Tibialis Posterior heel walking (Full Version)

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Steven 59 -> Tibialis Posterior heel walking (April 20, 2007 5:36:00 PM)

I have conflicting opinions at work regarding heel walking as an eccentric/concentric and or isometric activity for the tibialis posterior. I always understood that heel strike caused the posterior tibialis to contract eccentrically (I may be wrong). I have scoured pubmed and my books for a diffinitive answer but have not found one. Any thoughts/resources? Is heel walking an eccentric/concentric or isometric activity?




jlharris -> Re: Tibialis Posterior heel walking (April 20, 2007 6:50:00 PM)

It may get the tibialis posterior; however, the ant tib is in a mechanically adventitious position and will most likely be getting the bulk of the strengthening. Foot adduction with ankle in PF position will better isolate the post tib.

Also, heel walking seems to be an isometric exercise (no shortening or lengthening of the muscle). Is the foot plantar flexing? I may be misunderstanding the exercise being done.




Steven 59 -> Re: Tibialis Posterior heel walking (April 20, 2007 8:32:00 PM)

I think the isometric seems like the most likely answer; however I think maybe it has some eccentric action to it related to supporting the arch during heel strike.

I found these quotes " During the contact phase of gait, it contracts eccentrically to decelerate subtalar joint pronation and internal rotation of the tibia".
http://podiatry.curtin.edu.au/encyclopedia/pt/

"The orientation of the ankle and subtalar axes couples loading response dorsiflexion with eversion. Both are attenuated by eccentric contraction of the ankle inverters (ie, posterior tibialis)."
http://www.emedicine.com/pmr/topic225.htm

This lead me to believe that the contact phase or loading response cause the posterior tibialis to work eccentrically. Does this include the initial contact (heel strike)also?

I agree Jason with the anterior tib work and the other exercise you mentioned (I use it). I am in a zone where I am focused only on the post tib lol.




Tom Reeves DPT ATC -> Re: Tibialis Posterior heel walking (April 20, 2007 10:35:00 PM)

Why don't you try having the patient stand, have them allow their feet to pronate and then tell them to quickly reverse that and supinate. the Tib posterior is a triplanar muscle and in real life responds to ground reaction and the pronation of the foot, not to the brain telling it to contract non-functionally.




Steven 59 -> Re: Tibialis Posterior heel walking (April 21, 2007 1:19:00 AM)

Tom. Heel walking allows the tibialis posterior to react to ground forces (whether Tib. Post. is concentric, isometric etc. is the question)so we are both thinking functionally. Your idea is sound and I may use it for concentric strengthening.




Tom Reeves DPT ATC -> Re: Tibialis Posterior heel walking (April 21, 2007 12:12:00 PM)

Steven,

But if the forefoot never reaches the ground, the tp is not really loaded, it is stretched around the ankle. I my opinion, you really need to get the foot to pronate to load it in its primary functional plane.




Steven 59 -> Re: Tibialis Posterior heel walking (April 21, 2007 4:36:00 PM)

Tom,

Both activities are functional and I believe involve the posterior tibialis (at least I can't imagine the posterior tib is silent during heel strike).

I am confused about what the primary functional plane is?

Is it one of the anatomical planes?

What do you mean by loaded? Do you think the tibialis is not contracting or being silent during heel walking? If you think it is contracting is it a "stretching" lengthening contraction ?




Tom Reeves DPT ATC -> Re: Tibialis Posterior heel walking (April 21, 2007 10:33:00 PM)

I think that the pathway that the tib. posterior follows is posterior to the medial malleolus, then slightly laterally to the tarsals. If someone is walking on their heels, the tp is stretched and very minimally contracting, if at all. You are testing the dorsiflexors, not the plantar flexors. t.p. in anatomy class, plantar flexes and inverts, in real life, it decelerates dorsiflexion and eversion (pronation) of the foot. I do not see how it can possibly be tested or trained by heel walking.

When I said primary functional plane I mistyped. It primarily works in the sagittal plane but has large frontal and transverse plane functions as well.

Tibialis ANTERIOR is being tested/trained, not POSTERIOR.




Steven 59 -> Re: Tibialis Posterior heel walking (April 22, 2007 12:20:00 AM)

I think I may have found my answer.

I wish I was able to find the information from a primary source but I think this is the best I will find for now. Remember initial contact is heel strike.

http://www.podiatrytoday.com/article/290

"...tibialis posterior function is important in early and latter stance. In the initial contact period, eccentric contraction helps to slow rearfoot pronation and thus control the loading process. Failure of this mechanism can result in rapid and increased rearfoot pronation, and an inability to withstand the pronatory forces from ground reaction.".

This leans me toward an eccentric contraction for heel walking. I have been told it was eccentric before but always wondered why? I was thinking maybe there is eccentric shock absorption during heel strike from the tibialis posterior.

Does anyone have their own explanation in favor of an eccentric contraction or possibly a biomechanics article.

