Tibialis Posterior Strengthening | Flat Feet Exercises & Treatment
The tibialis posterior is an essential stabilizer of the foot during standing and walking. The tibialis posterior tendon provides dynamic support along the plantar aspect of the foot and arch and when the muscle or tendon is deficient, decreases in longitudinal arch height often occur and can lead to flat feet.
For this reason, tibialis posterior strengthening is recommended next to foot orthoses in the rehabilitation of painful pes planus to prevent tibialis posterior tendon dysfunction and foot arch collapse. But how can we strengthen this muscle ideally? Kulig et al. did an MRI study to determine which exercise most selectively and effectively activates the tibialis posterior. They found the greatest isolated activation with the following exercise:
Have your patients sit on the bench with his knees about a full arm’s length apart and flexed about 80°. Then the patient is asked to stabilize his leg by placing the contralateral forearm between the knees and reinforcing it with the ipsilateral hand. Then an elastic band is looped around the medial and distal part of the foot that is to be trained and stretched to full tension while maintaining an inclination angle of 45 degrees . While the examiner ensures tension throughout the whole movement, the patient is asked to slide his forefoot into adduction from full abduction with the foot remaining in contact with the floor. The total range of motion can be marked with a tape to ensure full range of motion with every repetition.
In 2005 Kulig et al. compared the activation of the tibialis posterior in patients with flat feet and found higher selective activation in those patients when wearing foot orthoses and shoes. As this is the patient group you would want to give this exercise to wearing insoles and footwear is recommended.
Progression can be adjusted based on the tension of the theraband by the examiner or by choosing a theraband with a higher resistance. Like with any other rehabilitation program the total volume of the exercise should be slowly increased over time. Kulig et al.were able to decrease pain and increase function in their third study in 2009 after a 10-week program with 3 sets of 15 repetitions twice per day.
If you want to learn how to assess for forefoot over-pronation check out our post on the navicular drop test.
Kulig K, Burnfield JM, Requejo SM, Sperry M, Terk M. Selective activation of tibialis posterior: evaluation by magnetic resonance imaging. Medicine and science in sports and exercise. 2004 May 1;36(5):862-7.
Kulig K, Burnfield JM, Reischl S, Requejo SM, Blanco CE, Thordarson DB. Effect of foot orthoses on tibialis posterior activation in persons with pes planus. Medicine and science in sports and exercise. 2005 Jan 1;37(1):24-9.
- 600+ Pages e-Book
- Interactive Content (Direct Video Demonstration, PubMed articles)
- Statistical Values for all Special Tests from the latest research
- Clinical Value Recommendation
- Detailed descriptions & searchable
- Currently on Version 6.0 – Free lifetime updates
- Available in 🇬🇧 🇩🇪 🇫🇷 🇪🇸 🇮🇹 🇵🇹 🇹🇷
- And much more!
- Lorcan Hormigo Torres04/09/23Orthopedic Physiotherapy of the Upper and Lower Extremities EXCELLENT COURSE
High quality course, with practical information that can immediately be applied, based on scientific literature up to date. Excellent to summarize the fundamentals of assessment.Josh Hermans23/07/23Orthopedic Physiotherapy of the Upper and Lower Extremities SUPERB COURSE
This course was everything I expected and more! Logical structure, enough depth and clinical reasoning is challenged.Lucinda de Vries20/02/23Orthopedic Physiotherapy of the Upper and Lower Extremities ORTHOPEDIC PHYSIOTHERAPY OF THE UPPER AND LOWER EXTREMITIES
Super interessante en leuke cursus. Ook zeker voor afgestudeerde fysiotherapeuten om hun kennis weer op te halen/bij te spijkeren. Ondanks dat ik al 5 jaar werkzaam ben als fysiotherapeut was deze cursus zeker een uitdaging en op veel punten echt heel moeilijk en leerzaam.
Het enige vervelende (waar weinig aan gedaan kan worden). de vertalingen eng-nl zijn soms heel onduidelijk.
Al met al zeer genoten tijdens het volgen van deze cursus en er zullen er zeker meerdere volgen.
- Aurelio Basile09/12/22Orthopedic Physiotherapy of the Spine ORTHOPEDIC PHYSIOTERAPY OF THE SPINE
Fantastic course! simple to follow and extremely helpful in assessing and treating spinal related issues. Furthermore, it is possible to immediately apply the knowledge acquired in the clinic. A must for us physiotherapists.Aurelio Basile09/12/22Orthopedic Physiotherapy of the Upper and Lower Extremities ORTHOPEDIC PHYSIOTERAPY OF THE UPPER AND LOWER EXTREMITIES
Great course! It allows you to make objective assessments with order and clarity. As a result, it is possible to set up effective and efficient treatments.
