The Runners Nemesis…

treatment of tibialis posterior

Treatment of Tibialis Posterior (TibP) is necessary for many runners. If  you have foot, heel or calf pain, you may have thought it was from tight calves and plantar fasciitis.

This is a common problem for many runners and other athletes. However, you may have treated your PF quite effectively, only to find out that some of the pain remains.

What is going on here? You may need treatment of tibialis posterior trigger points.

treatment of tibialis posterior heel pain

You are most likely to activate and require treatment of tibialis posterior trigger points if you run on uneven surfaces. Of course, natural trails are often uneven. However, the most common scenario is running on side of crowned roads. The problems is that we have usually developed a preference for running into the traffic or with it. So, we run down one side of the road for some distance and then return on the other side.

For instance, if you run against the traffic, you are running with your left side lower on the crown of the road than your right side. If you return on the same road, also running against traffic, you will repeat the pattern. Of course, it is safest to run on flat surfaces. However, if you need to run on a crowned road you should run against traffic one way and back on the same side, with traffic. This will “undo” the imbalance created.
Even so, one foot will always tend to pronate while running on a crowned surface. This pronation has been linked to a variety of repetitive stress injuries associated with running. Despite all this info, there are some running experts who maintain that the most important factor is over-training. Injuries happen from running too much, too far, too fast, too soon, etc. It may be that TibP is merely a “weak” spot and is secondary to over-training for some runners.

Myofascial Treatment of Tibialis Posterior

Traditionally, massage therapy is unable to reach the TibP, but most trigger point therapists can do it quite easily with manual pressure release and acoustic compression.

If you have trigger points in the TibP we will usually want to check you for Morton’s Foot Structure. This common skeletal variation makes your foot want to pronate. So it makes sense that a muscle whose primary function is to resist pronation would be unhappy. A simple correction with a posture control insert is usually all that is needed. Less often, the bones in the foot move too much and the arch has fallen. This requires an appropriate arch support that can be added to the posture control insole.

The TibP is notoriously difficult to fully stretch. Ideally we want to turn the ankle out to the side (eversion) to counter the tendency of TibP to pull it to inversion.

However, most of don’t have a nifty wedge like this. Instead we attempt to find standing or seated poses that allow us to move the ankle side to side through its entire range of motion.

Finally, we return to some adjustments, if possible, in the activity that perpetuates the problem. Runners should train on a flat track when ever possible.

We like the stretches and exercises in this series of videos. Stick this to the end for the balancing exercises and the chair stretch. For most people, strengthening the TibP is not the issue – we’re looking to get a nice stretch!

Next we work through the related muscles. Our tibialis posterior treatment protocol always includes of targeted compression to the full complement of muscles in the lower legs, along with movement through the entire range of motion of the ankle. First, we move gently between inversion/eversion and plantar flexion/dorsiflexion. Then we start to combine the movements. However, for the TibP we use eversion as a stretch.

We also use techniques like “post -isometric relaxation” to help reset the TibP. We follow this with stretching of the TibP, which can be challenging in both seated and standing positions.

Because issues with this muscles often happen in conjunction with other related muscles it is tempting to focus on those instead. Some of these helper muscles for TibP for inversion of the ankle and assisting balance are the long toe flexors, deep in the calf (flexor hallucis longus and flexor digitorum longus). The tibialis anterior also assists in this function. The primary antagonist to the ankle inversion of tibialis posterior is the fibulari (formerly peroneal group). Problems with the fibularis longus contribute to ankle instability. Subsquently, this can cause myofascial dysfunction of tibialis posterior.

Attempting to treat the leg as whole, we typically see calf, quad and hamstring stretches as part of a reconditioning the tibialis posterior. This are a great idea, but do not get at the heart of the matter

We can review a little bit of the anatomy to understand how this muscle works.

treatment of tibialis posterior heel pain

In this illustration the gastroc and soleus have been removed for clarity.

Tibialis posterior is located VERY deep to both of them. In addition, we can see that it crosses over the back of the leg from the outside to the inside, from top to bottom.

In fact, TibP crosses all the way to the inside of the heel and runs just under the front of the arch to the attach to the heel.

This muscle works together with a partner (fibularis longus) coming from the outside of the heel to form a sort of stirrup under the rear of the arch.

If you compare this diagram to the one our Plantar Fasciitis Treatment post you can see how the two areas overlap. They often occur together. The function of TibP is to prevent excessive pronation of the foot during midstance of walking or running. It also distributes body weight across the heads of the long bones of the foot (metatarsals).

“Co-contractions of the tibialis posterior and fibularis longus may help support the medial arch and prevent hyperpronation of the foot, especially in runners”


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What About My Pain?

Clearly, everyone is different. Many of us have additional challenges and complications. Naturally, we tailor our treatment plans to the individual. However, there are common foundations in this work with everyone.

Fortunately, if you are having similar issues, you may find that a just few treatment sessions helps! We will identify and treat root causes of your individual case.

Clearly, everyone is different. Many of us have additional challenges and complications. Naturally, we tailor our treatment plans to the individual. However, there are common foundations in this work with everyone.

We are licensed professionals. In addition, we all have additional training and certifications in advanced techniques. For instance, this includes trigger point therapy, fascial stretching, neuromuscular and movement therapy. Also we offer kinesio taping, myofascial release, cupping, acoustic compression, self-care classes and more. In fact, we often combine several of these techniques into a single session..

Of course, no one wants chronic pain! Fortunately,  can work together with you to help sort out the issues.

Click here or all us at 630-858-0000 today to make an appointment!
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