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Posterior Tibialis Activation Progression 4
Posterior Tibialis Activation Progression 4 is a powerful exercise program that helps strengthen the posterior tibialis muscle as well as other key supporting muscles in the lower legs. This program is designed to enhance stability, reduce the risk of injury, and improve posture and running performance. As part of a comprehensive strengthening program, Progression 4 includes dynamic drills, eccentric loading, balance and mobility exercises, which are combined to better engage the posterior tibialis and target multiple areas
Transcript
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This is Brent of the Brookbush
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...blank
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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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Good.
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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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tight,
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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
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