How To Treat Tibialis Posterior Tendinopathy
Steps To A Successful Recovery
Tibialis posterior tendinopathy treatment is made very simple and effective in a few easy steps. As reported in our previous blog ‘What Is Tibialis Posterior Tendinopathy?‘, it is a very common place, overuse condition, especially among runners.
Ankle pain when running and walking, as well as using unsupportive footwear are all classic characteristics. The diagnosis is the easy part – the key question then is how do we treat it?
Stretching alone will not cure tibialis posterior tendinopathy!
Loosely speaking, there are three steps to tibialis posterior tendinopathy recovery. The exact formula for recovery and the specifics of each stage will be outlined by your physiotherapist. The duration and severity of your symptoms will guide how you progress through the steps outlined below. Note that stretching is not mentioned!
Tibialis Posterior Tendinopathy Treatment
Reduce Pain
In an acute pain episode or flare up, follow the ‘POLICE’ protocol in the initial 48-72 hours:
- Protect > using good supportive footwear, taping or a short-term insole with medial arch support
- Optimal Load > general rest and offloading for the next few days, before steadily reintroducing movement as pain allows
- Ice > cold compress for 10-15mins every 2-3 hours to aid pain relief and reduce inflammation
- Compression > compress the injured area with an elastic, tubular bandage to slow the swelling
- Elevation > raise and support the injured area above the level of your heart to reduce swelling
Reset
Extracorporeal Shockwave Therapy is a relatively new intervention that has scientifically proven, excellent results with specific conditions. These include Plantar Fasciitis, Tennis Elbow, Achilles Tendinopathy and Hamstring Tendinopathy treatment. Shockwave Therapy owes its heritage to lithotripsy. This is when focused shockwaves break apart gall stones so they could be passed. A number of years later, a bit of lateral thinking and a strong evidence base now presents SWT as the ‘gold standard’ treatment.
As noted in our previous blog, ‘opathy‘ rather than ‘itis‘ is used to define the issue. This characterises the stalling healing process and disrepair (more commonly called scar tissue). SWT as part of tibialis posterior tendinopathy treatment aims to agitate or shock the injury back to its acute phase of healing. It uses acoustic energy – almost like pressing the ‘reset’ button. SWT ‘resets’ the stalled healing process. It expedites a return to activity and has a noticeable reduction in pain. It is then vital to introduce progressive load to the tissues to ensure an optimum recovery.
Strengthen
As we know the tibialis posterior tendon plays a crucial role in absorbing and producing force when walking, running and jumping. As a result, part of tibialis posterior tendinopathy treatment should focus on regaining localised strength of the deep calf muscles, as well as improving any weak links in the kinetic chain further up.
A study published in 2022 showed that a tailored, progressive strengthening programme provided significant improvement as part of tibialis posterior tendinopathy treatment.
Research has shown that shockwave therapy, in combination with a tailored strengthening programme, gives the most significant improvements in tibialis posterior tendinopathy treatment for chronic issues.
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