Anterior Tibialis

What Do Snowboarders and Runners Have in Common?

   Snowboarding is an exciting sport where athletes surf the powder, huck big air from jumps and spin on thin metal rails. Many people are captivated by the thrills they see on television and decide to go learn to snowboard.

   The first lesson involves learning to slide and stop on the heel-side edge of the snowboard for steering and control. If they let their toe-side edge get too low it catches in the snow and the participant is quickly slammed face first into the frozen ground. [pic 1]

   After several incidents of being planted into the snow, riders learn to use their anterior tibialis muscles to keep the toe-side edge from catching. Most beginners are not used to using these muscles and they get strained within hours of snowboard riding.

   The anterior tibias muscle originates from the anterior surface of the lateral superior tibia and inserts into the medial cuneiform and first metatarsal bones of the foot. [pic 2]

    It is responsible for dorsiflexing and inverting the foot. Runners commonly strain the anterior tibialis while running downhill.  Shin splints is the term used when there is a complaint about pain in the front of the calf.  The eccentric stress of running downhill and snowboarding can create tissue damage at the tendinous insertions, the fascia and in the muscle belly fibers.

   

Diagnosis

   Physical exam findings include tenderness and weakness of the anterior tibialis muscle. The pain may be exacerbated with stop and go running drills and/or walking downhill. When the anterior tibialis muscle is strained or irritated it can cause pain, weakness and nerve compression leading to tingling and numbness in the top of the foot and ankle.

   Look for a loss of range motion and/or a loss of coordination with foot dorsiflexion.  A dysfunctional anterior tibialis muscle can restrict ankle flexion preventing a deep squat from being fully performed and may also result in a foot drop with a “slapping” gait.

   Muscle test bilaterally and note the deficiency of the involved muscle. Eccentric-break manual muscle testing involves having the patient laying supine with foot fully dorsiflexed. The doctor stabilizes the lower leg with one hand and pulls the dorsiflexed foot downward. [pic 3]

Treatment

   Effective correction of the anterior tibialis involves reducing the hypertonic state of the muscle. Thrusting and/or pressing into the tender insertion points will affect the nerve receptors located there. Using 2-3 gentle thrusts with your hands or an adjusting instrument usually creates enough stimulation to cause a significant improvement in muscle power output, pain reduction and mobility. [pic 4]

   Adhesions in the muscle can be addressed by pressing and holding for 3-5 seconds into the tender muscle belly fibers. This typically unlocks the fibers and restores greater mobility and function to the muscle. Post treatment evaluation should be performed to determine treatment success and revealwether further correction is needed.

Rehabilitation

   The anterior tibialis can be stretched by opening the ankle joint. Gently bend the toes and top surface of the foot against the ground into plantar flexion then slowly roll the heel from side to side for five repetitions.

   Strengthening the anterior tibialis can be achieved by  elevating the distal foot while standing on the edge of a step. I prefer my patients work the good side first then train the involved side. This can be done using 10 second isometric holds, using multiple sets and reps without resistance or exercise tubing can be added to increase resistance.

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