In terminal stance, tibialis posterior activation assists in locking the transverse tarsal joints, creating a rigid foot necessary for normal heel rise as the body progresses forward during gait.
Kulig et al11 reported that the tibialis posterior muscle was most selectively and effectively activated during therapeutic exercises that focused on foot adduction movements. During aquatic walking, lower extremity extensor moments display increased hip and decreased knee and ankle contributions compared to land walking, providing an opportunity to initiate early gait training with limited ankle joint forces.12 Compared with heel-toe walking, toe walking produces greater plantar flexor moments during stance, higher peak plantar flexor moments during the loading response and midstance, lower mean plantar flexor moments during terminal stance, earlier soleus and gastrocne-mius activity, and higher levels of mean soleus and gastrocne-mius activity during stance.13 During toe walking, the peak internal knee extensor moment is lower in midstance and the power absorption is reduced in the loading response. Toe walking can be incorporated into a form run simulation with exaggerated transverse plane trunk rotation to restore nonimpaired active mobility and improve dynamic functional foot, ankle, knee, and hip stability while minimizing impact forces prior to return to running (Fig. 72-2). Backward walking on a treadmill can be used to facilitate ankle dorsiflexion and eversion in synergy with knee flexion and hip flexion-extension (Fig. 72-3). To further increase the dynamic stability demands at the foot and ankle, functional tasks such as single leg standing with trunk twists (Fig. 72-4), punching with dumbbells during single leg stance (Fig. 72-5) and single leg step-ups with trunk twists (Fig. 72-6), each performed barefoot with exaggerated transverse plane rotation, are encouraged to challenge synergistic dynamic lower extremity functional stability from the foot to the hip.
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The use of dumbbells gives you a much more comprehensive strengthening effect because the workout engages your stabilizer muscles, in addition to the muscle you may be pin-pointing. Without all of the belts and artificial stabilizers of a machine, you also engage your core muscles, which are your body's natural stabilizers.