Step-by-Step Guide to Posterior Tibialis Strengthening
In this article, I want to provide specific guidance for any runners who have been told to strengthen the posterior tibialis muscle. The following videos and descriptions provide a practical guide for how I usually progress the tibialis posterior strengthening exercises for runners who need to rehab the muscle and tendon.
As your ankle rehab progresses, and you work through the list of posterior tibialis exercises below you’ll move through the following different phases:
- Non-weight bearing range of motion exercises (unresisted/resisted)
- Weight bearing proprioception and balance exercises
- Anlke strengthening exercises in weight bearing
- Dynamic loading and plyometric exercises
- Phased return to running
1. Unresisted Ankle Movement Through Range
Depending on your injury, in the initial stages of your treatment and rehabilitation, your physiotherapist may well prescribe non-weight bearing, unresisted range of motion exercises, such as the exercise shown in the video below. These help to develop strength and pain-free range of motion into inversion and eversion in particular.
2. Resisted Movement Through Range
As your treatment progresses, resistance exercises further help to build strength and stimulate the healing process of the tibialis posterior tendon. Using a resistance band as per the video below particularly helps to build crucial eccentric strength.
3. Weight Bearing Proprioception
The next progression adds the important weight bearing and proprioceptive elements. Perform this exercise barefoot. The video demonstrates well how tibialis posterior has to constantly work dynamically to maintain medial arch height as the body moves above the foot.
4. Dynamic Weight Bearing Proprioception
As a progression to the above exercise, we now add more dynamic movement from the upper body, while still in single-limb stance. This challenges tibialis posterior further to maintain the medial arch. Once you appreciate how tibialis posterior helps to control dynamic foot posture, knowing how to strengthen tibialis posterior becomes more straight forward.
5. Heel Raise with Inversion
Here’s another weight bearing exercise to build strength in the tibialis posterior muscle, and around the ankle in general. You might also want to check out this similar weight-bearing posterior tibialis strengthening exercise for runners.
6. Low Level Plyometrics
Here’s another weight bearing exercise to build strength in posterior tibialis. You can learn more about plyos here:
Begin with 5 x 10-second efforts, and see how your tibialis posterior region reacts!
7. Ballistic Heel Raise Off Step
Here’s a ballistic weight-bearing exercise, working through a full range of motion, to build strength in posterior tibialis.
Start gently. Build up to the intensity of the exercise in the video!
8. Phased Return to Running
Once you have worked through this progression of posterior tibialis exercises, and are able to perform them all pain-free. Your physio will probably be happy to let you start on a phased “return to running” programme.
Here’s an example of the free programme I give runners to safely rebuild their mileage after injury: