Tibialis Anterior Pain


Tibialis Anterior Pain
Anterior tibialis tendonitis is an injury of the anterior tibialis tendon in the front of the ankle where it meets the foot. The tendon is important in pulling the foot up (dorsiflexion), lifting the foot off the ground while running, and in turning the foot inward (inversion).

Why is my tibialis anterior hurting?

Ankle Tendonitis | Anterior Tibial Tendonitis The tibialis anterior muscle runs down the front of the shin. The anterior tibial tendon lies on the inner-front of the, The muscle and tendon work together to flex the foot upwards. This condition occurs when the tendon is inflamed from overuse or traumatic,

How long does anterior tibialis tendonitis take to heal?

How to SPEED UP the healing time? –

  • Extracorporeal Pulse Activation Technology (EPAT) “Shockwave Therapy”
    • Non-invasive way to speed up the healing process with great results for both chronic and acute conditions.
  • MLS Laser Therapy
  • Platelet Rich Plasma (PRP) Injections

When conservative therapy fails, and patients continue to experience pain, surgical management becomes a viable option but is rarely needed:

Tendon Repair – remove damaged tendon and repair the remaining good tendon. Sometimes a tendon transfer or tendon graft is needed depending on the severity of the condition.

Anterior Tibial Tendonitis is a common condition seen with overuse of the tendon. It may take a few weeks to months to improve, depending on the severity. Many treatment modalities can speed up the recovery process and help you return to activity sooner. A foot and ankle specialist can guide you in your diagnosis and recovery process.

Can I still run with anterior tibialis tendonitis?

Returning to running after tibialis anterior injuries – Even though there are no specific guides to returning to running following tibialis anterior injury, we can use protocols developed for other tendon injuries. It appears to be safe to run on a tendon during the healing process, as long as the pain is only mild, and does not get worse day to day.

  1. One study stipulates that pain must be below a “5 out of 10” on a pain scale, where 10 is “worst pain ever” and 0 is “no pain at all.”5 Brad Beer backed this up in our injuries special podcast episode.
  2. This is important: Pain must not get worse week to week, and pain must not persist the next day.
  3. If these conditions are not met, you need to back off your running.

What’s the bottom line? As long as you’ve ruled out other injuries in the same area, tibialis anterior tendonitis or muscle strain doesn’t need to keep you on the sidelines for long. Focus on reducing stress on the tibialis anterior by wearing shoes with a lower heel and sticking to softer surfaces when you run, and increase the tendon and muscle’s strength by doing heel walks and wall toe raises.

Can you strain your tibialis anterior?

Footwear – Using the right footwear can be beneficial to reduce strain to the anterior tibialis muscle by assisting with the proper support. The proper footwear helps to compliment an orthotic device. An improper shoe can mean an orthotic may not be working to it’s full potential.

The proper shoe can depend on the specific foot mechanics. In most cases, a neutral running shoe or walking shoe is appropriate to wear with an orthotic device. In some cases, with the advice from your orthotic professional, a stability running shoe may be necessary in combination with the orthotic device.

Another factor to consider with the anterior tibialis muscle is the weight of the shoe. If the tibialis anterior muscle is weak or healing is slow, a lighter shoe may be recommended. If a physiotherapist is rehabilitating the muscle, they may provide recommendations on the shoe weight.

Is it shin splints or anterior tibialis?

By Harry A. Bade, III, MD, FACS Shin splints, or medial tibial stress syndrome, is a term used by athletes to describe anterior shin pain involving the anterior proximal or distal medial aspects of the leg. Posterior shin splints involve the posterior tibia muscle and tendon and occur one to six inches above and slightly posterior to the medial malleolus or medial ankle bone.

  • In younger runners, it usually represents either micro-tears of the muscle or tears involving the origin of the muscle fibers on the bone, which is described as periostitis.
  • It is frequently painful and tender both along the medial and posterior aspects of the distal tibia involving the posterior tibial tendon, and in more severe cases, the flexor digitorum longus and flexor hallucis longus tendons.

The pain is more severe when rising up on the toes or everting the foot, thereby stretching the tendon myofascia muscle complex. The first risk factor to consider is overtraining or normal training involving a younger or beginner runner. Evaluation of the runner’s schedule is important.

