By Mitch Hauschildt, MA, ATC, CSCS
A few weeks back, I published a 2 part blog series on Tibial Rotation (IR). In that series, we discussed the need for Tibial Internal Rotation and then how to correct it. I wrote about it, because I found a while back that I wasn’t looking hard enough at Tibial Internal Rotation and just about every one of my patients (especially those with lateral knee pain) had some sort of restriction there. Thus, I find that I am correcting it on a lot of my patients and it is paying off nicely with their rate of improvement.
From that 2 part series, I received a lot of positive feedback and a few questions. One question that came up a few times was, “How do I integrate exercise to reinforce the new range of motion?”
I found that I didn’t have what I felt was a great answer. Usually in a situation such as this, I recommend that you find a movement that challenges the new range of motion and exercise in that new range of motion. It is a little more difficult to come up with creative ideas on Tibial IR, since we don’t typically find ourselves actively moving into that pattern on a regular basis. We do need Tibial IR for proper movement though.
So, my stock answer is to put them in a neutral foot stance and squat through the available range. In all reality, while this isn’t that cool or sexy of a corrective, it probably is the best answer. Our body searches for that 20+ degrees of IR during the squatting movement. Thus, if you ask them to squat after improving their restriction, they should search for whatever range they have before continuing on to other compensation patterns. Thus, it does exercise through the full available range.
Recently, my good friend Adam Wolf presented his approach to using a helical taping technique to either improve or reinforce Tibial IR. The concept makes perfect sense because during gait, the lower extremity utilizes IR more and more as you move down the leg. Meaning, the body seeks more rotation at the lower leg than it does at the femur. Thus, we can encourage tibial IR by taping the femur because if we improve rotation at the femur, we can get an exponentially greater rotation at the lower leg. Take a few minutes and watch Adam’s video here for a better explanation.
The sequence I now follow for someone with a Tibial Internal Rotation restriction is to mobilize manually, perform movement(s) that challenge the new range of motion to reinforce the correction neurologically, and perform a helical taping to reinforce and promote Tibial IR within their activities of daily living. I think that you’ll find this approach will help you fix a lot of the chronic pain patients who are restricted in this area.
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