Would you like to view this video?

Tibial Internal Rotator Activation

Tibial Internal Rotator Activation is a type of exercise designed to strengthen the tibialis posterior, a muscle that is essential for healthy ankle and foot movement. It activates and stabilizes the tibialis posterior by targeting the deep, inner layers of the muscle, helping to improve strength, balance, coordination and stability for both the foot and ankle. This exercise is perfect for athletes and individuals who want to increase the range of motion in their ankles and correct any weaknesses or

Back To Videos

Transcript

00:00:0000:00:04

This is Brent, coming at you with another

00:00:0400:00:08

or tibial internal rotator activation. I'm actually really excited

00:00:0800:00:13

about this one. I've been working at this for a long time, to come up with a

00:00:1300:00:18

successful exercise that doesn't also gear up all of those overactive synergists

00:00:1800:00:22

that can play a role in some of our postural dysfunction. My friend, Yvette, is

00:00:2200:00:26

going to come out and help me demonstrate this exercise. I'm going to

00:00:2600:00:30

show you both manual style techniques, as well as self-administered, or self

00:00:3000:00:35

resisted techniques here. Now, if I want to get at the medial tibial rotators,

00:00:3500:00:40

this is for everybody who has that dysfunction where their feet turn out,

00:00:4000:00:44

right, which means their medial internal or tibial rotators would be long and

00:00:4400:00:49

under active, or all of those individuals where their knees cave in, which is

00:00:4900:00:54

relative tibial external rotation and femoral internal rotation, which means

00:00:5400:00:58

once again these same muscles are long and under active. Now the hard part about

00:00:5800:01:02

that is, all of these muscles are secondary muscles, they are two joint

00:01:0200:01:07

muscles for the most part, and trying to get them recruited usually involves

00:01:0700:01:12

potentially recruiting a lot of other muscles that could already be shortened,

00:01:1200:01:18

overactive, in that same dysfunction. So, here's what we've got to do. We're going to

00:01:1800:01:23

have to go ahead and get our patient or client in this long sit position to

00:01:2300:01:26

start with. We're then going to go ahead and bend the leg to 90 degrees here, and

00:01:2600:01:32

the first problem that I started to work out, was the fact that if

00:01:3200:01:36

I wanted to get the gracilis active, I needed to find a way to do that without

00:01:3600:01:42

getting the rest of the adductor complex active. That's actually not that hard to

00:01:4200:01:48

drive out. All I have to do is make sure that I get a little bit of abduction,

00:01:4800:01:54

alright, so if I resist here, and have Yvette push out towards me, boom, adductors are

00:01:5400:02:00

now reciprocally inhibited. The next thing I have to do, is make sure biceps

00:02:0000:02:05

femoris stays out, and TFL stays out. Well, that's actually not that hard to do

00:02:0500:02:10

either because biceps femoris and TFL are tibial external rotators. So if I can

00:02:1000:02:14

ensure that I'm doing tibial internal rotation, those guys will

00:02:1400:02:20

automatically gear down. Now, the way to resist this becomes a little complicated,

00:02:2000:02:25

but not unsolvable. We're going to go ahead and use the foot as a lever arm.

00:02:2500:02:31

Now, to make sure that I'm getting tibial internal rotation, and not inversion, the

00:02:3100:02:36

way we figured this out is by going into dorsiflexion. I posteriorally shift

00:02:3600:02:41

the talis, kind of jam it into the mortise of the ankle, and now I can't get

00:02:4100:02:46

any motion out of the ankle. So now we can use this as a nice firm lever, and if

00:02:4600:02:51

I get her to internally rotate her tibia, I know that it's coming from tibial

00:02:5100:02:55

internal rotation, and not inversion. Now what I'll go ahead and do with this

00:02:5500:03:01

exercise is, since tibialis anterior is usually under active, the extensors

00:03:0100:03:05

hallucis longus, and extensor digitorum longus is usually overactive, I'm going

00:03:0500:03:09

to go ahead and have hear dorsiflex, but then bring down her toes, I can kill

00:03:0900:03:13

two birds with one stone by activating tibialis anterior. Alright, so here's the

00:03:1300:03:19

setup. We're at 90 degrees, roughly, of knee flexion. I'm in midline with the

00:03:1900:03:23

hip, I don't want this position. If I put her here, this is the same position

00:03:2300:03:27

as knees bow inward, so I've got her in this position, what I'm going to go ahead and

