Daily exercises for posterior tibial tendonitis 

You're welcome!

Hi Kiran, Likewise much love and peace, and also gratitude for your passionate and challenging challenge, which makes me stop to reassess what I have been recommending. Everyone needs a challenge to keep them responsible. -:) Yes you are right, it is easy to do isometric work and overdo it such that it "burns the targeted muscle" - (perhaps you also mean "burns the targeted tendon"?). So yes, I do need to be more diligent about advising how to de-load the workout to a point that most people are working within the limits of what their damaged tendon can give them. Some comments. (1) A theraband exercise might also "burn the tendon and muscle", if one spends sufficient time with a strong band and with the toes in a hard ballet point, with the toe pointing inward - that makes the PTT and the PT muscle work extremely hard. (2) You need to find a comfortable and doable way to do the exercise for perhaps 5 minutes a day for three months or more. I'm sure some people can do that with a theraband, but I would find that a hard chore myself. (3) Whatever exercise is used, it should contract and strengthen all the muscles of the foot and ankle, because they are all team players and the all help protect and take the load off the PTT tendon. Standing isometric will do this more efficiently than the theraband. (4) Whatever exercise, the tendon must be loaded in a non-jarring way, in a more or less straight line, for two minutes per session. The beauty of "isometric" PTT work is you can do it on autopilot and check your emails while the healing stimulus heals the tendon. Finally Isometric has worked for me, but I do need to think about fine-tuning my advice and showing how to keep it low-level for beginners. Thankyou for your challenge It is very welcome.

@@btpilates-solutions Isometrics are goated fr.., last sep 2022 i underwent ankle surgery., and i see swelling on sides of ankle if i sit for minimum of 1 hr., those puffy ankles are disgusting tbh., so after i was able to walk due to my physio., i began the hunt for my solution. after these many months i discovered ., its the Intrinsic Foot Muscle Strengthening thats need to be heavily focused on., slowly building arch and stuff i recntly came across your video and after watching i did standing 3 min hold with posture as you mentioned., no cap this works...... thanks man..., love from India ::)

Thank you Rurik, and good luck. I suggest you read my reply to Tyler March below. Stay in touch and let me know how it's going in a year's time.

Can you run again? Did the exercises help?

You are welcome!

An ankle brace is a good idea. But I am not an expert in that. Try some searches on youtube and in the product comments at Amzon.com

Yes, a long time. Tendons are slow to develop their weak spots and slow to regenerate. If your daily management makes the rate of repair exceed the rate of degeneration, then improvement will eventually happen. Your job is to make that daily input an enjoyable habit. If you do that then 3 months will pass by quickly enough. Good luck.

Good. You need more than one strategy, however. Find a daily exercise routine that works for you.

I read your comment and swear I wrote it. 😢 How is your healing journey now?

Good question Can the tendon regenerate without significant rest? The question assumes that tendons are like muscles and need to rest from activity to heal. Not strictly true for tendons, however. Tendons rest when they don't (all at the same time) handle a heavy tensile load and go around a sharp corner. They can rest from damage while doing a straight line load or when unloaded and doing a sharp corner. But not both at the same time. If you slightly straighten your ankle every time you load your PTT tendon, you have given the tendon the rest from the sharp corner that it needs, while also providing the straight-line tension that stimulates healing. This is the safe way to load (and heal) the tendon. so... Regular and consistent time under load, **loading the tendon in a safe way** is the solution. Small or infrequent bursts of exercise won't work and are the main reason why PTT exercises fail. So the solution is to learn to **safely load**. Safe loading happens when you have done a good two minutes of loaded work, and you say to yourself, "yes I can do that again in 12 or 24 hours". (In other words, it's comfortably sore, and not desperately sore) This is how to safely load (3 strategies): 1. Isometric (minimal movement) 2. Reduced load (you can do this by sitting in a chair, lifting the heel of the affected ankle 2-3 cm off the ground, and then leaning a hand or elbow onto the knee (rest a dumbbell weight on it if you like - 2 kgs to start). Once you know the load you can perform for 2 minutes every 12 hours, you can increase the load gradually by (a) higher heel lift, (b) more pressure on the knee (heavier elbow or more dumbbell weight) 3. Avoid the tendon going around a sharp corner (already covered above by lifting the heel an inch or two). Tendons are not strong when going around sharp corners. You also reduce the tendon's sharp cornering during the day by wearing ankle braces/hiking boots, and using a heel wedge (but not all day - only on days that you have to do hard walking or prolonged standing/running). Once you have safely loaded for a good two minutes, you can give your ankle a shake out and some ankle circles (mobilise it to encourage the blood flow), and you can massage the PT muscle (it may be grumpy and knotted after all that sustained loading). Does that cover it? Thanks for the good question. Let me know how it goes

**If you are weight-bearing and able to walk (or is that hobble at the moment?), then yes! ** Do all the suggested interventions at a slow and gentle level. Work at a level that you can sustain day in and day out for months or years. For example, isometric loading will likely reduce pain by squeezing inflammatory fluid (doctors call that oedema) out of the inflamed areas of the tendon. But you will only know if you give it a go. **You must be disciplined about supporting your ankle during the standing activities other than your PTT exercises** Give your foot and ankle the support they need when you are walking (such as tightly laced hiking boots and instep lifting orthotics - you can loosen the laces when seated at the office desk). This support improves the alignment from "sunken down and rolled in" toward more of "ankles wide, knees wide and foot arch lifted". In this alignment, you load your painful tendon *in a straight line* which causes a lot less damage (tendons get damaged when they are loaded and moving around sharp corners). It also changes the geometry so that the muscles don't have to work so hard to maintain the correct alignment. **The wheel barrow analogy** When you stack logs on a wheelbarrow and start pushing it, you have to maintain an upright alignment because the moment the barrow sinks to one side, you have to use massive strength to bring it back to vertical. It's the same with your sunken PTT ankle. That's why support with boots is important. **You must be patient and disciplined** Once you have developed comfortable daily habits, keep going. The damage has probably developed over many years? It will take years to improve. My own experience (mild to moderate strain) is that a good daily habit will still deliver gains after five years. **It's a multi-strategy approach. Use help and advice from many sources.** Don't just rely on me!