This includes both the training and racing schedule shoe wear. Hyperpronation may also contribute to the problem, therefore, shoe evaluation is important. Shoes that are highly rated for control of pronation may be helpful. The running surface should be supportive such as all weather artificial tracks or packed dirt.

Avoid excessive hard and soft surfaces. General posterior stretching exercises and ice baths following running may offer some relief. They are not curative. Excessive pronation is a contributor to this problem, therefore, orthotics to control excessive pronation or heel lifts may offer some relief.

Avoid running on a canted surface because the uphill foot has excessive pronation during the full weightbearing force on the foot. Decrease training immediately and find the distance that you can run without reproducing excessive pain. Cross-training may be an alternative to include swimming, biking and pool running.

Also, physical therapy may help to include stretching, strengthening, electric stimulation and ultrasound. Appropriate anti-inflammatory medication may also be used. Anterior shin splints involve the anterior tibial muscle and tendon and occur along the proximal anterior lateral tibia for a distance of about four to five inches.

  1. There is a higher instance of either stress fractures or compartment syndrome problems as the differential diagnosis of this overuse problem.
  2. Again, this is a soft tissue injury involving the muscular origin of the tibialis anterior muscle on both bone and periosteum.
  3. There is usually a mechanical imbalance between the posterior and anterior muscle groups.
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The posterior muscle groups are usually too tight and relatively too strong. At heel strike, (initial foot contact with the ground), the anterior muscles must function to slow the forward or downward plantarflexion of the foot. This is a deceleration function.

  • If the posterior muscle groups are too tight and strong, they will force the anterior muscles to work harder and longer to control the foot.
  • The second imbalance occurs during toe off when again, the anterior muscles are overused to lift up or dorsiflex the foot so it will clear the ground as the leg is brought forward.

As the anterior muscle grip fatigues, it becomes dysfunctional producing over trauma or muscle micro tears/strains. This imbalance is accentuating by running downhill, which only exacerbates the overuse on the anterior leg muscles. Running on harder surfaces is also a more frequent problem with anterior shin splints.

  • Overtraining and improper shoes also can accelerate this problem.
  • Shoes must have appropriate shock absorption and again, overtraining only makes the situation worse.
  • The muscles naturally become more fatigued and dysfunctional, causing more injury.
  • The treatment is similar to that for posteromedial shin splints.

It should also include stretching the posterior muscles of the leg and calf to include the hamstrings, changing shoes to a more shock absorbing or soft shoe as compared to a shoe that controls pronation, and avoidance of downhill running and running on hard concrete-like surfaces.

Should you stretch tibialis anterior?

A Word From Verywell – Stretching your anterior tibialis muscles is important in preventing and treating MTSS, or shin splints. Doing this program of stretches and exercises as you increase your running or walking mileage is one smart way to prevent shin pain.

  1. Deshmukh NS, Phansopkar P. Medial tibial stress syndrome: a review article, Cureus,14(7):e26641. doi:10.7759/cureus.26641
  2. Deshmukh NS, Phansopkar P, Wanjari MB. A novel physical therapy approach in pain management and enhancement of performance in shin splints athletes: a case report, Cureus,2022 Jul; 14(7): e26676. doi:10.7759/cureus.26676
  3. Guo S, Liu P, Feng B, Xu Y, Wang Y. Efficacy of kinesiology taping on the management of shin splints: a systematic review, Phys Sportsmed.2022;50(5):369-377. doi:10.1080/00913847.2021.1949253

Additional Reading

National Institutes of Health, National Library of Medicine. Shin splints – self care, MedlinePlus.

By Wendy Bumgardner Wendy Bumgardner is a freelance writer covering walking and other health and fitness topics and has competed in more than 1,000 walking events. Thanks for your feedback!

Does walking work tibialis anterior?

Introduction: The human tibialis anterior (TA) muscle has two distinct roles during walking : (1) to concentrically dorsi-flex the ankle during swing for foot clearance and placement; (2) to eccentrically contract during ankle plantar-flexion in the initial foot contact with the ground.

Does massage help tendonitis?