Tom. I am not concerned with the tibialis anterior in regard to heel walking at this moment. I would not test tibialis posterior with heel walking. I would however use heel walking (if I am satisfied it is eccentric) to hopefully positively effect the posterior tibialis tendon with the eccentric activity.




Tom Reeves DPT ATC -> Re: Tibialis Posterior heel walking (April 22, 2007 1:45:00 AM)

Steven,
I just think that you can do it better than with heel walking.




Steven 59 -> Re: Tibialis Posterior heel walking (April 22, 2007 2:21:00 AM)

Tom. I agree there are much better exercises. I am truly curious how the muscle acts during heel strike. It is fun reviewing my books and searching for the truth. I am learning new things and reviewing a lot of old things about the foot. I must remember never to assume anything.




jlharris -> Re: Tibialis Posterior heel walking (April 22, 2007 4:28:00 PM)

Concentrically, TP is a plantarflexor. Therefore, you are being very inefficient trying to strengthen in a DF position (not to mention the TA superior action in the position basically overriding any significant effect from the TP).

Your quote mentions TP's eccentric function, but your heel walking is out of context as it is an isometric exercise and TP's eccentric work happens from heel strike to foot flat (ie actively not staticly).

Better exercises for the TP:

1. The exercise I mentioned above - in a PF position, adduct the foot with or with out opposing T-band resistance. I also place a large emphasis on the eccentric control returning the neutral to help focus on TP's main action during gait.

2. Standing foot supination. Tend to still get some overriding TA action but one could overcome this with tactile biofeedback. Again, emphasis on the eccentric phase (eg, pronation).




Steven 59 -> Re: Tibialis Posterior heel walking (April 22, 2007 6:20:00 PM)

Jason,

I agree it appears to be an isometric activity but does it really contract isometrically during heel strike and heel walking? Heel strike I believe encompassess movement from the time the heel hits until foot flat (about the same amount of movement I notice with heel walking). I think it is different than dorsiflexing your foot and holding at the same joint angle in a classic isometric contraction.

During the heel walking movement one is picking the foot up off the ground and dynamically putting it back on the ground with a lot of stress from ground reaction forces (on the heel the whole time). At one point I was thinking it would be isometric briefly then eccentric then some concentric possibly when lifting the heel off the ground.

Those two ecxercises you mentioned seem to be good and I have never used the supination exercise, which I will likely add to my exercise selection. I am still confused as to how the tibialis posterior behaves in heel strike and with heel walking. Thank you both for the input so far.




Tom Reeves DPT ATC -> Re: Tibialis Posterior heel walking (April 23, 2007 1:55:00 PM)

concentric "possibly" when lifting the heel off the ground? What exactly do you think the primary function of tp is?




Steven 59 -> Re: Tibialis Posterior heel walking (April 23, 2007 2:39:00 PM)

Tom. I know what the primary function is. You stated it earlier. What do you think it is doing when lifting off the ground?




Tom Reeves DPT ATC -> Re: Tibialis Posterior heel walking (April 23, 2007 3:00:00 PM)

It is resupinating the foot and plantarflexing the ankle, in that order. at foot flat, it decelerates the collapse of the arch, i.e. decelerates pronation, just before reversing it and supinating.




Tom Reeves DPT ATC -> Re: Tibialis Posterior heel walking (April 23, 2007 3:43:00 PM)

Check the link below for an analysis of when muscles contract during the gait cycle. Specifically, look at page 64. I believe that the chart (figure 4) begins at heel strike, and the solid line just past "60" is "toe off" or "preswing". TP does not contract "at" heel atstrike, but just afterward and throughout midstance until just before the period where the heel rises.

http://www.biomech.uottawa.ca/english/teaching/apa6905/lectures/emg-reading.pdf




Steven 59 -> Re: Tibialis Posterior heel walking (April 23, 2007 3:45:00 PM)

Tom.

What do you think happens with the tibialis posterior when you are heel walking and lift the heel off the ground? I think it may be a concentric contraction. "It is resupinating the foot and plantarflexing the ankle, in that order". Is this what you think is happening when the heel is lifted from the ground? If it is that sounds to be concentric. Obviously this would be a quick motion and a small ROM.




Tom Reeves DPT ATC -> Re: Tibialis Posterior heel walking (April 23, 2007 4:08:00 PM)

The point is, who does that???
It sounds like you are defending the position that tp can contract concentrically or eccentrically while heel walking. Well, OK, maybe it can, but the point is, it doesn't during real life.

What about my and Jason's earlier explanations do you not understand? because something "can" do something, does not mean that it "does" something. the gluteus maximus "can" abduct the hip during life, but what it really does is decelerate adduction. I realize that I am opening a can of worms here, but function is different that the anatomy many of us learned in school. Rectus abdominis "can" flex the trunk, but in real life, gravity does that for us. In stance, RA decelerates extension.

Read the link i posted.




orthotherapist -> Re: Tibialis Posterior heel walking (April 23, 2007 4:47:00 PM)

You did not open a can of worms - as we treat patients we need to think about how muscles function in the real world and gravity is a component of that equation. Anatomy tooko gravity out of the equation and taught us what muscles do in an open chain world




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