One of the most common causes of shin pain or “Shin Splints” is Tibialis Posterior tendinopathy, also known as Posterior Tibial Tendon Dysfunction (PTTD). This is usually caused by overloading the Tibialis Posterior tendon during running or other sporting activities, which leads to a gradual degeneration and weakening of this tendon. This post looks at the Tibialis Posterior and how to strengthen it. I will discuss the various types of shin pain and their treatment in a later post.
What is the Tibialis Posterior?
The Tibialis Posterior is a muscle that attaches to the posterior aspect of the Tibia and runs down the back of the lower leg.
It forms a tendon which passes behind and under the medial malleolus (the bump on the inside of the ankle) and attaches to the bones of the foot.
The Tibialis Posterior has a number of key roles –
- helps maintain the arch of the foot
- inverts the ankle (turns the foot in)
- plantarflexes the ankle (points foot down)
The following exercises strengthen the Tibialis Posterior and can be beneficial for preventing or treating conditions associated with a weakness of this muscle, such as Posterior Tibial Tendon Dysfunction, Plantar Fasciitis or a fallen arches. Just a word of caution, if you are currently experiencing pain it is best to get an accurate diagnosis from a Health Professional before trying these exercises.
Exercise 1 – Isometric Contraction
Stand with the inside of your foot against a step. Try to push your foot inwards against the step – there shouldn’t be any movement of your foot. Hold the contraction for 5 secs and repeat 10 – 15 times. This is a very basic exercise that is most beneficial when pain or weakness do not permit you to perform the more active exercises.
Exercise 2 – Arch Lift
Stand sideways on a step with your foot halfway over the edge. Lower your arch off the step and then raise it back up as high as it will go. The movement should be slow and controlled.
Exercise 3 – Calf Raise
Stand sideways on to a wall, with both feet flat on the floor and your arches held in a good neutral position (i.e. not collapsed onto the ground!). Place one hand against the wall to assist with balance. Push up on to the balls of your feet, hold for a second at the top of the movement, and return slowly to the starting position. Make sure that when your feet return to the ground you do not allow your arches to collapse inwards.
Exercise 4 – Single Leg Balance
Stand on one leg, whilst maintaining a good arch on your foot, and attempt to balance on that foot. Hold this for 30-60 secs. Progress on to doing this with your eyes closed. It is essential you maintain a good arch throughout this exercise.
Exercise 5 – Single Leg Calf Raise
Stand sideways on to a wall, on one foot, with your arch held in a good neutral position. Push up onto the ball of your foot, hold for1 second at the top of the movement, and return slowly to the starting position. Make sure that when your foot returns to the ground you do not allow your arch to collapse inwards.
Exercise 6 – Single Leg Calf Raise with Balance
Stand balancing on one foot with your arch held in a neutral position (as with exercise 4). Raise up onto the ball of your foot, hold for 1 second, and return slowly to the starting position. Make sure that when your foot returns to the ground you do not allow your arch to collapse inwards.
Exercise 7 – Eccentric Knee Reaches
Stand facing a wall, on your injured leg, approximately one arms length away from the wall. Your good leg should be bent at the knee so that your shin is parallel with the floor. Place your fingertips on the wall for balance. Bring the knee of your good leg forward so that it touches the wall whilst bringing your upper body slightly backwards so that it remains over the foot of your injured leg. Return to the starting position. Bring your knee forward again towards the wall but this time move it towards the left hand side (again leaning slightly backwards). Return to starting position. Finally bring your knee towards the wall again, this time moving it to the right hand side. Complete the repetition by returning to the starting position.
All these exercises should be performed in a slow and controlled manner. If you are currently experiencing shin pain you should contact a healthcare professional before starting these exercises. They will diagnose your injury and advise on the appropriate exercises and the number of sets and reps that you should perform.