Home > Blog > Using Massage to Manage Tendonitis Massage therapy has been proven to be a great alternative to traditional pain management. For people suffering from tendonitis, it can help with pain relief and speed up the recovery process. Since tendonitis can take weeks to heal, using a massage therapy program to both relax and strengthen the inflamed tendon can give the sufferer a better chance of a full and speedy recovery.

Do squats work tibialis anterior?

ABSTRACT – Background Previous studies reported that one-leg squat has various advantages in functional activities, no study has studied the effect of muscle activity on ankle stability. Purpose The purpose of this study was to investigate the differential effects of squat type on the activity of the tibialis anterior, peroneus longus and tibialis posterior muscle for ankle stability.

  • Study design Cross-sectional study.
  • Methods The participants were 30 healthy adults.
  • During each squat execution, tibialis anterior, peroneus longus and tibialis posterior muscle activities were assessed using surface electromyography under control of each squat posture.
  • Results The muscle activity of the tibialis anterior and peroneus longus applying Bulgarian split squat was significantly higher than lunge squat.

However, the activity of the tibialis posterior showed no significance between squat conditions. Conclusions This study demonstrated that Bulgarian squat was more effective at eliciting ankle dorsiflexor and evertor that are known as important role for ankle stability.

Keywords: Ankle stability; Bulgarian squat; Electromyography; Peroneus longus; Tibialis anterior Question Can Bulgarian squat exercise increase more muscle activity of tibialis anterior, peroneus longus, and tibialis posterior which are contribute the ankle stability? Findings Muscle activity of the tibialis anterior and peroneus longus applying Bulgarian split squat was higher than applying lunge squat.

Activity of the tibialis posterior showed no difference bet-ween squat conditions. Meaning Bulgarian split squat was more effective to elicit ankle dorsiflexor and evertor for ankle stability. More than 85% of ankle sprains that occur frequently in clinical practice are caused by excessive inversion of ankles.

Repeated ankle sprains can lead to chronic ankle instability (CAI). Causes of CAI are looseness of lateral ligaments of the ankle, deterioration of proprioceptive sensation, decrease of posture control ability, and muscle weakness after ankle sprain. Dynamic ankle stability is defined as the ability to maintain balance in response to disturbing forces from the outside.

, Stabilization of dynamic joints is achieved by contraction of muscles surrounding joints. Eccentric activity of calf muscles and concentric activity of tibialis anterior and posterior muscles are important for ankle stability., As a method to prevent CAI, strengthening of peroneus longus that, contributes to eversion of the ankle joint has been, suggested.

  1. Among therapeutic interventions to prevent CAI, squat exercises are typical closed-chain movements that occur simultaneously with movements of ankle, knee, and hip joints.
  2. They can be properly performed through overall biomechanics and neuromuscular control.
  3. Squat exercises are also important to maintain good alignment of ankle posture.

They have been recommended for the management of CAI. Previous studies have shown that one leg squat requires more neuromuscular activity due to reduced mediolateral base of support compared to two leg squats. – Increased neuromuscular activity has also been reported to have a positive effect on proprioception and strength in functional activities.

  • Although many studies have reported that one-leg squat has various advantages in functional activities, no study has studied the effect of muscle activity on ankle stability.
  • Therefore, the objective of this study was to investigate the effect of two types of single-leg squat exercise commonly used in clinical practice for strengthening and rehabilitation of lower limbs on muscles activity of the tibialis anterior (TA), peroneus longus (PL), and tibialis posterior (TP).

The hypothesis of this study was that muscle activities of TA, PL, and TP muscles at Bulgarian split squat could be higher than those at lunge squat. This study recruited 30 healthy volunteers (15 males, 15 females) who met the selection criteria. Participants were given a detailed explanation of the study procedure.

  • Written informed consent was obtained from each participant.
  • This study was conducted in accordance with principles of the Declaration of Helsinki.
  • Volunteers who were able to maintain single-leg squat posture for longer than 10 s to check shank muscles activity were recruited for this study.
  • Volunteers who had any neurological, musculoskeletal, or cardiopulmonary problems were excluded.
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True leg length was used to set the distance between the front and back feet during squatting. True leg length was defined as a distance from the anterior posterior iliac spine of the pelvis to the medial malleolus. Mean age, height, weight, and leg length of these participants were 22.9±1.7 years, 168.5±11.1 cm, 64.0±12.9 kg, and 85.1± 5.9 cm, respectively.

