Tibialis posterior tendonitis exercises can begin as soon as they can be performed without pain, either during, after or the following day. Here we explain specific exercises to strengthen the tibialis posterior, as well as ankle mobility, strengthening, and proprioception exercises.
The guidelines below are for information purposes only. We recommend seeking professional advice before attempting any rehabilitation.
Mobility & stretching exercises
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 calf muscles and tibialis posterior 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 times a day.
Tibialis posterior strengthening exercise
- These exercises will specifically strengthen the tibialis posterior muscle.
- It is important that you have given the tendon enough time to heal before attempting strengthening exercises.
- Move the ankle from an everted position to inversion using an elastic resistance band for resistance.
Ankle inversion exercise
- In a seated position, wrap a resistance band around the foot and either attach it to something to the outside of the foot or get someone to hold it. Invert the foot against the resistance of the band.
- Ensure you are only using the ankle/foot to perform this movement and not the lower leg/knee. Slowly return to a neutral position and repeat. Start with 10 repetitions and gradually increase to 20 reps.
Isometric exercises are often done in the very early stages of rehabilitation and do not involve movement of the ankle. A therapist provides resistance as the athlete tries to push the foot outwards against their resistance.
There shouldn’t be any movement in the ankle, just use the muscles to resist. This is the first exercise that can be performed after the injury as it places the least stress on the tendon.
Inversion using a step
This exercise is a more advanced tibialis posterior strengthening exercise, using body weight as resistance.
Stand (in bare feet) long ways on a step with the inside of the foot halfway over the step. Gently roll the foot inwards (evert or pronate) so the inside of the foot rolls in and downwards.
Return to the starting position by inverting it so it is flat on the step again. Aim for 3 sets of 10 repetitions and gradually build up to 3 sets of 30 repetitions.
This exercise will also strengthen the calf muscles (Gastrocnemius and Soleus).
- Stand with your feet on the floor, shoulder-width apart, close to something to hold on to
- Rise up onto your tiptoes as high as possible
- Lower the heels back down to the floor
- You should be able to progress quite quickly with this one but aim for 3 sets of 10 and build up steadily, a few each day
- You can then progress to performing on single legs
Focus on keeping the ankle straight and not allowing the foot to flatten as you push up. You can also perform these on a step so that the heels drop down below the level of the step. Apply ice/cold therapy after stretching in the early stages of rehabilitation to help reduce any inflammation that may occur after exercises.
These exercises focus on improving balance and coordination. Although they are not specific tibialis posterior tendonitis exercises, they are important for all foot and lower leg injuries.
- Try balancing on one leg with your eyes closed.
- This will improve proprioception (the neuromuscular control you have over your muscles). Proprioception is frequently damaged in foot and ankle injuries and helps to prevent you from suffering future injuries.
- Begin by standing on the injured leg for just 30 seconds. Once this is easy, close your eyes to increase the difficulty.
- The next step is to balance on an unstable surface such as a trampette, wobble cushion, or half foam roller.
Wobble board exercises
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).
The heel-toe balance exercise, sometimes called a tandem stance is designed to start to work on proprioception and balance.
This is a good build-up to wobble board work. The athlete stands with the involved foot immediately behind the other foot, with the toes touching the front heel as shown. This position should be held for 30 seconds without losing balance.
Heel-toe walking is a great exercise for the ankle and calf muscles. It will strengthen all muscles of the lower leg, as well as help, improve proprioception or balance.
- Walk slowly across the floor
- Start with a heel strike and once you get to the forefoot push-off, come up onto the toes
- Swing the other leg forward and heel strike with the next foot to continue
Tibialis posterior tendonitis running exercises
When the athlete can comfortably do all of the above exercises without adverse reactions then they are ready to start the next phase and begin to return to activity. The range of motion exercises and stretching should continue.
Maintain and improve on what has been 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.