Tibialis posterior muscle exercises. Posterior thigh muscles: structure, functions and exercises Posterior muscle

This is the main muscle that holds the arch of the foot (see Fig. 58). The development of flat feet is associated with its weakness. In addition to the fact that it plays a major role in the formation of the arch of the foot, it also stabilizes the fibula, thereby taking part in stabilizing the knee and ankle joints.

When the posterior tibialis muscle (PTM) is weak, the arch of the foot drops, the stabilization of the ankle and knee joints is disrupted, which leads to injuries to these joints and ligaments of the joints even with a light load. Pain in the knee joint is often associated with weakness of this muscle. It is also one of the first to begin to get tired when walking for a long time, causing instability of the foot and knee joint.

The two most common causes of weakness of this muscle are impaired innervation and injury to the muscle itself.

Very often you can now hear about the interconnections of all parts of our body. Some of these connections have nothing to do with reality. Some are quite minor. But the third group really has an impact. The foot belongs to such connections.

The foot is formed in such a way that when the weight of the body is transferred to one leg during a step, the arch of the foot flattens slightly, and then, when the load is transferred to the other leg, it becomes the same again. And this happens with every step.

But when this mechanism is disrupted and the muscles that hold the arch of the foot lose the ability to return it to its original state, then problems begin.

The more pronounced the weakness of the PV muscle, the more muscles they suffer from this. First of all, the calf muscles try to compensate for its weakness. If they fail to do this (and usually they fail), then everything spreads higher. Turns off popliteus, disrupting the stability of the knee joint.

As a result of this, all conditions are created for damage to the ligaments of the knee joint and menisci under loads, when the entire load goes not to the muscles, but to the ligaments of the joint.

Then he will begin to suffer hip joint, all the muscles that are attached to the fibula will stop working (since it is unstable). Then the disturbances will spread higher: the lower back muscles will be switched off, the movement of the diaphragm will be limited, etc.

As you can see, foot problems can cause a lot of trouble. Everything would be fine, and everything seemed clear.

There is a weakness in the ZBB muscle, it needs to be eliminated, all the problems come from it.

But the most difficult thing is not to find weak muscles (although this is also difficult, because you need to do muscle testing correctly). The hardest part comes after, when you need to understand in what sequence to treat all this.

And suddenly the weakness of the posterior tibialis muscle turns out to be due to shortening quadratus muscle lower back and innervation disorders. And in order to turn it on, you need to remove the shortening of the quadratus lumborum muscle (see Fig. 59).

In the end, as you understand, it’s like a complicated detective story, where everything is tied into one ball and it’s not so easy to figure it out.

Case from practice
A woman came to me complaining of pain in her lower leg. According to her, the tibia hurt, the pain was inside the lower leg, and it seemed to her that the bone hurt.

This pain continued for five years, getting worse after physical activity, walking or standing for long periods of time.

The patient had not been able to wear high-heeled shoes for several years. I tried different treatment methods without success. The last thing she was asked to do was a diagnostic autopsy: sawing through the bone and seeing what could be hurting inside.

As a result of the diagnosis, it turned out that the patient has a sharp weakness of the posterior tibial muscle on both sides, associated with compression of the nerves internalizing it at the level lumbar region spine. The pain she felt was caused by the muscle itself, or rather, what was left of it, and the periosteum of the tibia at the site of attachment of this muscle.

Also very painful were the calf muscles, which took on the load of the non-working muscle and had to overexert themselves in an attempt to stabilize the fibula.

After I eliminated the weakness of the posterior tibialis muscle by restoring its innervation, the soreness of the calf muscle immediately decreased by 50%.

After the muscle started working and all the other muscles that had stopped working due to the weakness of the BB muscle were turned on, the patient did exercises on them for several days.

It was necessary to restore the motor pattern, because the wrong habit of walking had already formed without using those muscles that did not work before treatment. Some of them joined the movement on their own, but some were unable to do this, since they turned off a long time ago and did not have time to join the movement; Instead, out of habit, the muscles that replaced them worked.

After all the work done, the pain completely disappeared. And besides this, the patient was able to start not only walking without pain, but also running. I started working out in the gym, but, of course, taking into account all my recommendations.