  • Before measuring electromyography (EMG) signals and attaching electrodes, any hair on the skin to be attached was shaved.
  • The skin was then cleaned with an alcohol swab before attaching the electrodes.
  • EMG electrodes were attached to the TA, PL, and TP according to published recommendations.
  • A Delsys Trigno EMG system (Delsys, Inc, Wellesley, MA, USA) was used to collect EMG data.

EMG signals were converted to digital signals and processed using Works Acquisition EMG analysis software for personal computers (Delsys, Inc, Wellesley, MA, USA). The sampling rate of EMG signals was 2,000 Hz and EMG frequency bandwidth was restricted to 20-500 Hz.

The common mode rejection ratio was set at 110 dB. The application of each squat was in random order. Metronome application was used to keep squat posture time constant. EMG measurement and operation of the metronome were started at the same time. After the start of the measurement, a squat posture was made for three seconds at the start position.

The squat posture was maintained for five seconds. It was then returned to the start position for three seconds. EMG measurement value analysis and processing were performed using root mean square (RMS) value for five seconds to keep the posture except for the first and last one for three seconds.

  • For Bulgarian split squat, the meta-tarsophalangeal joint of the left foot was placed on the support board which was 30% length of each subject’s height.
  • The hip joint was allowed to extend 10 degrees.
  • During the squat, the squat depth was adjusted so that the femur and tibia of the right leg were at an angle of 90 degrees and the right knee moved forward only to the position of the right toe ().

