start trying to perfect this a 4:49 little bit. Make sure that the individual 4:51 is going into plantar flexion and 4:53 inversion. What you will find is that some 4:56 individuals will start to collapse. 4:58 They'll start to let their body rotate 5:00 in this way, but that's what the arm is here 5:02 for. We need to keep her nice and 5:04 straight this way, so that this stays 5:06 plantar flexion and inversion and 5:08 doesn't become plantar flexion and 5:09 eversion as she tries to find a way to 5:12 kind of get back into this position, 5:14 which, maybe, was her compensation 5:15 pattern. Alright, up again, making sure 5:19 her toes are coming up, or she's at least 5:21 trying to pull her toes up. The other 5:24 mistake you'll see, although Melissa's 5:26 being a lot better on this particular 5:27 take up this video, if she goes up, a lot 5:31 of people will just flop back down. 5:33 I'd like to concentrate on eccentric 5:37 control, especially since overpronation 5:39 is a lot of times what I'm using this 5:41 for, which is the inability to be 5:44 eccentrically control flat-footedness. I 5:46 want her to go up as high as she can, hold, 5:49 make sure all this is tight, give her a 5:51 little posture check at the top, and then 5:53 a four-second eccentric- two, three, four. 5:57 Good. Back up. 6:01 Make sure you're staying straight this way. Back down. Now, 6:06 with this leg she's being a little lazy. 6:09 We do have a couple choices with this 6:11 other leg. We can leave it on 6:14 the floor. If this is the first time, 6:15 maybe, I'm doing this progression, and I'm 6:17 progressing from a two-footed 6:19 tibialis posterior activation exercise, 6:22 then maybe I want her to just- I'm going to 6:25 give her this kickstand of just allowing 6:27 the ball of her foot to stay on the 6:29 floor so that she's not lifting quite so 6:31 much weight with this leg. 6:33 That's okay. I'm okay with 6:36 that initially, but then as she gets 6:38 better, I want her to pull this leg up. 6:40 I'm even going to have her dorsiflex an 6:42 invert so that I'm reinforcing triple 6:44 flexion mechanics on this side, triple 6:46 extension mechanics on this side. You 6:48 guys can see how the carryover and 6:50 transfer would happened there to some of 6:51 her other athletic activities. Good, back 6:55 up and back down. Let's show everybody 6:59 what it looks like from the other side. 7:03 Lean over. Oh, good, Alright, so she's 7:07 going to post up against the wall here. 7:09 Make sure that she's perpendicular to 7:11 the wall. I don't want her- what tends 7:14 to happen to people is they start 7:15 falling in this way. That's what this 7:17 arm is for. No need to turn this into a 7:19 stability exercise. I have other 7:20 exercises, I have other techniques that I 7:23 can use to start working on her stability 7:25 and balance. This is just tibialis 7:27 posterior activation. Turn this foot in 7:30 a little bit. Because you're so 7:33 advanced, we're going to go ahead and 7:35 lift this leg up, dorsiflex, reinforce 7:38 that triple flexion mechanic. Let's 7:40 reinforce this triple extension mechanic, 7:42 squeeze your glute, no anterior pelvic 7:44 tilt, little tuck under if we need to 7:46 drawn in, quad tight, drive through 7:49 the ball of your foot, ankle straight up. 7:51 Alright, so that time you kind of turned 7:53 out on me and then caved in, so let's 7:56 step out just a little bit from the wall. 7:58 Good. Drive into the wall. There you go. 8:04 Just giving individuals the 8:08 cue to push a little bit into the wall 8:10 sometimes helps. Sometimes that will help 8:11 get their ankle to go up and out rather 8:14 than cave in. 8:17 Good. 8:25 Getting tired? Good deal. Alright, so 8:29 before we we wrap this video up, I do 8:32 want to give you guys a closer look at 8:34 what's happening to Melissa's feet. 8:36 Once again, guys, just to go over the 8:40 position of the feet, make sure 8:41 she's slightly internally rotated, pinkie 8:44 toe pointing straight ahead, we don't 8:46 need crazy internal rotation just a 8:48 little bit, we want toes up, driving 8:51 through the full ball of the foot. From 8:53 big toe all the way to little toe, 8:56 just behind the ball of her foot is 8:58 driven hard into the ground. And then 9:00 you're going to watch the lateral 9:02 malleolus to see if it goes up and out 9:04 just a little bit as we try to stimulate 9:07 both plantar flexion and inversion to 9:10 make sure that we are getting as much 9:12 positive activity as we possibly can. So 9:15 there you go, guys. That's the hardest 9:18 tibialis posterior activation 9:20 progression I have in my arsenal. Any 9:23 athlete who comes to me with any sign of 9:26 foot, ankle, or lower extremity 9:28 dysfunction, anybody with feet 9:30 turn out, feet flat, or knees cave in that 9:34 overhead squat assessment, anybody who's 9:36 lacking dorsiflexion, anybody who has 9:39 that functional flat foot or pes planus, 9:42 those individuals who as soon as they 9:44 take shoes off and step barefoot, you watch 9:47 the medial longitudinal arch collapse, 9:49 their goal- this exercise. In fact, not 9:53 just this exercise. I want to see 20 reps 9:57 at a 4-2-2 count, that's eccentric, 10:00 isometric, concentric, so we're really 10:02 focused on that eccentric deceleration 10:06 before every lower extremity workout. 10:10 That's part of their corrective exercise 10:12 program, integrated warm-up, movement prep, 10:15 whatever you want to call it. In fact, I'm 10:17 going to take this one step farther. 10:18 Forget just my athletes. I want to see 10:21 how many of you can maintain 20 10:26 repetitions at a 4-2-2 count with 10:29 perfect form. Toes up, glutes tight, quads 10:33 tight, 10:34 no speeding up the tempo to get through 10:37 the set faster. I look forward to hearing 10:39 about your outcomes. I look forward to 10:41 seeing how this exercise affects you 10:43 personally. I can't wait to see you guys 10:45 send me those videos of proof of you 10:49 doing this exercise. I hope you enjoyed it.