Exercises to restore the tibialis posterior muscle

1. Elimination of trigger points. The only part accessible for massage is the place of its attachment to the tibia with inside.

2. Static pressure with the foot, while the heel remains in place, the foot does not lift off the floor (Fig. 60).

3. Exercise with a tourniquet, rubber expander. The heel remains in place, the foot slides, overcoming the resistance of the tourniquet. The foot does not leave the floor. In this exercise, the number of repetitions may be greater than in others. But it’s still better to start with 10 repetitions, maximum 20 and gradually increase. Do 2-3 approaches. Maintain muscle tension throughout the movement (see Fig. 61).

The tibialis posterior muscle originates from the junction of the tibia bones at the top of the ankle and passes into a long, strong tendon at the bottom. It passes through the talus bone of the heel and attaches to the metatarsal bones. This is in Latin deep muscle called tibia posterior, which literally means “back flute” or “pipe”. It is elongated and long, widening slightly at the base and narrowing towards the end. The anatomy of this amazing muscle determines its functions; it is involved in the process of unfolding the foot, in plantar extension and flexion of the ankle joint.

Location and functions

The photo shows the anterior and posterior tibial muscles

The posterior tibial muscle (PTM) is located between the small and large tibia bones of the leg and is attached to the interosseous septum. She occupies the deepest position. Above it are the flexor muscles of the fingers, the flexor of the thumb and the muscles of the lower leg. Its base is located closer to the heads of the tibia.

MBA functions:

Forming the arch of the foot, lifting it up. This is an isolated movement.
Stabilization of the fibula. If fibula is not fixed to the required degree, it will wobble. Friction between the heads of the tibia and fibula causes knee instability. This gradually leads to arthrosis of the knee joint. There is also instability in ankle joint, the position of the talus changes. It moves slightly forward, which limits the flexion and extension of the foot. This is especially important for athletes, since the stride shortens during walking and running. If this phenomenon is observed in one leg, over time it leads to the formation of a difference in the volume and tone of the buttocks.
Supports the arch of the foot and stabilizes the knee joint.

It may seem that the MBA is just holding up the arch. But if its functions are weakened, the location of the hip, knee, and bones of the lower leg changes. This leads to various pathological changes in the skeleton and pain, poor posture, degenerative changes in the spine.

If the backbone is weak, other muscles cannot work correctly: neither the gluteal muscle nor the extensors of the fingers. They turn off during movement, during a step. This causes pain and discomfort, ultimately leading to decreased mobility of the lower leg.

A sign of weakness in the cervical spine is pain in the calf area.

Weakness of the tibialis posterior muscle provokes weakness of the ligamentous apparatus of the foot; all the small bones that form its arch diverge to the sides, this leads to flat feet.

The transverse and longitudinal arch of the foot forms the tone of this muscle. The effectiveness of all legs depends on it.

Causes and consequences of weakening the BMS

Pain in the leg when the sciatic nerve is compressed is a consequence of weakness of the sciatic nerve

As a result of loss of tone, tendinopathy of the posterior tibialis muscle develops - the tendon of the posterior tibial muscle undergoes pathological changes. The main symptom of this disease is an unpleasant sensation, especially after walking or running, in the area of muscle attachment, ligament and localization of the ligament.

Inflammation in the muscles, vessels, veins and arteries of the leg is also very likely.

It becomes difficult for them to supply the muscle with blood in the required volume, as a result it partially loses its functions.

Weakness of the backbone not only causes flat feet, but also inhibits development gluteal muscle. In this case, it will be possible to pump up the buttocks only after the functions of the hip joint have been restored.

Principles of MBA training

Daily exercises to restore the functions of the brain can be performed at home

To restore the functions of the hip joint, you need to perform a special set of exercises to reduce it, and also tone it with every step. This is possible if the foot extends well with each step.

Isolated movement of the hip joint occurs when the foot moves inward. Only the tibialis posterior muscle works this way.

This movement is used for its training and development.

For athletes and those who have weakened muscle tone, if they have flat feet, it is important to follow the principles of training and exercise regularly, this is the only way to achieve results.

