Kinesiology THURSDAY – Tibialis Anterior Mensical Pinch (Why Did That Work?)

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“Fix what you find.” That’s one of my treatment philosophies. As a clinician, sometimes things don’t present as we expect. Sometimes, like the invention of velcro, things get discovered by accident. This week, I wanted to start a series called, “Why did that work?!” and the first thing I wanted to talk about is medial meniscus impingement.

A Case Study (short and sweet)

53-year old female presented with complaints of anterior medial knee joint line pain that increased with walking or standing. No history of trauma. She ambulates with mild antalgia and supinated gait pattern. Severe pain was elicited in end range knee flexion with over pressure. ROM was otherwise normal. Palpation revealed severe trigger point and fascial restrictions in tibialis anterior. Soft tissue mobilization and facial release of tibialis anterior resulted in pain-free knee flexion with over pressure and elimination of pain with weight bearing.

Why did that work?!

The tibialis anterior (TA) doesn’t even cross the knee. How could it affect knee ROM?

The TA dorsiflexes and inverts (supinates) the foot. Try moving your foot into supination. Notice your tibia also internally rotates and adducts. It is difficult, if not impossible, to separate these movements. Trigger points in the TA signal a tibia that is probably chronically internally rotated and adducted, a prime cause of anterior medial meniscal pinch.

How does this happen?

Over supination (which is main cause of TA trigger points) is often due to one or more of the following:

  1. Weak quadricep – The main job of the quadricep muscle is to decelerate knee flexion when you walk or run. It works less if you supinate the foot. If your quad is weak, you will supinate when you walk.
  2. Lack of subtalar joint eversion – Because of #1, prolonged supination compensation can lead to hypomobile STJ eversion, resulting in chronic compression of the medial knee compartment

There you go. The next time you encounter someone with medial knee joint line pain, check the tibialis anterior and fix what you find.

Because nobody has time to be in pain.

Until next time…

Kind Regards,
MoveWell Academy
[email protected]

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