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Posterior Tibialis Manual Muscle Testing (MMT) for an Active Population

Posterior Tibialis Manual Muscle Testing (MMT) is a simple and effective method for assessing the strength and mobility of the posterior tibialis muscles in an active patient population. The patient is asked to dorsiflex the foot while the practitioner applies gentle manual resistance to the patient’s ankle. The force of the resistance is progressively increased until the patient is unable to maintain ankle dorsiflexion against the applied force. The results are then documented and compared to norms

Transcript

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This is Brent the Brookbush Institute, and
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in this video we're going to go over
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posterior tibialis manual muscle testing for an active population. Now I know many
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of you have learned the one through five Kendall scale with the pluses and
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minuses, and we have can this person move against gravity, do they have full range
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of motion, can they move against resistance or can they hold against
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resistance, and that scale is still very important to use especially for a
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clinical setting. But I think us sports medicine professionals, us athletic
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trainers, the human movement professionals out there, see problems
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with our athletic population that indicate weakness, and then the manual
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muscle testing grades of 3 plus to 5 are a little ambiguous; and the tests
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themselves may not be provocative enough to give us the information we need, that
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would influence us to change our intervention or program. So
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we're going to look at some ways of making these tests a little bit more
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provocative, so that you can see where somebody is breaking down a bit. I'm
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going to have my friend Melissa come out, she's going to help me demonstrate
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posterior tibialis manual muscle testing for the active population. Now I
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explained this in the last video we did, the scale we're going to use is a little
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different, we're going to we're going to leave the Kendall scale to Kendall, we're
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going to use strong, weak with compensation right, or pain, ow, right pain.
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Okay so here's what this particular test looks like. First know what your
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posterior tibialis does, your posterior tibialis does plantar flexion and
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inversion. Alright so the traditional test is plantarflex and
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invert, alright pull in, good, and what we do is test their ability to maintain
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inversion of the foot. The reason why you don't end up pushing against plantar
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flexion as well is, that's always going to test strong because all of their calf
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plantarflexes. So if I were to just go okay hold this and I went like this, I
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could probably stand up push with both of my arms, I could probably take a
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running start and she's going to test strong, even though you know I might have
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gotten weakness in like let's say an overhead squat assessment, where maybe
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her feet would flat. Alright so we're going to go ahead and test inversion,
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because that's a more unique movement to the posterior tib. Now the other thing
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that comes up a lot is this synergistic dominance, you know our athletes, our
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active population they're great compensators, they'll figure out a way to
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get it done. The compensation here would be flexion of the toes right. So if we
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started to see this thing alright, very common among dancers, you'll find right
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they danced around a point for so long that if you put them in point they want
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to do this, but what that's also an indication of is the flexor hallucis
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longus and flexor digitorum longus, the FHL on the FDL are becoming
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synergistically dominant for a weak posterior tibialis. So I have to make sure I
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get that out of the movement. How do we reciprocally inhibit these, well if
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they're the long flexors of the toe we'll just extend the toes, and there we
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go. Now we have a more provocative test. Go ahead and invert for me. I'm
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actually going to push her right through the ball of her foot, because especially
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for the posterior tib, a big job of the posterior tib is trying to maintain that
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medial longitudinal arch, and decelerate when you when you land on the ball of
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your foot. Alright so I'm going to push right here, try to maintain your foot
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inward, and she's she's still pretty strong in this position. Now the thing I
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mentioned in the tibialis anterior video is, does she have strength throughout her
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entire range, and that actually matters less in this test. Most people do not
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lose plantarflexion, at least a younger more active and athletic population, they
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don't end up losing this plantarflexion. But keep in mind guys, keep in mind these
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little extras. You want to make sure that you're going ahead and plantarflexing
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and inverting, that you're making them extend the toes so that they're not
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using those overactive synergists, and then rather than testing plantar flexion, go
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ahead and stabilize the ankle with this hand, and just push them straight back
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into eversion, and see if they can hold and maybe even hold for a few seconds.
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Maybe we'll test her endurance, so this would be a strong test. Compensation what
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would that look like, let's see here if I pushed on her what would happen, her toes
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would go down right. She would try to curl, she basically try to curl her foot
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around my hand., you guys will see that a little bit. If she was just weak,
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I would go to press, and with very little resistance her foot would go into
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eversion, and of course the last result would be, go ahead and toes up, foot down,
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press in and, 'OW' right pain, which means if you're not a licensed professional
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you should probably refer out, or at least check in with a licensed
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professional or physician so that you get a good diagnosis or assessment of
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what is causing that pain, and whether that individual is safe to continue on
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in your program. I hope you guys enjoy using this test, I hope it gives you a
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little better indication of when somebody might need some posterior
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tibialis anterior or posterior tibialis activation, or potentially you saw
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flatfoot, and in Melissa's cases we found out just doing these couple of videos her
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tibialis anterior tested weak, her posterior tib tested strong which means
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I don't need to do postive activation, but I should still work on tibialis
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anterior activation, despite her being a very athletic individual. I will talk with you
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guys soon. I look forward to hearing about how you used test.