I also found the sections on the epidemiology and course of the diseases very useful, in order to educate patients and obtain greater compliance with the treatment. Super recommended!!DUNCAN10/01/21Orthopedic Physiotherapy of the Upper and Lower Extremities GREAT COURSE
Great course, lots of information, the instruction videos are really helpful.
- DOUWE WILLAERT28/12/20Orthopedic Physiotherapy of the Upper and Lower Extremities i would recommend this course to everyone.
if i may give one suggestion that is maybe hard to implement. but i sometimes struggle with explaining things in patient language. so maybe add some frequent asked questions / mechanisms from patients and how to explain it simple or with a metaphore ?
Thanks again for all your work putted in to this course <3JEROEN VAN ZANTEN20/10/20Orthopedic Physiotherapy of the Upper and Lower Extremities I LOVE IT
This course really helps the starting physio. It gives you more convidence. The first year out of school i was really not convident and after this ( relative cheap) course, it got better! Thanks a lot physiotutors! I also got motivation to start studying manual therapy, as i know now, that there is way more to learn.WOUTER13/09/20Orthopedic Physiotherapy of the Upper and Lower Extremities FUN AND EASY TO IMPLEMENT IN THE CLINICAL PRACTISE
Took my time to learn and enjoy form this course!
Would definitely recommend this to other physiotherapist who work in the first-line care.
- ANTONIUS SMOOK22/08/20Orthopedic Physiotherapy of the Upper and Lower Extremities GREAT COURSE
They go, from the basic assessment to the lower and upper limb, step by step with scientific reasoning. It’s a very usefull course to improve your clinical reasoning in practice.JASMIN KONJIC07/07/20Orthopedic Physiotherapy of the Upper and Lower Extremities REALLY REALLY GREAT!
Everything is extremely well-researched and carefully structured! My only complaint, or actually just a hope for their future courses is that more things should to be structured as bullet points. It can sometimes hard to remember facts from a big block of text. Other than that, amazing. Thanks for your great work guys, it’s been a big help!AVIV27/05/20Orthopedic Physiotherapy of the Upper and Lower Extremities Great course, very nice and clean, full attention to details, great job boys!
- Thomas20/03/20Orthopedic Physiotherapy of the Upper and Lower Extremities STARKES KONZEPT!
Starkes Konzept wissenschaftlich untermauert für die Haupt-Diagnosen der Extremitäten. Sehr übersichtliches Design. Gute Möglichkeit das Lernen einzuteilen. Fortbildung der Zukunft. Nur zu empfehlen. Freue mich auf die nächsten Kurse!Marc07/01/20Orthopedic Physiotherapy of the Upper and Lower Extremities LEERZAAM
Goede opbouw en uitleg per onderdeel.JUDITH06/01/20Orthopedic Physiotherapy of the Upper and Lower Extremities My compliments for this online course! I’m feeling all up to date now! I can see why it is highly accredited with the KNGF. Other than expected I quite enjoyed taking the course! Good structure ,good balance between text en videos and content en quiz. For me the assessment assignments worked great to lock the knowledge in! Quizzes are sufficiantly challenging and force/ motivate to really study the contents, think about it and listen to the questions carefully!
Great video footage of tests and exercises! Great links to articles! All very useful for dailey practice (even in osteopathy ;)) and immediately applicable! Should contribute to communication with other health care specialists e.g. when it comes to clinical reasoning for requesting further medical examination e.g. immaging. I already recommended the course to several colleagues!
One point of attention: I got the feeling that the short quizzes at the end of each unit didn’t always mach the unit’s content or plainly state differently (e.g. Type of SLAP lesions).
- AARON03/01/20Orthopedic Physiotherapy of the Upper and Lower Extremities PERFECT INFORMATION
Much of it was fresh rehearsal including some new insights! Would recommend.DIMITRY22/12/19Orthopedic Physiotherapy of the Upper and Lower Extremities THE FUTURE OF PHYSIOTHERAPY
I think this course should be done by all physiotherapists! The evidence based principle should be adopted by every physiotherapist, this course is a great way to learn how to apply tests, but also background information, advice for patients and some rehabilitation. I believe this kind of course is the future of physiotherapy and is very suitable for everyone.Marijke13/12/19Orthopedic Physiotherapy of the Upper and Lower Extremities BEDANKT!
Uitstekende manier van leren.
- LIEKE11/12/19Orthopedic Physiotherapy of the Upper and Lower Extremities PERFECT
The course was very interesting Learned a lot!JORN08/12/19Orthopedic Physiotherapy of the Upper and Lower Extremities ZEER LEERZAAM!
Zeer leerzame cursus, welke zeker de moeite en tijd waard is!
Gaat goed stapsgewijs dieper in op de stof.
Zorg er wel voor dat je engels up-to-date is.MATAN03/12/19Orthopedic Physiotherapy of the Upper and Lower Extremities GREAT COURSE
Super cursus!! Overzichtelijk en up to date.
