Tibialis Posterior Tendinopathy Pain in Runners
The tibialis posterior muscle is one of the major players when we talk about stability of the ankle joint complex. It has a huge part in stabilising the ankle and medial arch when it comes to running walking and jumping. Unfortunately, through various reasons it is also one of the more commonly injured tissues or tendons when it comes to the ankle and in particular runners.
Recognizing Tibialis Posterior Dysfunction
Pain down the inside of the shin or behind the ankle bone can be indicative of tibialis posterior dysfunction. An aching feeling at rest or a sharp burning pain when walking, running or jumping in these areas frequently is from tibialis posterior injury. Whilst it may feel better with rest in the short term if you notice that the pain is still present or even worsening with running and jumping then it’s time to pay attention to the area.
Understanding the Tibialis Posterior Muscle
If you’re suffering from the above symptoms there’s a good chance your tibialis posterior muscle is dysfunctional and needs some work. First of all, lets understand what this muscle actually does. Tibialis posterior is the deepest and most central muscle in the posterior lower leg. The tibialis posterior originates off the back of the tibia and fibula bones up near the knee joint, travels down the leg and behind the ankle joint on the inside of the leg before finally attaching on the plantar surface of the foot just in front of your heel bone. The tibialis posterior’s function is to plantar flex and invert the foot.
Through its action on the ankle, the tibialis posterior’s main action is to help the other more powerful muscles elevate the heel up off the ground when the foot is planted. Now it becomes obvious that it is a big player in running and jumping.
Other functions of the tibialis posterior include resisting foot eversion and playing a supporting role in elevating, tensing and reinforcing the medial longitudinal arch of the foot. This helps distribute body weight through the foot when it is impacting or planted firmly on the ground, for example during the heel strike phase of gait during walking or running.
Possible Injuries and Strains
Given the role of the tibialis posterior it is easy to see how if the whole lower leg and foot complex is either weakened or not functioning optimally in one or more areas, the muscle and tendon can endure more stress than it is designed to handle and hence lead to muscular strain or tendinopathy.
Quite often we see runners and walkers presenting with tibialis posterior tendon pain. Symptoms associated from tibialis posterior tendinopathy will feel like:
Pain and swelling anywhere from the inner side of the ankle and foot up to the inner side of the calf or shin bone.
Pain may be exacerbated by activity, standing on your tip toes or walking up and down stairs.
We may even see a limp develop or a flattening of the arch of the foot when walking or running.
Now you may feel this is the cause of your pain but it’s often best to gather a firm diagnosis to make sure you treat it correctly and not waste time with the wrong exercises. Luckily these tests are easy to do at home and quickly confirm if this indeed is your injury. Along with just the presentation or location of your pain there’s a basic manual muscle test to determine if there is any weakness or pain when isolating the tibialis posterior muscle as best we can.
Secondarily you can do a simple calf raise starting with double leg and then assessing single leg to see if functionally there is any pain or weakness that may present from the tibialis posterior. In this test as we get right up the top of the calf raise at end range of motion we want to see the foot or heel bone invert to the midline a little bit. This is demonstrating the strength of the tibialis posterior muscle.
Finally, here’s a test we like to do to assess the endurance of the tibialis posterior. This is a good test because quite often fatigue will need to be present to replicate some symptoms. At home you can mimic the muscle test from earlier or do it side lying as in the video to make it easier on the tester. An alternative we use in the clinic is to use a strong resistance band in the side lying position which you can do if you have access to a resistance band. During the test we want to see at least a 20-30 second hold without a change of position of the foot testing the endurance and fatigue of the tibialis posterior muscle.
If after all this you think you may have some tibialis posterior weakness or dysfunction the good news is there’s some really simple exercises and mobility work you can do at home to start to add some strength and restore function. At Elite Health and Performance, we start by de-loading the tissue with myofasical release shown in the video that you can perform at home.
We then recommend starting off with isometric holds for a few days before then moving to concentric reps or consulting your therapist to guide you if you are confused.
Watch video here - Tibialis posterior ball raise
Watch video here - Tibialis posterior band raise
If you still are suffering from issues it may be best to get a therapist to look over your injury. Quite often in the acute phase methods of tissue release and dry needling can alleviate pain and tension and then allow for a personalised strengthening program to be tailored around your case and goals.