This is Brent of the Brookbush
Institute and in this video we're going to
discuss tibialis posterior activation
progression, specifically, the hardest
tibialis posterior activation
progression I have in my arsenal. Now,
when I tried to create this exercise,
realize I had three goals. I want to kind
of explain how this happened. I wanted to
try to find a way to get the line of
pull of gravity to line up with the
obliquity of the tibialis posterior, so I
essentially wanted to be able to resist
both plantar flexion and inversion.
Second, I wanted to be able to
reciprocally inhibit my overactive
synergist just as I do on all of these
activation techniques, so that I'm not
reinforcing any of the movement
dysfunction that's causing the
individual's movement impairment or
reducing their performance. Third, I
wanted to try to take what we're doing
at the foot and ankle and integrate it
into a commonly used pattern,
specifically, triple extension in this
case, so that we have better carry over
to functional activities. Now, I'm going
to have my friend, Melissa, come
out and she's going to help me demonstrate
this exercise. Alright, so first things
first, let's talk about the tibialis
posterior anatomy. The insertion wraps
around the medial side of the foot and
then, actually, the origin is on the
lateral side of the tibia. That creates
this little diagonal here, this obliquity
that comes out this way. So, how am I
going to get that obliquity to line up
with gravity, which pulls straight down?
That's actually fairly easy. All I'll have to
do is have Melissa lean over. So,
if she leans into a wall, now gravity
goes from lateral tibia right over the
medial side of the foot so I have that
nice line of pull. And if you guys think
about her ankle coming straight up from
this position,
you can kind of see how not only is
plantar flexion now resisted, but
inversion as well. I can stimulate
inversion a little bit more by having
you bring your foot in so that pinkie toe
is actually pointing forward, so just a
little bit of tibial internal rotation
there, guys. Now, step two: reciprocal
inhibition of overactive synergists. The
overactive synergists for my tibialis
posterior are my flexor hallucis longus
and flexor digitorum longus, i.e. my long
toe flexors. If I want to inhibit toe
flexors, I should probably just do toe
extension, right? I'm going to lift my
toes up, or ask her to lift her toes up.
The other thing this does, which is real
great for our athletes, is it starts
teaching them to drive through the balls
or just behind the balls of their feet,
specifically, that first MTP, or just
behind that first MTP, just behind the
big toe. As soon as she lifted her
toes, she should feel the balls of her
feet kind of push into the ground a
little bit which is a lot better than
running off the toes, which is going to
jack up all of those those toe flexors,
which we already know are overactive
synergies. Third, how do I get that
integrated into the performance of the
rest of the body? Well, I can definitely
add it into my triple extension mechanic.
if you think about how she's pushing
into the wall, right, I can have her use
her glute to extend and even abduct a
little bit. I want you to actually-
we're going to use your forearm
here, have you post up against the wall, and
have this pushing against the wall. This
isn't a stability exercise. I don't want
her back and forth this way. I don't
want her to feel unstable. I want her to
feel nice and stable as she pushes into
the wall. She's going to squeeze her
glute, squeeze her quad, so now we
have that triple extension. And now as
soon as I ask her to do a calf raise, we
can see that's on a diagonal but close
to the same mechanics she's going to use
to either push off and run or do a
lateral step if she's, let's say guarding
somebody and has to move laterally, or if
she was a basketball player, give a
little crossover. Alright, so she's going
to push up into a calf raise, drive
through her glute and her quad, making
sure she stays internally rotated a
little bit here, and back down. So just
getting her to do a calf raise first is
the first thing I want to do. Now I'm
going to start trying to perfect this a
little bit. Make sure that the individual
is going into plantar flexion and
inversion. What you will find is that some
individuals will start to collapse.
They'll start to let their body rotate
in this way, but that's what the arm is here
for. We need to keep her nice and
straight this way, so that this stays
plantar flexion and inversion and
doesn't become plantar flexion and
eversion as she tries to find a way to
kind of get back into this position,
which, maybe, was her compensation
pattern. Alright, up again, making sure
her toes are coming up, or she's at least
trying to pull her toes up. The other
mistake you'll see, although Melissa's
being a lot better on this particular
take up this video, if she goes up, a lot
of people will just flop back down.
