♪ Bob and Brad ♪
♪ The two most famous physical therapists ♪
♪ On the internet ♪
- Howdy folks?
I'm Bob Schrupp, physical therapist,
- Brad Heineck, physical therapist
- And together we have the most famous
physical therapist on the internet.
- In our opinion of course, Bob.
- And Bone Aparta agrees.
- Yeah, he'll testify at anything.
- Yeah, he better.
- Okay, Posterior Tibial Tendonitis,
three of the best treatments for it.
- Okay?
- Okay.
- Sounds good. I'll put that word down below or
Those words down below.
So people know what we're talking about.
- Sure, We just did a video
on the anatomy of it and how to test for it.
- Yeah, I'll link that right here.
- Okay. So we know that we have it,
And now how are you gonna treat it?
First thing you're gonna do
it's gonna be sore when you walk or you run.
So you're gonna rest it.
- Gonna be sore right in here.
- Right? You're gonna rest it, ice it
those types of things.
- Ice right on here.
- Right, 15 to 20 minutes. One thing you can try
this is not a treatment, but it will help
possibly is get an insert for your shoe,
a cushion arch insert that that feels comfortable.
And you'll know if it's the right thing to do.
Cos when you put it on and you walk,
it makes the pain go down.
It may only 20 to 50% and you're gonna use that.
- And I would probably not even try a custom made one.
- No.
- I would just do one right off the shelf.
- Right.
- And try to find one that fits pretty well.
- Right, I usually spend, cos I think that, that's a good-
but you don't have, whatever works for you.
- Sure.
- They're 20 to 30 dollars. All right.
If you don't wanna do that, you can, but you don't have to
you can go into the treatment of
of the tibia or of the tendon itself.
One thing you can do if you've had it for a few days
or a week, and there's always some scar tissue in there
you want to use our cross friction massage.
We've got a lot of videos
with a lot of positive feedback
- Cross fiber friction massage.
- There you go. And here's the tendon.
So we're gonna go across this direction.
- Yep.
- You're gonna get in there with your fingers
and you're gonna push down relatively hard to get in.
Now there's some bones right in there
so you're not gonna grind the tendon over the bone.
So you're gonna use your good judgment
on that and work over that.
And after about 30 seconds
it should start to feel either numb or feel better.
- Right. If it's getting worse after 30 seconds to a minute
then you need to back off and ice for a while.
- Right, It needs more time.
- It's a, it's a real focal massage.
I mean really localized massage.
- Right.
- You're really working, you know
very specific to one small area.
- Exactly.
- Like Brad said,
after 30 seconds to a minute, actually like you said
it's getting numb or it's getting a little bit better.
- Right.
- That's a good sign.
That's that's a
- then you're gonna keep going
for another three to five minutes
or long as your fingers can hold up.
And like our mentor, one of our mentors, Siri X
says you can go up to 20 minutes
but your fingers are probably not gonna last that long.
- Right, And I don't know that he would recommend
20 minutes on this type of area.
- Sure.
- it was more different areas.
I, I think the three to five minutes is a good
- Okay.
- Safe,
- Super
- safe bet so,
- And the other thing is the muscle belly up here.
If that muscle's real tight and holding tension
on this all the time and not giving it a chance to relax
and get circulation, you can work a deep massage
on the muscle belly up here itself.
- Sure.
- Okay.
- And you could do that yourself.
- Yep.
- You can go in here like this
and you can also do this massage by yourself.
Okay? You're going across the tendon,
But the massage is right in the muscle itself.
- Right. And you're gonna get deep cos this muscle is deep.
It's not the big gas track muscle. So you're gonna get in
- it's down below that in there.
- Yeah.
- Yep, so
- And you're gonna work that for five minutes or so
as well, As long as you can, you can hold it. Okay?
- And then you're gonna do a stretch, right?
- Oh, absolutely.
What stretches are gonna be?
You're gonna do the stretch like this.
If you have an incline board, that's the ideal thing.
- Right.
Can I maybe go this way, Brad?
- Sure Yep, you do it
- Make sure, can you see this?
- Oh, this is nice
- I'm stretching the back one.
- Yep. Bring that right down here.
Look at that nice leg. Ha, ha, ha
anyways, the stretch is here.
Now you're gonna do this gently. It shouldn't,
If you get sharp pain with it, it's way too early.
This is later on in the rehab.
You're gonna stretch that gently. But
- you wanna show what I'm doing with my knee?
Brad? I'm not like this,
- Right.
I'm not straight
- Good point, Bob
- I'm actually bent.
- Right. And that isolates the posterior tib muscle.
If you go straight, it works on the gas track,
We're not gonna get into that.
- Yeah.
- Just remember bend it, see what you can and
get the heel to the floor
and you're gonna hold it 30 seconds a minute
or even longer than that.
If tolerated and, and depending how it feels.
Okay? Now as it progresses and starting to feel better
you want to strengthen it.
Why don't you have a seat Bob?
- Sure.
- Because this muscle actually pulls
up and inverts the, the foot.
The two ways you can strengthen it is number one,
Why don't you stand again Bob?
- Okay
- I'm sorry to make you going up and down,
is just simply two feet toe up.
Just like the test.
- Okay.
- But you're gonna use both feet
and you're gonna put as much weight
as you need through the good foot,
and only work this one as tolerated
- [Bob} Okay.
- And you 10 to 15 of them.
- You might wanna hold onto a chair even a little bit to
- Chair or a cane.
- How many of these are you gonna do?
- 10 to 15.
- Okay.
- By that time it should be feeling fatigued.
Oh, You almost tipped over huh Bob?
- I sure did.
- Okay. And now sit down.
- [Bob] Okay.
- The next one is
because this muscle pulls the foot inward like this.
You have some resistance, you would have a
put a Thera Band around here and
- A stretch band stretch band.
- Stretch band, Thera Band, and you're gonna
push in, my hand represents that.
So I'm giving some resistance
and you could do this, You know,
if you've got a loving wife that wants to help
- Yep.
- She could do just what I'm doing there.
- Could you do it yourself Even?
- You could do it yourself with resistance,
If you don't have a, Thera Band.
if you're like me and really like to be frugal.
- Yeah.
- This works. It just takes a little more effort.
Okay. But the tow up one is really nice.
- Right.
- Is more functional.
- Exactly.
- Yeah.
- Weight bearing.
- So I'm thinking this
- Close Chain.
- Yeah. These are nice exercise to get that
posterior tib back into the running or the walking game.
And again, we can fix just about anything in the human body
but what?
- We can't fix a broken heart.
- Right, but look at that size of that heart going on.
And you know, if that ever gets broken
we're gonna fix you up.
- You're in trouble buddy.
- Yeah, yeah
- Take care.