Rehabilitation of tendinopathies such as to Tibialis Posterior should be treated with rest, ice, stretching and strengthening exercises
The rehabilitation guidelines below are for information purposes only. We recommend seeking professional advice before attempting any rehabilitation.
Aims of rehabilitation:
The aims of rehabilitation of Tibialis Posterior tendinopathy can be broken down into stages:
- Decrease initial pain and inflammation.
- Improve mobility and flexibility.
- Improve strength
- Re-establish neural control and coordination.
- Return to full fitness.
Decreasing Pain and Inflammation
This should start as soon as possible. This phase can last from 2 days to a week (or more) depending on how bad the injury is.
Rest - this is essential. Try to avoid any activity or movement which aggravates the condition.
Ice - use cold therapy throughout the rehabilitation process. Apply ice for 15 minutes every 2-3 hours initially for the first day then gradually reduce this to 3 times a day.
Compression - use a tube grip bandage or taping. Even better are products that specifically apply compression at the same time as cooling.
Improve Mobility and Flexibility
This should begin as soon as pain will allow. If it hurts to perform any of the exercises then wait longer until there is no pain.
Perform ankle circle movements in the early stages to keep it mobile.
Stretching the muscles at the back of the lower leg is important.
Make sure you stretch the calf muscles with both the knee straight and the knee bent. This will ensure all muscles in the back of the lower leg are stretched thoroughly.
Perform stretching exercises 2 to 3 time a day.
Apply ice / cold therapy after stretching in the early stages of rehabilitation to help reduce any inflammation.
This can begin as soon as they can be performed without pain.
The athlete should be able to maintain fitness by swimming or cycling if pain allows.
To specifically strengthen the Tibialis Posterior muscle you must work the ankle into inversion (turning the sole of the foot inwards).
It also assists with plantar flexion (pointing the foot away) and so calf raise exercises can be useful.
Try balancing on one leg with your eyes closed. This will improve proprioception (the neuromuscular control you have over your muscles). This are frequently damaged in foot and ankle injuries and help to prevent you from suffering future injuries.
A wobble board is a useful piece of kit to have. It is a flat board that you stand on with a semi-spherical bottom. By balancing on this you strengthen the ankle and improve proprioception (balance).
Return to Full Fitness
When the athlete can comfortably do all of the above exercises without adverse reaction then they are ready to start the next phase and begin to return to activity.
Range of motion exercises and stretching should continue. Maintain and improve on what has done in the previous phase.
Begin running as long as it is not painful. Start with a gentle jog/walk program and gradually build up the time spent running.
Once running in a straight line for 10 minutes is comfortable, gradually introduce corners and changes of direction.
When the athlete has:
- Full range of motion without pain.
- Good strength in the ankle which is equal in both legs.
- No pain or swelling present either during exercise, after or the following day.
- Restored proprioception (able to balance on one leg with eyes closed).
They may be ready to return to competition and full training.