0:04 This is Brent the Brookbush Institute, and in this video we're going to go over 0:07 posterior tibialis manual muscle testing for an active population. Now I know many 0:13 of you have learned the one through five Kendall scale with the pluses and 0:16 minuses, and we have can this person move against gravity, do they have full range 0:21 of motion, can they move against resistance or can they hold against 0:26 resistance, and that scale is still very important to use especially for a 0:30 clinical setting. But I think us sports medicine professionals, us athletic 0:35 trainers, the human movement professionals out there, see problems 0:39 with our athletic population that indicate weakness, and then the manual 0:45 muscle testing grades of 3 plus to 5 are a little ambiguous; and the tests 0:50 themselves may not be provocative enough to give us the information we need, that 0:56 would influence us to change our intervention or program. So 1:01 we're going to look at some ways of making these tests a little bit more 1:04 provocative, so that you can see where somebody is breaking down a bit. I'm 1:09 going to have my friend Melissa come out, she's going to help me demonstrate 1:12 posterior tibialis manual muscle testing for the active population. Now I 1:17 explained this in the last video we did, the scale we're going to use is a little 1:20 different, we're going to we're going to leave the Kendall scale to Kendall, we're 1:23 going to use strong, weak with compensation right, or pain, ow, right pain. 1:31 Okay so here's what this particular test looks like. First know what your 1:38 posterior tibialis does, your posterior tibialis does plantar flexion and 1:42 inversion. Alright so the traditional test is plantarflex and 1:47 invert, alright pull in, good, and what we do is test their ability to maintain 1:53 inversion of the foot. The reason why you don't end up pushing against plantar 1:57 flexion as well is, that's always going to test strong because all of their calf 2:03 plantarflexes. So if I were to just go okay hold this and I went like this, I 2:07 could probably stand up push with both of my arms, I could probably take a 2:13 running start and she's going to test strong, even though you know I might have 2:17 gotten weakness in like let's say an overhead squat assessment, where maybe 2:22 her feet would flat. Alright so we're going to go ahead and test inversion, 2:25 because that's a more unique movement to the posterior tib. Now the other thing 2:32 that comes up a lot is this synergistic dominance, you know our athletes, our 2:37 active population they're great compensators, they'll figure out a way to 2:42 get it done. The compensation here would be flexion of the toes right. So if we 2:50 started to see this thing alright, very common among dancers, you'll find right 2:55 they danced around a point for so long that if you put them in point they want 2:59 to do this, but what that's also an indication of is the flexor hallucis 3:03 longus and flexor digitorum longus, the FHL on the FDL are becoming 3:09 synergistically dominant for a weak posterior tibialis. So I have to make sure I 3:14 get that out of the movement. How do we reciprocally inhibit these, well if 3:19 they're the long flexors of the toe we'll just extend the toes, and there we 3:24 go. Now we have a more provocative test. Go ahead and invert for me. I'm 3:30 actually going to push her right through the ball of her foot, because especially 3:33 for the posterior tib, a big job of the posterior tib is trying to maintain that 3:37 medial longitudinal arch, and decelerate when you when you land on the ball of 3:43 your foot. Alright so I'm going to push right here, try to maintain your foot 3:47 inward, and she's she's still pretty strong in this position. Now the thing I 3:54 mentioned in the tibialis anterior video is, does she have strength throughout her 3:58 entire range, and that actually matters less in this test. Most people do not 4:04 lose plantarflexion, at least a younger more active and athletic population, they 4:11 don't end up losing this plantarflexion. But keep in mind guys, keep in mind these 4:16 little extras. You want to make sure that you're going ahead and plantarflexing 4:23 and inverting, that you're making them extend the toes so that they're not 4:28 using those overactive synergists, and then rather than testing plantar flexion, go 4:34 ahead and stabilize the ankle with this hand, and just push them straight back 4:38 into eversion, and see if they can hold and maybe even hold for a few seconds. 4:44 Maybe we'll test her endurance, so this would be a strong test. Compensation what 4:51 would that look like, let's see here if I pushed on her what would happen, her toes 4:54 would go down right. She would try to curl, she basically try to curl her foot 4:58 around my hand., you guys will see that a little bit. If she was just weak, 5:03 I would go to press, and with very little resistance her foot would go into 5:07 eversion, and of course the last result would be, go ahead and toes up, foot down, 5:12 press in and, 'OW' right pain, which means if you're not a licensed professional 5:18 you should probably refer out, or at least check in with a licensed 5:23 professional or physician so that you get a good diagnosis or assessment of 5:29 what is causing that pain, and whether that individual is safe to continue on 5:32 in your program. I hope you guys enjoy using this test, I hope it gives you a 5:36 little better indication of when somebody might need some posterior 5:40 tibialis anterior or posterior tibialis activation, or potentially you saw 5:45 flatfoot, and in Melissa's cases we found out just doing these couple of videos her 5:50 tibialis anterior tested weak, her posterior tib tested strong which means 5:55 I don't need to do postive activation, but I should still work on tibialis 6:00 anterior activation, despite her being a very athletic individual. I will talk with you 6:05 guys soon. I look forward to hearing about how you used test. 6:16