The starting position of the lunge squat was the same as the Bulgarian split squat. In order to maintain the trunk in upright posture, each hand was placed on the iliac crest. During lunge squat, the left knee was placed about two inches above the floor while the right leg was perpendicular to the floor. Figure 1. Experimental posture used to measure tibialis anterior, peroneus longus and tibialis posterior muscle activity during lunge squat (A) and Bulgarian split squat (B). To prevent muscle fatigue, subjects were allowed a 2-min break between measurements. RMS of EMG was used to measure the activity of each shank muscle. Three measurements were taken for each squat and the mean value of RMS of each muscle was calculated. All analyses were conducted using SPSS (ver.21.0; IBM, Armonk, NY, USA). Kolmogorov-Smirnov test was used to confirm that the data were distributed normally. Paired t -test was used to compare differences in muscle activity during each squat condition. Statistical significance was accepted at p <0.05. There were significant differences in the EMG activities of the TA ( t -value=7.591, p <0.01) and PL ( t -value=2.771, p <0.05) between squat conditions (). During Bulagrian split squat, EMG activities of the TA and PL were significantly higher than those at lunge squat. In contrast, the RMS value of the TP showed no significant difference between the two squat conditions ( t -value=0.303, p >0.05) (). Figure 2. Muscle activity during Bulgarian split squat and lunge squat in the same group (* p <0.05, ** p < 0.01). Squat activity is achieved through cooperative contraction of the hip, knee, and ankle muscles. Various types of squat exercise have been used in physical training and rehabilitation of individuals with CAI or knee joint deformities such as knee valgus and patellofemoral pain. - This study was conducted to examine the effect of two types of squat on muscle activities of the anterior tibialis ankle, long calf muscle, and tibialis ankle contributing to the stability of the ankle joint. As a result of this study, when Bulgarian split squat was applied compared to lunge squirt, muscle activities of TA and PL muscle were increased significantly ( p <0.05). This result can be explained by increased tendency to support body weight with anterior leg during the Bulgarian split squat, thereby increasing the contraction force of TA and PL muscles important for ankle stability. The TA muscle is used as the main actor of ankle dorsiflexion during squat. It occurs as a closed chain movement in the ankle joint. During squat, anterior-posterior ankle stability is mainly dependent on alternating activity of the TA and medial gastrocnemius. - When the anterior leg moves forward beyond the vertical line, the eccentric contraction of calf muscle is increased while the activity of TA muscle is increased when moving backward during squat exercise. The role of PL muscle is to maintain ankle stability by preventing excessive ankle inversion. Supination of the rear foot that occurs during squatting contributes to dynamic stability of the ankle complex through eccentric contraction of PL and peroneus brevis muscles. In particular, the PL muscle limits ankle inversion and plantarflexion to prevent damage to lateral ligaments of the ankle joint. The TP muscle is the main inverter of the ankle joint. It is a dynamic stabilizer that supports the medial longitudinal arch. In the present study, there was no significant difference in average value of TP muscle activity between the two squat conditions. The average value of TP muscle activity during lunge squat was 0.029 mV. It was 0.031 mV during Bulgarian split squat. The reason for this is that the muscle activity of TP during squat movement (which is mainly activated by plantarflexion and inversion of the ankle joint) is relatively low during dorsiflexion and eversion of the ankle joint. Hip extension occurred more during Bulgarian split squat than that during lunge squat. This caused the body to move forward and naturally increased weight bearing of the anterior foot while the center of pressure was located at the forefoot. Therefore, muscle contractions of the ankle dorsiflexor and everters contributing to ankle stability during Bulgarian split squat seemed to be increased more than that during lunge squat. This study has several limitations. Although we used a predetermined target frame to control the squat exercise, the speed of squat movement which might affect EMG signals was not controlled for each subject. In addition, surface EMG was used to monitor muscle activity, leaving the possibility of crosstalk from adjacent muscles. Therefore, further studies are needed to verify the effect of various squat exercises on the activity of leg muscles in individuals with musculoskeletal abnormalities of the lower extremity. This study investigated the effect of ankle stabilization on lunge squat and Bulgarian split squat to compare muscle activities of the TA, PL, and TP. Muscle activities of the TA and PL during Bulgarian split squat were significantly higher than those during lunge squat. However, there was no significant difference in muscle activity of the TP between the two squat conditions. Therefore, the hypothesis of this study was partially confirmed in that the Bulgarian split squat showed higher ankle stability than lunge squat. Eils E, Rosenbaum D. A multi-station proprioceptive exercise program in patients with ankle instability. Med Sci Sports Exerc.2001; 33(12):1991-1998 Hertel J. Functional anatomy, pathomechanics, and pathophysiology of lateral ankle instability. J Athl Train.2002; 37(4):364-375 Freeman MA, Dean MR, Hanham IW. The etiology and prevention of functional instability of the foot. J Bone Joint Surg Br.1965; 47(4):678-685 Iwamoto Y, Takahashi M, Shinkoda K. Differences of muscle co-contraction of the ankle joint between young and elderly adults during dynamic postural control at different speeds. J Physiol Anthropol.2017; 36(1):32 Kim MK, Yoo KT. The effects of open and closed kinetic chain exercises on the static and dynamic balance of the ankle joints in young healthy women. J Phys Ther Sci.2017; 29(5):845-850 Thompson C, Schabrun S, Romero R, Bialocerkowski A, Marshall P. Factors contributing to chronic ankle instability: a protocol for a systematic review of systematic reviews. Syst Rev.2016; 5:94 Kobayashi T, Gamada K. Lateral ankle sprain and chronic ankle instability: A critical review. Foot Ankle Spec.2014; 7(4):298-326 Kim Y, Kim E, Song Y, Han D, Richards J. The effects of functional instability of the ankle joint on balance. Physiother Pract Res.2016; 37(1):3-9 Salem GJ, Salinas R, Harding FV. Bilateral kinematic and kinetic analysis of the squat exercise after anterior cruciate ligament reconstruction. Arch Phys Med Rehabil.2003; 84(8):1211-1216 Giatsis G, Kollias I, Panoutsakopoulos V, Papaiakovou G. Biomechanical differences in elite beach-volleyball players in vertical squat jump on rigid and sand surface. Sports Biomech.2004; 3(1):145-158 Nairn BC, Sutherland CA, Drake JD. Motion and muscle activity are affected by instability location during a squat exercise. J Strength Cond Res.2017; 31(3):677-685 Severin AC, Burkett BJ, McKean MR, Wiegand AN, Sayers MGL. Quantifying kinematic differences between land and water during squats, split squats, and single-leg squats in a healthy population. PLoS One.2017; 12(8):e0182320 Graci V, Van Dillen LR, Salsich GB. Gender differences in trunk, pelvis and lower limb kinematics during a single leg squat. Gait Posture.2012; 36(3):461-466 Surface ElectroMyoGraphy for the Non-Invasive Assessment of Muscles Web site, Recommendations for sensor locations on individual muscles.2015, Available from:, Graci V, Salsich GB. Trunk and lower extremity segment kinematics and their relationship to pain following movement instruction during a single-leg squat in females with dynamic knee valgus and patellofemoral pain. J Sci Med Sport.2015; 18(3):343-347 Lewis CL, Foch E, Luko MM, Loverro KL, Khuu A. Differences in lower extremity and trunk kinematics between single leg squat and step down tasks. PLoS One.2015; 10(5):e0126258 Scattone Silva R, Serrão FV. Sex differences in trunk, pelvis, hip and knee kinematics and eccentric hip torque in adolescents. Clin Biomech (Bristol, Avon).2014; 2(9):1063-1069 Almeida GL, Carvalho RL, Talis VL. Postural strategy to keep balance on the seesaw. Gait Posture.2006; 23(1):17-21 Maeda N, Urabe Y, Fujii E, Moriyama N, Iwata S, Sasadai J. The effect of different stretching techniques on ankle joint range of motion and dynamic postural stability after landing. J Sports Med Phys Fitness.2016; 56(6):692-698 Williams VJ, Nagai T, Sell TC, et al. Prediction of dynamic postural stability during single-leg jump landings by ankle and knee flexibility and strength. J Sport Rehabil.2016; 25(3):266-272 Ashton-Miller JA, Ottaviani RA, Hutchinson C, Wojtys EM. What best protects the inverted weight bearing ankle against further inversion? Evertor muscle strength compares favorably with shoe height, athletic tape, and three orthoses. Am J Sports Med.1996; 24(6):800-809 Moon D, Park H, Choi E, Kim D, Kim M. Posterior tibialis tendon dysfunction: Preliminary report. J Korean Orthop Assoc.2008; 43(6):799-807 : Comparison of Activities of Tibialis Anterior, Peroneus Longus, and Tibialis Posterior Muscles according to Lunge Squats and Bulgarian Split Squats in a Healthy Population

