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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

Transcript

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This is Brent, coming at you with another
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or tibial internal rotator activation. I'm actually really excited
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about this one. I've been working at this for a long time, to come up with a
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successful exercise that doesn't also gear up all of those overactive synergists
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that can play a role in some of our postural dysfunction. My friend, Yvette, is
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going to come out and help me demonstrate this exercise. I'm going to
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show you both manual style techniques, as well as self-administered, or self
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resisted techniques here. Now, if I want to get at the medial tibial rotators,
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this is for everybody who has that dysfunction where their feet turn out,
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right, which means their medial internal or tibial rotators would be long and
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under active, or all of those individuals where their knees cave in, which is
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relative tibial external rotation and femoral internal rotation, which means
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once again these same muscles are long and under active. Now the hard part about
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that is, all of these muscles are secondary muscles, they are two joint
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muscles for the most part, and trying to get them recruited usually involves
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potentially recruiting a lot of other muscles that could already be shortened,
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overactive, in that same dysfunction. So, here's what we've got to do. We're going to
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have to go ahead and get our patient or client in this long sit position to
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start with. We're then going to go ahead and bend the leg to 90 degrees here, and
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the first problem that I started to work out, was the fact that if
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I wanted to get the gracilis active, I needed to find a way to do that without
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getting the rest of the adductor complex active. That's actually not that hard to
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drive out. All I have to do is make sure that I get a little bit of abduction,
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alright, so if I resist here, and have Yvette push out towards me, boom, adductors are
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now reciprocally inhibited. The next thing I have to do, is make sure biceps
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femoris stays out, and TFL stays out. Well, that's actually not that hard to do
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either because biceps femoris and TFL are tibial external rotators. So if I can
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ensure that I'm doing tibial internal rotation, those guys will
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automatically gear down. Now, the way to resist this becomes a little complicated,
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but not unsolvable. We're going to go ahead and use the foot as a lever arm.
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Now, to make sure that I'm getting tibial internal rotation, and not inversion, the
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way we figured this out is by going into dorsiflexion. I posteriorally shift
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the talis, kind of jam it into the mortise of the ankle, and now I can't get
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any motion out of the ankle. So now we can use this as a nice firm lever, and if
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I get her to internally rotate her tibia, I know that it's coming from tibial
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internal rotation, and not inversion. Now what I'll go ahead and do with this
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exercise is, since tibialis anterior is usually under active, the extensors
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hallucis longus, and extensor digitorum longus is usually overactive, I'm going
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to go ahead and have hear dorsiflex, but then bring down her toes, I can kill
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two birds with one stone by activating tibialis anterior. Alright, so here's the
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setup. We're at 90 degrees, roughly, of knee flexion. I'm in midline with the
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hip, I don't want this position. If I put her here, this is the same position
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as knees bow inward, so I've got her in this position, what I'm going to go ahead and
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do is, I'm going to go ahead and bring my fingers underneath her heel,
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because you can actually see me queue a little bit of extension too, to try to
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further get TFL out of the mix, I'm then going to place my hand along this border
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of her foot, so along that first ray, and then I'm going to place the palm
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of my hand just outside of her knee. First thing I'm going to have Yvette do
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is go ahead and push out against my hand a little bit, she doesn't have to kill me,
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and then I can use whatever activation protocol you guys are comfortable with,
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so you guys can use that 25, 50, 75, 100 protocol, you can use several isometric
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holds, you could do isometric holds of the beginning range, end range, but at the end
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of the day you're going to go, "go ahead and push out, alright, pull down, pull
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your heel down and into the bench a little bit, down against my fingers, and
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then I want you to internally rotate your foot against my forearm,
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good, hold that, push, don't let it go, push out against this hand, push against
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this arm, and relax". And then, for me, I'm going to keep ramping up the amount
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of effort she's putting in, as long as I can maintain optimal form, and I'm sure,
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and you guys can palpate to make sure, you can palpate here, making sure that
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semitendinosus, membranosis, and gracilis are nice and active, and that
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you actually have a little bit of a soft spot here, where that other adductor mass
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is. Alright, so one more here, I have her dorsiflexed, toes down, have her push down her
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heel into the table, good, push out here. I've got the inside of her foot braced, and
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she's going to push into my forearm. Now, this doesn't have to be a manual
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technique, she can do this on her own. All I've done here is wrapped a band around
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the table leg, I'm going to go ahead and flip this around her foot this way, she
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can scoot over a little bit to add a little bit more resistance, let's go down
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just a little this way, good. So go ahead and dorsiflex, good, toes down, now I'm
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going to have her use her hand to provide that abduction resistance to get
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adductor's down. Alright, now all she has to do is, let's go ahead and do 15 slow reps,
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of internal rotation, and there you guys go. You guys can see this is all tibial
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internal rotation. Keep dorsiflex. Alright, I can actually see a little bit of her
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tibial tuberosity, I don't know if you guys can see that in the camera. I can see a
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little bit of a tibial crest moving inward. If I wanted to palpate here, I can
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actually feel her semitendinosis, membranosis, and gracilis tendon, really, really
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geared up. What we would hope to find, of course, is if we've done all of
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our mobility work, we've done all of our release, stretching, joint mobilizations.
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We've done our other activation work, and Yvette had feet turn out, then after doing
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this exercise, we could have her redo whatever functional task assessment
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we're doing, maybe like a squat assessment, and we
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would see an improvement in her feet staying a little bit more in line. I hope
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you enjoy this activation technique, You could see this as
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somewhere between like a Pes anserinus activation, or a semimembranosus,
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tendinosis, gracilis, and popliteus activation. I hope you get huge