How to restore the tone of the tibialis posterior muscle

Massage will help restore muscle tone

It is very difficult to influence the MBA from the outside. You can get to her between calf muscle and tibia.

You can do the massage yourself by doing the following:

tapping on the posterior tibia from the bottom to the top and in the opposite direction. At the same time you need to move your foot left and right. This will enhance the effect. Tapping should not be forceful, the use of force will only cause harm;
pressing thumbs arms or the base of the palm along the tibia from the inside from the base of the hip bone to the foot. Closer to the ankle joint, there are nerve endings in this place and pressure can be very painful.

You need to work out the muscle well with a massage, relax tense areas and then begin the exercises.

To treat flat feet, you need to start training to maintain and restore the tone of the backbone with static exercises.

While sitting, place your feet on the floor. You need to press on the inside of the foot in the toe area. At this time, apply resistance with your foot for several seconds. In this case, the knee does not move and remains in a static position. Perform up to 10 repetitions.
While sitting on a chair, move your foot, without lifting it off the floor, inward towards the other foot. The heels stand still, the toes move towards the opposite leg. Do 10 repetitions for each leg.
Do exercise 2, but with both feet at the same time. When your fingers touch, press against each other for 3 seconds. The feet seem to be trying to move inward, but they interfere with each other. Perform 5 to 10 repetitions.

The second stage of the training is exercises for the tibialis posterior muscle with a rubber band.

Fasten the tourniquet and make a loop. Place the loop on your foot and sit on the floor with your leg extended forward. Make an isolated movement of the foot (rotating the toes inward with effort) with a tourniquet draped over it. The number of times is individual, until the muscle becomes tired. This version of the exercise can be performed while sitting on a chair.
This movement needs to be connected when the first ones are performed with ease. You need to place your foot on the step along the edge. It is advisable that half of the foot hangs slightly from the elevation. Now you need to rise a little, shifting your body weight to the foot of your working leg, then return to initial position. Perform until you are tired, it is important not to overdo it.

To restore and maintain the tone of the brain, you need to carefully and calmly perform the entire complex and massage every day. Regular training of the tibialis muscle will return it to its former functionality.

In the video you can see the anatomical structure of the lower leg and foot, and see the basic exercises to maintain the functions of the hip joint.

This syndrome is a cause of medial hindfoot pathology that is often overlooked and misdiagnosed, especially in the early stages. This is a direct result of loss of function of the tibialis posterior tendon.
Chronic inflammation leads to degeneration and stretching of the tendon with the formation of interstitial edema, thinning and chronic tendon damage. If untreated, all this leads to disruption of the alignment of the hind and midfoot with pronation of the heel, plantaflexion of the talus, subluxation of the talonavicular joint and, as a result, the formation of a unilateral flat foot.
The tibialis posterior muscle is active during the stance phase, engages immediately after heel contact, and quickly stops contracting after heel lift. Her belly starts deep inside her rear end lower limb, the tendon follows down to the back of the medial malleolus, where it is anterior to the tendon flexor longus fingers, posterior tibial neurovascular bundle (posterior artery, vein and nerve) and flexor tendon of the thumb. All of these structures are limited to the flexor retinaculum near the medial malleolus. The tendon of the posterior b/b muscle passes in the groove behind and below the medial malleolus, dividing into 3 parts at the medial side of the talus. The anterior part is attached to the tuberosity of the scaphoid, the middle part continues into the plantar tarsal region and is attached to the plantar part of the sphenoid bones, the cuboid and at the base of the 2, 3 and 4 metatarsals. The posterior portion is inserted as a fascicle into the anterior portion of the inferior calcaneonavicular ligament. The medial malleolus acts as a multi-roller pulley, allowing the posterior b/w tendon to change direction of pull, and these attachment points provide supination of the hindfoot and midfoot during weight bearing while stabilizing the midfoot arch structure.
The main function of the posterior muscle is to achieve supination in the subtalar joint and adduction of the forefoot around the oblique axis of the midtarsal joint.
. At the beginning of the stance phase, the posterior b/w muscle contracts eccentrically to slow down the pronation that occurs at the subtalar joint and during internal rotation of the b/w bone.
. During mid-stance, the muscle contracts concentrically, providing stability to the midtarsal joint in preparation for propulsion.
. At heel strike, this provides a plantar torque that lifts the heel off the ground.
Thus, the posterior b/b muscle acts as a primary stabilizer against posterior valgus, anterior abduction, and as an antagonist peroneal muscles, especially the short fibula.

