Q&A Time! How Do You Improve Tibial IR? | Modern Manual Therapy Blog - Manual Therapy, Videos, Neurodynamics, Podcasts, Research Reviews

Q&A Time! How Do You Improve Tibial IR?

starting position
Today's Q&A is from OMPT Channel subscriber who wants to know how to improve tibial IR.

look for supination, toes lifting off, assess actively and passively
make sure the knees/hips stay still!

The above pics are a great self screen to teaching patients!

Lack of tibial IR is a very common dysfunction in the lower quarter. This is a chicken or the egg thing, it could be due to a lack of dorsiflexion, leading to ankle eversion in stance phase, causing tibial ER. This could also be caused by inhibited or weak gluteus medius, this causing facilitation in the TFL and causing more tone in the ITB. This could lead to a further cycle of loss of tibial IR.

A lack of tibial IR could also cause a loss or pain with
  • knee flexion
  • ankle dorsiflexion
To improve tibial IR, I start with the EDGE and treat the lateral patterns of the upper and lower leg 2-5 minutes per pattern. A facilitated ITB could prevent tibial IR, and restrictions in the lower leg patterns (bony contours of the lateral tibia) could prevent fibular head antero-lateral glide, which is really a component of tibial IR.

I then teach the patient self tibial IR mobilization with movements, repetition and end range is key 

After the IASTM, I perform some open chain then progress to closed chain MWM for tibial IR then teach the patient this for HEP. You should see some rapid changes in knee flexion, but less so for ankle dorsiflexion. 

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