In contractures of the anterior tibialis muscle , to determine the effectiveness of physical movements (strengthening, stretching) of the tibial anterior muscle in parallel with the treatment (foam cylinder massage and Shockwave therapy).

Abstract

Tibialis anterior occurs in several places; Lateral condyle of the tibia. Upper two-thirds of the lateral surface of the tibia. Anterior surface of the interosseous membrane. Deep surface of the deep fascia of the leg. Anterior intermuscular septum. It runs down the leg, giving off a cord-like tendon in the distal third of the tibia. The tendon passes through the ankle and the dorsum of the foot, inserting at the medial cuneiform and adjacent base of the first metatarsal. The tibialis anterior lies medial to the extensor digitorum longus and extensor hallucis longus, making it the most medial muscle in the anterior tibia.(2) It also encloses the anterior tibial vessels and the deep peroneal nerve in the proximal tibia.(7) The deep peroneal (peroneal) nerve (L4, L5), a branch of the common peroneal nerve, innervates the tibialis anterior muscle. (8) The anterior tibialis muscle pain comes from the muscle, which lies at the front of the lower leg, and attaches to the top of the foot. Pain in this area can be confused with shin splints, which is pain on the inside of the lower leg/shin. Instead, this pain would be at the front of the lower leg to the outside of the tibia bone, or at the tendon on the top of the foot.(13) This tendon is the large tendon visible crossing the front of the ankle. One of the main functions of the anterior tibialis muscle is to pull the foot up (ankle flexion or dorsiflexion), and it assists in keeping the arch from collapsing. When the anterior tibialis muscle is overworked or injured, pain can develop here.(14) Because the anterior tibialis muscle assists in keeping the medial (inside) arch up, an arch collapse can overwork the muscle. If there is pain elsewhere causing an abnormal gait, the anterior tibialis muscle may compensate by overworking. One example of this is pain at the ball of the foot causing a heel walk, which activates the anterior tibialis muscle with more force and for a longer period of time. Another instance when the tibialis anterior muscle becomes overworked, is when another related muscle is weak or not activating properly. If the tibialis anterior muscle has to take over the job of another muscle, the load may be too much to handle. Tight anterior tibialis muscles can be rather annoying as it makes the simple task of walking unpleasant. The causes of tight tibialis anterior can lead to shin splints and can be a result of any of the following:  Direct trauma to the muscle area  Intense workouts or prolonged workouts where your ankle is constantly flexed upwards  Running, jumping or other high impact activities on hard surfaces  Imbalance gait while walking or running  Sudden change in exercise routine (40) There are many treatments for muscle tight, ranging from exercises therapy to physiotherapy. Conventional treatment options include massage or massage with Foam roll, stretching, physical therapy. Extracorporeal shock wave therapy (ESWT) is a non-invasive procedure that includes delivering shock waves to the traumatic region with the goal of decreasing pain and encouraging soft tissue healing. The shock waves for orthopedic signs are the same as those used to break up kidney stones, but they have 10 times less energy. Low energy defocused ESWT or soft focused acoustical wave pattern is used for wound healing.