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What exercises should not be done with tendonitis?

Tennis Elbow Exercises to Avoid – Any activity that causes shooting or sharp pain in your arm or elbow should be avoided altogether. However, before hitting the gym, you may want to take these exercises or workouts out of your routine:

  • Bench presses, pushups and chin-ups: These exercises can strain your flexors, further irritating your tennis elbow and worsening your condition.
  • Wrist exercises: Many wrist exercises can cause additional stress to your forearm and elbow, worsening your injury and making the pain chronic. Activities you should particularly avoid include barbell extensions and dumbbell curls.
  • Straight-arm exercises: Keeping your arms straight and your elbows fully extended can strain your wrist extensor muscles.
  • Repetitive motions or lifting: Any repetitive exercise that makes you move your elbow and wrist can cause agitation for your condition. When working on activities for tennis elbow, try to avoid doing too many repetitions when possible.

What causes anterior lower leg pain?

What is anterior compartment syndrome? – The muscles in the lower leg are divided into a number of compartments by ‘sleeves’ of thick, inelastic connective tissue. The anterior compartment is on the outside surface of the front of the lower leg. Blood flow to this compartment is increased during exercise and, therefore, the muscles within it increase in volume (swell).

  • If there is not enough room inside the compartment to accommodate this swelling, compartmental pressure rises.
  • This pressure can interfere with the blood flow to the muscles and nerves in the compartment, causing pain.
  • Potential causes of anterior compartment syndrome include; direct trauma (causing swelling within the compartment), a muscle tear within the compartment, a rapid increase in the size and volume of the muscles within the compartment, unfamiliar vigorous exercise, or gradual tightening of the surrounding connective tissue ‘sleeve’.

Physiotherapy is an important treatment for anterior compartment syndrome. Above: Soft tissue massage applied to soleus muscle by specilaist therapist