00:03:2700:03:32

do is, I'm going to go ahead and bring my fingers underneath her heel,

00:03:3200:03:36

because you can actually see me queue a little bit of extension too, to try to

00:03:3600:03:41

further get TFL out of the mix, I'm then going to place my hand along this border

00:03:4100:03:47

of her foot, so along that first ray, and then I'm going to place the palm

00:03:4700:03:51

of my hand just outside of her knee. First thing I'm going to have Yvette do

00:03:5100:03:55

is go ahead and push out against my hand a little bit, she doesn't have to kill me,

00:03:5500:03:59

and then I can use whatever activation protocol you guys are comfortable with,

00:03:5900:04:06

so you guys can use that 25, 50, 75, 100 protocol, you can use several isometric

00:04:0600:04:09

holds, you could do isometric holds of the beginning range, end range, but at the end

00:04:0900:04:14

of the day you're going to go, "go ahead and push out, alright, pull down, pull

00:04:1400:04:17

your heel down and into the bench a little bit, down against my fingers, and

00:04:1700:04:21

then I want you to internally rotate your foot against my forearm,

00:04:2100:04:26

good, hold that, push, don't let it go, push out against this hand, push against

00:04:2600:04:34

this arm, and relax". And then, for me, I'm going to keep ramping up the amount

00:04:3400:04:40

of effort she's putting in, as long as I can maintain optimal form, and I'm sure,

00:04:4000:04:45

and you guys can palpate to make sure, you can palpate here, making sure that

00:04:4500:04:49

semitendinosus, membranosis, and gracilis are nice and active, and that

00:04:4900:04:53

you actually have a little bit of a soft spot here, where that other adductor mass

00:04:5300:05:00

is. Alright, so one more here, I have her dorsiflexed, toes down, have her push down her

00:05:0000:05:06

heel into the table, good, push out here. I've got the inside of her foot braced, and

00:05:0600:05:10

she's going to push into my forearm. Now, this doesn't have to be a manual

00:05:1000:05:16

technique, she can do this on her own. All I've done here is wrapped a band around

00:05:1600:05:22

the table leg, I'm going to go ahead and flip this around her foot this way, she

00:05:2200:05:27

can scoot over a little bit to add a little bit more resistance, let's go down

00:05:2700:05:34

just a little this way, good. So go ahead and dorsiflex, good, toes down, now I'm

00:05:3400:05:38

going to have her use her hand to provide that abduction resistance to get

00:05:3800:05:43

adductor's down. Alright, now all she has to do is, let's go ahead and do 15 slow reps,

00:05:4300:05:51

of internal rotation, and there you guys go. You guys can see this is all tibial

00:05:5100:05:56

internal rotation. Keep dorsiflex. Alright, I can actually see a little bit of her

00:05:5600:06:00

tibial tuberosity, I don't know if you guys can see that in the camera. I can see a

00:06:0000:06:06

little bit of a tibial crest moving inward. If I wanted to palpate here, I can

00:06:0600:06:11

actually feel her semitendinosis, membranosis, and gracilis tendon, really, really

00:06:1100:06:16

geared up. What we would hope to find, of course, is if we've done all of

00:06:1600:06:21

our mobility work, we've done all of our release, stretching, joint mobilizations.

00:06:2100:06:25

We've done our other activation work, and Yvette had feet turn out, then after doing

00:06:2500:06:30

this exercise, we could have her redo whatever functional task assessment

00:06:3000:06:32

we're doing, maybe like a squat assessment, and we

00:06:3200:06:37

would see an improvement in her feet staying a little bit more in line. I hope

00:06:3700:06:42

you enjoy this activation technique, You could see this as

00:06:4200:06:46

somewhere between like a Pes anserinus activation, or a semimembranosus,

00:06:4600:06:50

tendinosis, gracilis, and popliteus activation. I hope you get huge

Would you like to view this video?

Tibial Internal Rotator Activation

Transcript

Any Questions, Concerns or Recommendations?

Please contact us through the
Support Page

Legal

Social

Would you like to view this video?

Tibial Internal Rotator Activation

Transcript

Certifications, Courses & More

Any Questions, Concerns or Recommendations? Please contact us through the Support Page

Legal

Social

Any Questions, Concerns or Recommendations?

Please contact us through the
Support Page