This article is a transcribed edited summary of a video Bob and Brad recorded in June of 2023. For the original video go to https://youtu.be/Xcg8zKFnOAU
Brad: As a therapist and working with people for many years, I have found, and I think any therapist would agree, that as we age, it gets more difficult to walk. Aches, pains, and limping can come in and can actually lead to falls. So this challenge is going to be faced and we're going to show you options to eliminate this problem with our lifestyle.
Mike: And we're going to show you an exercise to help improve your walking, balance, and leg strength.
Brad: By the end of this, you're not only going to understand why to do the exercise, but you'll be able to do the exercise and work on that walking pattern and become more graceful.
Mike: So the muscle we're going to talk about is called the tibialis anterior or as Brad corrected me, anterior tibialis. It means the same thing. It's this muscle right on the front of the shin bone. Do you want to talk about a little bit, Brad?
Brad: Sure. If you put your fingers right in that muscle belly and you pull your toes up, you will feel the muscle fibers contract, and as you go down, they relax. It's a very critical muscle, it's a part of walking, and that's how people oftentimes stumble or fall because this muscle is weak and the toes or the forefoot is not being elevated.
Mike: In the next section, we're going to talk about why it's important to strengthen this muscle for your walking.
Brad: And also how to strengthen it.
Mike: So the first reason you want to strengthen your tibialis anterior is if you're the person that commonly trips over your own feet or toes by not lifting your foot up enough when you're walking if the tibialis anterior is weak, this is commonly what causes you to fall over.
Brad: Right. A couple examples of this are drop foot or slap foot. If you have a tendency to do foot slap, in other words, when you walk your heel comes first as normal, and then that forefoot of the foot slaps down, you can actually hear it with people as they walk on a hard floor. This is going to help eliminate that problem as well.
Mike: Strengthening this muscle can help rapidly improve your balance, stability, and your ability to move side to side without tripping over as well.
Brad: Right. It's amazing what one muscle can do as far as improvement or making your balance a little off. So one way or another, we're correcting it.
Mike: Now, to strengthen the tibialis anterior muscle, we have to bring your toes up off the ground while leaving your heels down. We're going to do this against the wall. This is a slightly more advanced version. If you're too weak, we will show a different version you can do seated right after this. So to perform this, you need an open wall space. Get your back flat against the wall and then slowly walk your feet out. The further your feet are away from the wall, the more challenging this is going to become. So to start, be closer to the wall.
Brad: Before we go any farther, it's absolutely critical to make sure you have shoes on or your feet do not slip at all because once you bring your foot out, they could slide out and then we'll have a problem with safety. So make sure that is very stable before you get started.
Mike: So once you feel secure here, you're going to do toe raises and you're going to go up and down nice and slow. As you can see, my knees are straight as I'm doing this. I do not have a bent knee. Nice posture against the wall. And you're going to aim to do 25 reps and do three sets of that, but do it throughout the day. Now, if you're brand new to this, maybe start with five to 10 reps the first day because you might have some sore front shin muscles the next day when you wake up.
Brad: So Mike, are you saying if this was too difficult, could we bring our feet in even closer?
Mike: Yep, and then make it a little bit easier. And if I go out farther, then I'm really going to work that muscle a little bit more. It just adds a little more resistance without actually adding weight to yourself.
Brad: You may want to hold onto a stick or be by a wall or a chair just for stability. It really can make a big difference in feeling comfortable while you're doing this. Look at those anterior tibs working.
Mike: And people often don't strengthen this muscle group so you might feel a little bit of a burn when you're first working it. Most people, when you walk, you work the other muscle group, the calves, so this is going to feel a little different if you're not used to it.
Brad: That's right. Don't overdo it. You don't want to be sore the next day. 10 repetitions, if you haven't done it, it'll probably be good for the first day.
Mike: So now we'll show a seated variation.
Brad: All right, now, if you have severe weakness with your anterior tib and you're unable to lift that foot up even without resistance in the seated position, this could be very likely after a stroke or an injury, something of that nature, or maybe you've been sedentary for a while because of an illness and you're elderly, this can be extremely taxing. So what we're going to do in a firm chair, not a lounge chair, what you can do is take a cane and you're going to actually help pull up the foot, get a little stretch is okay. At this point, this is called an eccentric exercise. We're going to take the cane away and hold that foot there. And you'll find if you're really weak, and that's not unusual where, "Oh, it's even hard to hold it there." So the first step is up. See if you can hold it for three seconds, one, two, three, and then let it down slowly. It's important that you let it down slowly. That's where the eccentric comes in. You don't need to understand that. Just believe us because it's been studied a lot and it does help. So up, let it down slow, and do 10 repetitions like that.
Brad: Do that for three or four days and hopefully within a week or so you'll be able to pull that up without the cane. You know your progress is good at that point and then work your 10 to 15 repetitions like that.
Brad: And then you can go over to the wall after you get to that point. Usually one to two weeks, you should be there. If it's longer, it's okay. Particularly if you've had some nerve damage or a stroke, then the progress will take longer. After you've strengthened that muscle and you feel the difference in strength, it's really important to monitor your walking or we call it gait in therapy. Actually, look in a mirror if you can, if you have a hallway and you can look in a full-length mirror and watch your feet, and then think about pulling that foot up and bringing it down. And if you watch it, that's feedback into your mind and that will also stimulate those muscle fibers to pull that ankle up and get back into a normal walking pattern. As a matter of fact, I think some people are in such a habit, that they have no idea that they're dropping that foot until they stumble. But if you think about it and do the exercises, it works out really strong and it's a definite win-win situation. Mike, do you think anything about that? Am I doing okay?
Mike: I think you're doing okay, but if you'd like to watch another video about how to improve your walking, check out our videos "Physical Therapist Shows How to Walk Correctly," and "Fastest & Easiest Way To Walk Properly."
Brad: Very good. Good luck everyone.
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