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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.