Etiology.
The causes are unclear and are associated with the following conditions:
. Obesity
. Excessive pronation of the foot, which leads to compression and disruption of the blood supply to the tendon that goes around the medial malleolus deep under the support.
. Structural and anatomical abnormalities, eg accessory navicular, rigid or mobile pes planus, proliferation of osteophytes in the medial malleolar groove, shallow groove and equinus of the ankle joint.
. Inflammatory joint diseases, RA, seronegative arthritis
. Collagen vascular diseases
. Direct trauma when the tendon is torn by fragments of the medial malleolus
. Indirect trauma such as ankle fracture, eversion ankle sprain, acute avulsion injury of the scaphoid and posterior b/w tendon displacement
. Iatrogenic effects (injection of steroids into the area)
Pathology.
The concept of dysfunction can be divided into 4 stages:
1. Asymptomatic stage. Assessment of the patient may reveal underlying abnormalities that may lead to the development of dysfunction. For example, fully compensated hindfoot varus, or obesity.
2. Stage of initial symptoms. Tendonitis (inflammation of the tendon sheath in the area of the flexor retinaculum). Mild weakness of the b/w muscles.
3. Stage of severe dysfunction. Characterized by damage within the tendon, elongation without damage, even separation of the tendon from the rook. Pronounced pronation of the middle section and abduction of the anterior section.
Other classification:
. Acute phase. Lasts 2 weeks after onset, during which tendon pathology may not be diagnosed. Typically: diffuse swelling, tenderness on the medial side of the ankle joint. There may be soreness and fatigue in the muscles of the lower limb.
. Subacute phase. Lasts from 2 weeks to 6 months. There is pain and swelling along the tendon, from the back of the medial malleolus to the internal longitudinal arch. This may also be a symptom of tarsal tunnel syndrome due to compression of the local nerve. Passive movements in the subtalar and midtarsal joints usually do not cause pain, but the gait changes, there is no push, the anterior part is abducted, there is no supination when the heel and toes are lifted off.
. Chronic phase. Occurs in approximately 6 months. Patients have unilateral rigid flat foot. In advanced cases, pain may move from the medial to the lateral part of the tarsal sinus. Lateral pain occurs due to progressive hallux valgus deformity hindfoot, which leads to calcaneofibular axial loading, periosteal inflammation, peroneal tendinitis, and subtalar tendinitis.
Clinical picture.
In approximately 50% of cases, it is preceded by local trauma - severe eversion of the posterior segment.
Women over 40 years of age and younger athletes are more often affected.

Patients often do not seek help in the early stages, in the 1st or acute phase, because... symptoms are mild.
. Patients usually present in stage 2 or subacute phase, with diffuse swelling and heat in the medial ankle and along the tendon. Patients experience difficulty or a feeling of instability when lifting the heel on the affected side, and the heel does not supinate when lifting it off the surface.
. In stage 3 or the chronic phase, the patient notices a gradual decrease in the height of the longitudinal arch, the development of a flat foot on one side, and fatigue in the lower limb when walking. When viewed from behind, there is excessive abduction of the forefoot (too many toes). In severe cases, loss of the longitudinal arch, eversion of the calcaneus. Excessive wear on the medial heel of a shoe.
Diagnosis and differential diagnosis.
The integrity of the posterior b/b tendon is assessed by palpation when the patient actively plantarflexes and adducts the foot and the examiner applies abduction force to the forefoot. It is important to determine the exact location of the injury within the tendon and compare it with a healthy foot. Direct pressure along the course of the tendon may reveal pain, and active inversion of the foot against resistance may reveal decreased strength of the posterior abdominal muscle. If there is partial damage to the tendon, this can be palpated.
If the tendon is completely damaged, the tendon will not be palpable along its normal bed and the patient will not be able to invert the foot against resistance.
Partial or complete damage due to trauma is accompanied by various pains in the area of the tuberosity of the scaphoid bone. Damage due to excessive loads and tendon degeneration present with pain distal to the medial malleolus.