- Willem01/12/19Orthopedic Physiotherapy of the Upper and Lower Extremities EXCELLENT COURSE!
A course of the highest quality. It adresses a plethora of conditions both theoreticaly and practically. Everything is well laid out and substatiated with current research. Its fun to take and challenging. If you spend the nescessary time on this course youre sure to learn a lot.
Theres allways room for some pointers so
Andreas you should stop staring so aggresivly during the examinations, its scaring me. Just lay off the steroids for a while and youll mellow out soon enough, theyre other ways to get swole bro.
Kai youve been blasting me with research citations during the whole course. my head is about to explode. Youve been luring me to the dark side of science but i know this knowledge has been paid for in missed sleep and coffee. The bags under your eyes attest to this.
Just joking, you guys are heroes to everyone enrolled in the physiotherapy eduction and therapists alike. ill be buying all of your courses as will the rest of my team.HYEOK17/11/19Orthopedic Physiotherapy of the Upper and Lower Extremities GREAT COURSE FOR NOT ONLY FIRST YEAR PHYSIOS BUT ALSO EXPERIENCED PHYSIOS.
I’ve been working in this field for 10 years and still learn from many resources such as books, youtube channels, essays and so on. And this course is awesome because it’s time efficacy and broad perspective of information in each chapter from basic anatomy, pathophysiology, to treatment. After taking this course for 5 months, I able to give more clear, updated information about each patient’s conditions and course of the current problem.
I hope you guys make another course for the spine . I wil take it!Rik24/10/19Orthopedic Physiotherapy of the Upper and Lower Extremities This course showed me some new insights that I can use in my own practice.
The course is easy to follow in your own time.
I really enjoyed it!
- M.J. Post08/09/19Orthopedic Physiotherapy of the Upper and Lower Extremities As I said, great course. When you take this course, you’re being pushed into improving your assessment skillset.Vadym Grytsenko29/07/19GREAT ILLUSTRATION OF WHAT ONLINE EDUCATION SHOULD BE! The great course with absolutely new approache to study information online!
Content is extremely useful in daily physiotherapy routine and all the material is based upon scientific researches. I did rehearse the screening and assessment process.
Great illustration of what online education should be!Jerry06/06/19GREAT! It was an excellent course! Took me 33 hours and 26 minutes to complete. I liked the cases a lot and the statistics gave me a totally new point of view to assess different tests. This course will make me a better physiotherapist. Thank you!
- Francisco Javier31/05/19THE UNIVERSITY OF THE FUTURE Awesome Course!!!, honestly it´s the University of future, you will learn all the commmon pathologies of the body with just 1 click: epidemiology, prognostic factors, course, asessment and treatment, everything from a scientific point of view. Well structured, easy to read, fast navegation, high quality videos. You will be able to answer your patient how long the complaints will last base on the last evidence with proper numbers, giving a fair prognosis which will help you to keep them motivate to the therapy and be patients and constant. There is no a day when I dont use it in the practice to consult a specific test or the sensibility of this one. Even you get you acreditation points, a bunch of them actually in comparison with other courses that you will never use in your daily routine. 100% advisable!!!
Curso Magnifico!!!, honestamente, es la universidad del futuro, aprenderá todas las patologías comunes del cuerpo con un solo clic: epidemiología, factores pronósticos, curso, evaluación y tratamiento, todo desde un punto de vista científico. Bien estructurado, fácil de leer, navegación rápida, videos de alta calidad. Podrás responder a tu paciente cuánto tiempo durarán sus molestias basado en la última evidencia con los números adecuados, lo que les dará un pronóstico justo que los ayudará a mantenerlos motivados para la terapia y ser pacientes y constantes. No hay un día en el que no lo use en la práctica para consultar una test específico o la sensibilidad de este. Incluso se obtienen puntos de acreditación, un monton ellos en comparación con otros cursos que luego nunca usas en su rutina diaria. 100% recomendable!!Nathan28/05/19Orthopedic Physiotherapy of the Upper and Lower Extremities A great course for new grads! I have found this course to be very well put together. Firstly the formatting is very user friendly – it’s easy to work through but also very to easy to navigate to specific sections to use as a reference resource. As always with these guys the videos are very high quality. The attention to detail with academic references is also spot on. You can be assured that the info is evidence based. Overall, highly recommended.Stijn14/02/19GREAT COURSE I thinks this course is great, I find the framework it teaches you very useful in assessing my patients. I like how the different pathologies are very clearly explained from epidemiology to pathophysiology to diagnostics to treatment, all evidence based. The Physiotutors-style videos used to explain the subject matter are really useful for studying too. Finally, the assingments at the end of the chapters are a great way to test and practice your knowledge on the subject you just studied.