I'd like to concentrate on eccentric
control, especially since overpronation
is a lot of times what I'm using this
for, which is the inability to be
eccentrically control flat-footedness. I
want her to go up as high as she can, hold,
make sure all this is tight, give her a
little posture check at the top, and then
a four-second eccentric- two, three, four.
Good. Back up.
Make sure you're staying straight this way. Back down. Now,
with this leg she's being a little lazy.
We do have a couple choices with this
other leg. We can leave it on
the floor. If this is the first time,
maybe, I'm doing this progression, and I'm
progressing from a two-footed
tibialis posterior activation exercise,
then maybe I want her to just- I'm going to
give her this kickstand of just allowing
the ball of her foot to stay on the
floor so that she's not lifting quite so
much weight with this leg.
That's okay. I'm okay with
that initially, but then as she gets
better, I want her to pull this leg up.
I'm even going to have her dorsiflex an
invert so that I'm reinforcing triple
flexion mechanics on this side, triple
extension mechanics on this side. You
guys can see how the carryover and
transfer would happened there to some of
her other athletic activities. Good, back
up and back down. Let's show everybody
what it looks like from the other side.
Lean over. Oh, good, Alright, so she's
going to post up against the wall here.
Make sure that she's perpendicular to
the wall. I don't want her- what tends
to happen to people is they start
falling in this way. That's what this
arm is for. No need to turn this into a
stability exercise. I have other
exercises, I have other techniques that I
can use to start working on her stability
and balance. This is just tibialis
posterior activation. Turn this foot in
a little bit. Because you're so
advanced, we're going to go ahead and
lift this leg up, dorsiflex, reinforce
that triple flexion mechanic. Let's
reinforce this triple extension mechanic,
squeeze your glute, no anterior pelvic
tilt, little tuck under if we need to
drawn in, quad tight, drive through
the ball of your foot, ankle straight up.
Alright, so that time you kind of turned
out on me and then caved in, so let's
step out just a little bit from the wall.
Good. Drive into the wall. There you go.
Just giving individuals the
cue to push a little bit into the wall
sometimes helps. Sometimes that will help
get their ankle to go up and out rather
than cave in.
Good.
Getting tired? Good deal. Alright, so
before we we wrap this video up, I do
want to give you guys a closer look at
what's happening to Melissa's feet.
Once again, guys, just to go over the
position of the feet, make sure
she's slightly internally rotated, pinkie
toe pointing straight ahead, we don't
need crazy internal rotation just a
little bit, we want toes up, driving
through the full ball of the foot. From
big toe all the way to little toe,
just behind the ball of her foot is
driven hard into the ground. And then
you're going to watch the lateral
malleolus to see if it goes up and out
just a little bit as we try to stimulate
both plantar flexion and inversion to
make sure that we are getting as much
positive activity as we possibly can. So
there you go, guys. That's the hardest
tibialis posterior activation
progression I have in my arsenal. Any
athlete who comes to me with any sign of
foot, ankle, or lower extremity
dysfunction, anybody with feet
turn out, feet flat, or knees cave in that
overhead squat assessment, anybody who's
lacking dorsiflexion, anybody who has
that functional flat foot or pes planus,
those individuals who as soon as they
take shoes off and step barefoot, you watch
the medial longitudinal arch collapse,
their goal- this exercise. In fact, not
just this exercise. I want to see 20 reps
at a 4-2-2 count, that's eccentric,
isometric, concentric, so we're really
focused on that eccentric deceleration
before every lower extremity workout.
That's part of their corrective exercise
program, integrated warm-up, movement prep,
whatever you want to call it. In fact, I'm
going to take this one step farther.
Forget just my athletes. I want to see
how many of you can maintain 20
repetitions at a 4-2-2 count with
perfect form. Toes up, glutes tight, quads
tight,
no speeding up the tempo to get through
the set faster. I look forward to hearing
about your outcomes. I look forward to
seeing how this exercise affects you
personally. I can't wait to see you guys
send me those videos of proof of you
doing this exercise. I hope you enjoyed it.