MRI is the most useful method for examining the tendons around the ankle and identifying damage. Other diagnostic tests include a bone scan and injection of radiocontrast material into the tendon sheath. Early diagnosis does not improve with direct radiographs, however, review of the foot will indicate the extent of structural changes in stage 3. A standard anteroposterior radiograph shows an increase in the angle between the longitudinal axis of the talus and the longitudinal axis of the calcaneus, abduction of the forefoot, and displacement of the 2nd metatarsal. The long axis of the forefoot no longer bisects the angle of the hindfoot. Normally, the linear relationship between the talus, navicular, medial cuneiform, and first metatarsal is lost on the lateral radiograph.
If the situation progresses, then osteoarthritis of the 1st metatarsophalangeal joint, secondary to hallux limitus, appears.
The differential diagnosis should exclude:
bone abnormalities
1. scaphoid syndrome (os tibiale externum), triquetrum syndrome, scaphoid avulsion, scaphoid stress fracture
2. osteochondritis or avascular necrosis of the head of the talus or navicular
3. fracture of the medial malleolus
4. subtalar tarsal coalition
5. inflammation of the medial sinus tarsi
soft tissue disorders:
1. deltoid ligament sprain
2. medial capsulitis of the ankle joint
3. Tarsal tunnel syndrome
4. Stretching the flexor pollicis longus or flexor digitorum longus muscles
5. posterior calcaneal bursitis
Other cases of unilateral flat foot (difference in leg length, true or relative, tarsal coalition) should also be taken into account when making a diagnosis.
Treatment.
Treatment depends on the stage or phase of the disease. Treatment must be done quickly and aggressively to prevent further deterioration. In the early stages - reduction of inflammation, joint stabilization, pain control - up to 8 weeks. In more severe and persistent cases, surgical repair of the tendon with joint fixation is possible.
Conservative treatment: NSAIDs, ultrasound, taping of the hindfoot in an inversion position to reduce tension in the tendons. Orthotics with soft temporary orthoses (valgus pads, medial pads under the entire foot - cobra) are used to invert the hindfoot. Individual rigid anti-pronator orthoses enable the posterior b/w muscle to function more efficiently, because targeted at the underlying pathomechanical defect. The orthosis controls movement at the subtalar joint, reducing tendon stretch by controlling anterior abduction (using the lateral flange). Exercise therapy is aimed at strengthening the posterior b/w muscle. More severe cases require immobilization of the foot in an inverted position in a plaster cast up to the knee for several weeks. Steroid therapy is not used due to the potential for damage to the already weakened tendon.
Surgical treatment is indicated at stage 2 or in the subacute phase. If there is no effect from 8 weeks of conservative therapy or in the 3rd stage and 4th phase. In persistent cases with moderate tenosynovitis but no obvious tendon damage, tendon release and synovectomy are indicated.
Synovectomy, tendon insertion strengthening, or flexor digitorum longus transfer are indicated in more severe cases characterized by tendon elongation.
Severe cases with complete damage or fibrosis of the tendon are treated with transplantation of the flexor digitorum longus, shortening of the ligaments and talonavicular capsule, and surgical widening of the bony canal under the medial malleolus. Arthrodesis of the hindfoot joints, such as between the talus and calcaneus, subtalar arthrodesis, talonavicular fusion, or combined talonavicular and calcaneocuboid arthrodesis may be indicated in advanced stages with pain in the lateral hindfoot.
The results of corrective surgery are not always straightforward. The procedure requires a long period of recovery, rehabilitation, and exercise. The amount of postoperative correction of planalgus in degrees is difficult to predict accurately, however, an increase in stability during the period of support can be expected. Osteoarthritis of the joints in the hindfoot develops over a long period of time, because... When normal joint alignment is disrupted due to arthrodesis, the repaired tendon may weaken in the future with a return of preoperative symptoms.

