The Runners Nemesis…
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.
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.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 i
s 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.
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).
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Janet was great. FANTASTIC person who knew how to treat and deal with my conditions. Very informative. Finally, someone who knew what I was talking about.
Really Good
It was interesting, and helpful for my IT band and hip
My experience was wonderful. Janet was very kind and attentive. I felt great after my session and would recommend to try it out.
The lady that assisted me was awesome! I suffer from fibromyalgia and when I left I felt like a brand new person! I plan to return when I get time!
Janet was great - knowledgeable and she found all my "hot spots."
Seriously, if you are looking for massage therapy that actually does your body good--that changes its function for the better and actually makes pain go away--then this is the place you need to come. Not Massage Envy. Not a chiropractor. You need trigger point from knowledgeable experts in the craft.
If your have pain in any part of your body this is the place to go. It focus on the muscles where the pain is. you will feel like a new person. Awesome will be returning. Thanks nice friendly and attentive
amazing!!!
I felt so much better after my appointment. Thank you and thanks for the self care tips!
Experienced therapist. Feel great after appointment...
Highly recommended!
What a great experience. The provider was able to recommend things I can do to improve my pain. Address issues I didn't even share with her that she was able to tell just by her exam and treating me for what i went for. Will be back. Feeling grateful
I spent so much money on chiropractors. This is much better. Everybody should try it out.
Beautiful, relaxing setting. Therapist was knowledgable and professional. I'll be going back. Thank you.
Janet is very informative. I loved that she explained which muscles/groups she was working on. I learned a lot about my posture and why some of my muscles are not activating. She also provided me with a list of considerations and excercises to improve my posture. I will be back!
Janet has a unique gift and talent in trigger point therapy. I’m definitely seeing her again!
I loved my experience. Janet is extremely knowledgeable in a vary wide variety of conditions. She is thorough and attentive. Makes you feel right at home!
It's like an hour of physical therapy (the good parts of P.T. where they massage you and stretch you). She also takes time to explain some ways to help your specific issues. Highly recommend!
Janet is very knowledgeable and informative. She thoroughly explains where you have weakness and what muscles are over compensating. She gives exercises, stretches, or everyday changes you can make to help you are progress on your own. I highly recommend a visit!
Janet was very knowledgeable and never in a hurry. She took her time explaining every little detail, great service
Felt much better after the trigger point massage, highly recommend.
Excellent
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.
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