Posterior tibialis tendonopathy can be tricky to treat sometimes. There are many different theories to the causes of PTT. However, what we do know is some of the signs of posterior tibial tendon dysfunction which can include: increased heal valgus, PF of the talus, flattening of the medial longitudinal arch, and abduction of the forefoot. While we won't go into the examination of the posterior tibial tendon dysfunction or tendinopathy in this post, we will go over the functions of the posterior tibialis.
The tendon is posterior to ankle axis and medial to the STJ axis which makes it a plantarflexor and invertor. Additionally, it directly opposes the action of the peroneus brevis muscle by acting as an adductor of the forefoot. It is the primary dynamic stabilizer of the medial longitudinal arch.
The closed chain foot adduction exercise is one of the more effective ways of strengthening the posterior tibialis. In 2004, Kulig, et al. conducted a study using magnetic resonance transaxial imaging to find the signal intensity of the posterior tibialis muscle during 3 exercises (closed chain foot adduction, unilat. heel raise, and open chain foot supination). What they discovered was that in individuals with a normal arch index, the posterior tibialis was most activated during closed chain foot adduction when compared to the other two exercises mentioned above.
To perform this exercise, place a theraband around the leg of a table/therapy plinth and the patient's foot. Instruct them to keep their foot on the ground throughout the exercise. Teach them to perform foot adduction. Be sure to look for substitutions as they are often common when prescribing this exercise.
This is an easy, simple, and effective way to help your patients "feel" their low trap working. By cueing them to rotate their head away from the arm pushing down, the upper trap will relax a little. Give it a try if you can't get your patients to stop substituting at the upper traps.
With the theme of rhythmic stabilization the past few weeks, this week's exercise focuses on the GH joint and scapula stabilizers of the shoulder. This exercise challenges the patient to recruit the scapula stabilizers which is important to keep normal kinematics. By instructing the patient to keep the palm open instead of tightly closed over the ball, more activation of the shoulder stabilizers must come into play.
Instruct the patient to be seated on a stability ball with their palm on the ball against the wall. Keeping their feet close together, begin applying rhythmic stabilization in all directions, increasing speed as needed. To progress this exercise, have the patient extend their opposite knee to create more imbalance to the exercise. A final progression would be to have the patient abduct their opposite shoulder with a light weight for a sustained hold.