MBA functions:

Forming the arch of the foot, lifting it up. This is an isolated movement.
Stabilization of the fibula. If the fibula is not properly secured, it will become loose. Friction between the heads of the tibia and fibula causes knee instability. This gradually leads to arthrosis of the knee joint. Instability also occurs in the ankle joint, and the position of the talus changes. It moves slightly forward, which limits the flexion and extension of the foot. This is especially important for athletes, since the stride shortens during walking and running. If this phenomenon is observed in one leg, over time it leads to the formation of a difference in the volume and tone of the buttocks.
Supports the arch of the foot and stabilizes the knee joint.

If the backbone is weak, other muscles cannot work correctly: neither the gluteal muscle nor the extensors of the fingers. They turn off during movement, during a step. This causes pain and discomfort, ultimately leading to decreased mobility of the lower leg.

Weakness of the tibialis posterior muscle provokes weakness of the ligamentous apparatus of the foot; all the small bones that form its arch diverge to the sides, this leads to flat feet.

The transverse and longitudinal arch of the foot forms the tone of this muscle. The effectiveness of all legs depends on it.

Principles of MBA training

To restore the functions of the hip joint, you need to perform a special set of exercises to reduce it, and also tone it with every step. This is possible if the foot extends well with each step.

Isolated movement of the hip joint occurs when the foot moves inward. Only the tibialis posterior muscle works this way.

For athletes and those who have weakened muscle tone, if they have flat feet, it is important to follow the principles of training and exercise regularly, this is the only way to achieve results.

How to restore the tone of the tibialis posterior muscle

It is very difficult to influence the MBA from the outside. You can get to it between the calf muscle and the tibia.

You can do the massage yourself by doing the following:

tapping on the posterior tibia from the bottom to the top and in the opposite direction. At the same time you need to move your foot left and right. This will enhance the effect. Tapping should not be forceful, the use of force will only cause harm;
pressing with the thumbs or the base of the palm along the tibia from the inside from the base of the hip bone to the foot. Closer to the ankle joint, there are nerve endings in this place and pressure can be very painful.

You need to work out the muscle well with a massage, relax tense areas and then begin the exercises.

To treat flat feet, you need to start training to maintain and restore the tone of the backbone with static exercises.

While sitting, place your feet on the floor. You need to press on the inside of the foot in the toe area. At this time, apply resistance with your foot for several seconds. In this case, the knee does not move and remains in a static position. Perform up to 10 repetitions.
While sitting on a chair, move your foot, without lifting it off the floor, inward towards the other foot. The heels stand still, the toes move towards the opposite leg. Do 10 repetitions for each leg.
Do exercise 2, but with both feet at the same time. When your fingers touch, press against each other for 3 seconds. The feet seem to be trying to move inward, but they interfere with each other. Perform 5 to 10 repetitions.

The second stage of the training is exercises for the tibialis posterior muscle with a rubber band.

Fasten the tourniquet and make a loop. Place the loop on your foot and sit on the floor with your leg extended forward. Make an isolated movement of the foot (rotating the toes inward with effort) with a tourniquet draped over it. The number of times is individual, until the muscle becomes tired. This version of the exercise can be performed while sitting on a chair.
This movement should be used when the first exercises after a fracture are performed with ease. You need to place your foot on the step along the edge. It is advisable that half of the foot hangs slightly from the elevation. Now you need to rise a little, shifting your body weight to the foot of your working leg, then return to the starting position. Perform until you are tired, it is important not to overdo it.

Name

Musculus tibialis posterior

Start

interosseous septum of the leg

Attachment

foot bones

Blood supply

a. tibialis posterior

Innervation Function

flexes the foot

Antagonist Physical examination

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Catalogs

Tibialis posterior muscle(lat. Musculus tibialis posterior) - muscle of the lower leg of the posterior group.

Function

Flexes the foot and adducts it along with the tibialis anterior muscle. Together with other muscles attached to the medial edge of the foot, it also participates in the formation of the “stirrup”, which strengthens the transverse arch of the foot.

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Notes

Pelvic muscles

Inner group

Outdoor group

Thigh muscles

Calf muscles

Front group

Back group

Lateral group

Foot muscles

An excerpt characterizing the tibialis posterior muscle

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