Tibialis Posterior: Pain & Trigger Points

The tibialis posterior is the “deepest” muscle of the calf and can trigger severe pain at the Achilles tendon and the sole.

This pain is usually caused by muscle tensions and trigger points.

What most people do not know is that they can relieve these pains with a self-massage.

The effects are amazing, even if they are underestimated by many patients and even therapists.

On this page you will not only learn how to massage your tibialis, but also …

  • what complaints it can cause.
  • its location.
  • its functions.
  • how it develops trigger points.

1. Pain Patterns, Symptoms & Differential Diagnoses

1.1 Pain patterns

Tensions in the tibialis posterior often lead to calf pain and local sensitivity to pressure.

Trigger points, however, trigger pain in the area of the Achilles tendon, and can refer pain down to the sole or up into the calf.

1.2 Symptoms and further ailments

The pain described above usually arises under stress/load/movement, but it can also occur at rest.

Particularly in the sole of the foot and the Achilles tendon, affected persons often experience pain when there are active trigger points in the tibialis posterior.

2. Attachment Points

The tibialis posterior is the deepest muscle in the posterior part of your lower leg. It originates in the upper rear part of the lower leg and runs all the way down to the arch of the foot.


  • Membrana interossea
  • Inside of the fibula
  • Back of the tibia
  • Intermuscular septum of adjacent muscles


  • On most bones that form the arch of the foot.


  • The muscle is innervated by the nervus tibialis.

3. Tibialis Posterior: Function

I would like to explain the functions of this muscle using bullet points and pictures, and then show you what meaning they have in everyday life.

  • Plantarflexion/Pressing toes towards/in the ground
  • Supination




3.1 Plantarflexion in everyday life

With every step, you push yourself off the ground and thus lift your heel.

Of course, the same function is needed to jump in the air, as for example in volleyball or basketball.

Thus, this muscle is very important for locomotion.

3.2 Supination in everyday life

When walking, with each step you stand on one leg for a short time. In this phase, the muscle prevents your ankle from bending too much inwards.

4. Tibialis Posterior: Trigger Point Activation

Trigger points are mainly activated through overload in sports.

Jogging in general or jogging on uneven or slippery ground can quickly activate trigger points.

In “normal” jogging, it is the monotonous movement sequence that triggers the overload of individual muscle fibers.

Especially if you are not used to this kind of stress, give the muscle too little time to adjust or do not perform balancing activities such as massages and stretches.

On uneven ground, the muscle needs to stabilize the ankle more heavily, which can overload it, too.

On slippery ground, the toes slip slightly backwards with every step. This is a high stimulus for the muscle and may overload it.

Other factors that favor the development of trigger points are instabilities at the ankle joints.

5. Palpation

Since the muscle lies very deep in the calf, it is not possible to distinguish it from the surrounding muscles.

You can still massage it. All you need to know is where to put your hands and how to perform the massage. That’s exactly what I’ll show you in the next chapter.

6. Tibialis Posterior: Self-massage

You can massage the muscle with a foam roller, a massage ball or the Body Back Buddy and apply various massage techniques.

6.1 Self-massage of the posterior tibialis with a foam roller

  • Sit on the floor and place the roller under your lower leg, just below the hollow of your knee.
  • Push yourself off the floor and slowly roll over your lower leg.
  • Once you encounter a painful tension, massage it by rolling a few times from just before to just after the painful point.
  • Proceed in this way all over the posterior part of your lower leg.

Note: In the picture I put my “free” leg over the other one. This is the only way I can build up enough pressure to penetrate the tibialis posterior.

If this causes too much pain, do not cross your legs. This reduces the pressure and makes the massage less intensive.

This prevents you from getting deep into the tissue and massages the soleus and gastrocnemius, which lie above the tibialis.

However, this is not a problem, as these two muscles often develop trigger points along with the tibialis posterior.


  • Calais-German, Blandine. Anatomy of Movement. Seattle: Eastland Press, 1993. Print
  • Davies, Clair, and Davies, Amber. The Trigger Point Workbook: Your Self-Treatment Guide For Pain Relief. Oakland: New Harbinger Publications, Inc., Print
  • Simons, David G., Lois S. Simons, and Janet G. Travell. Travell & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual. Baltimore, MD: Williams & Wilkins, 1999. Print.
  • Schünke, Michael., Schulte, Erik, and Schumacher, Udo. Prometheus: Lernatlas der Anatomie. Stuttgart/New York: Georg Thieme Verlag, 2007. Print