When the hips and core call BS on the foot

……….an arch that collapses when doing any sort of bilateral or unilateral squatting motion. I’ve assessed him for anterior pelvic tilt and hip internal rotation, thinking this might be the driving force behind the collapse, but nothing shows up. I’m wondering if it’s stemming from structural issues in the foot? If so, am I stuck with referring him to a podiatrist?

If basically the individual is awesome at the hip and core and still falls into valgus collapse, here are some things to think about……
1) They are not awesome at the hip and core. Recheck ASLR and SM in the FMS and be very discriminate. Recheck MSF and MSE.  Recheck everything.
Is it terribly likely that an upper body limitation is going to filter through a solid middle and lead to the feet falling?  No, it’s not, but it is possible.  I think it’s fair to be skeptical here.

Movie Sucked

2) Look at the foot. As we know what is flat is not always flat.
What does the foot look like off the ground? Does the shape change to something more resembling an arch when it’s unloaded?
Can they walk on their toes? No one walks on their toes without an arch.
What’s big toe mobility?  If the big toe doesn’t hyperextend, the midfoot won’t have a “reason” to stabilize with an arch.  The Windlass Mechanism won’t be set up if there isn’t substantial push-off.
Do you teach, or does the person claw with their toes during lifts.  Clawing the toes gains stability, but I believe it also inhibits the deep foot muscles as well as the hip.  Without the freedom of the toes to go into push-off, I suspect the brain does not allow for maximal neural flow to the hips to blast through.  They won’t blast because the brain doesn’t think propulsion is being asked for.

You still think your foot is flat, or does it just get flat?

3) Mobilize the foot.
If the foot appears flat, don’t give up yet.  Joints can be mobilized through manual therapy and neuromuscular training.
There are aggressive manipulative techniques for the foot as well as softer PIR/MET that I have used recently.
Training on wobbles and teeters that have a flat surface as Pr Janda taught have been shown to facilitate the short foot.  DNS positions, particularly, Creeping with hanging, is another powerful neuromuscular mobilization of the foot.

Not silly. Very not silly.

4) If you are confident of all else, try static training, with a surface angled up and away from half the foot.  This was something Shelby Turcotte published years ago on Strengthcoach.com.
Foot is flat. Put say a thinnish mat underneath half of the foot, so the lateral foot is raised.  The foot basically starting in what resembles pronation/valgus collapse. Then ask the individual to engage the exercise. See if this RNT allows for a fix.

[youtube]http://www.youtube.com/watch?v=0_RwK-PL4H0&feature=player_embedded[/youtube]

5) Yes, send them to someone if you can’t filter through one of the routes above.  I don’t care if it’s a podiatrist or a ditch digger.

  • July 3, 2011

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Mike T Nelson Reply

Another option that I have used with great success is a “b-stance” One foot is raise so that only the ball of the foot is contact with the ground (heel is up) and then perform your “standard” lifts–pressing, deadlifts, etc.

If you use a B-stance on the deadlift, you will find it is a great way to load the entire body and add some stiffness to the foot in a very position specific way. This also works great to transition people to more barefoot running styles too.

Thoughts?
rock on
Mike T Nelson PhD(c)

Fraser Dods Reply

My philosophy is to “clear” those potentially contributing factors closest to the area of pain/dysfunction before looking too far afield (up/down the kinetic chain or spine/core). If someone is excessively pronating (triplanar evertion, dorsiflexion and abduction of the foot) the most likely culprit (closest contributor) is either a structural propensity (unlikely to be changed dramatically if rearfoot is in valgus or forefoot adducted and in which case orthotics may be indicated) OR tibialis posterior is weak and not providing sufficient strength to maintain or control inversion/pronation. With forces through the foot being 5-10x BW during athletics, the tib post muscle must be sufficiently strong so as to decelerate or control that natural and normal pronation of the foot on footstrike. If tibialis posterior can’t prevent excessive or prolonged pronation the foot takes on a flattened appearance and the excessive pronation may contribute to a host of maladies, from plantar fascittis locally to spinal dysfunction “upstream”. In my practice, 90% of the time a course of progressive tibialis posterior strengthening (with release of tib post and posterior compartment/calf trigger points) will alleviate if not all, then a majority of the excess pronation (assuming hips and core are satisfactorily strong in functional closed-chain testing).
Main point – look “locally” before chasing ‘far flung’ suspects…

Fraser Dods BScPT Sports Therapist

craig Reply

Fraser, do you not think it’s a little naive to blame a flat foot on the tibialis posterior. This muscle will obviously be over lengthened and appear weak in a flat foot but do you not think some of the bigger muscles further up the chain could not be doing there job which creates less integrity throughout the leg leaving the foot to deal with ground reaction force alone. I doubt if a tibialis posterior on it’s own could could decelerate the entire body weight especially as you mention 5-10 x BW in athletic movement.

Craig

Eric Reply

Fraser, as someone who suffers from plantar fascittis/ankle pain, your post obviously got my attention. I am getting fit for custom orthotics so that I can start to run again with less pain. But I do feel that is a bandaid on the problem and I am more interested in actually fixing the problem as opposed to the symptoms. That being said, what type of program would you recommend to target the tib post?

Hector Reply

Fraser,
you said: “In my practice, 90% of the time a course of progressive tibialis posterior strengthening (with release of tib post and posterior compartment/calf trigger points) will alleviate if not all, then a majority of the excess pronation (assuming hips and core are satisfactorily strong in functional closed-chain testing).”

How do you strengthen the post tib without the rest of the muscles around it?

What about the hip in the transverse plane? Try this: Stand shoulder width apart and and take your hands out in front of you at shoulder height. Rotate them to the left with your trunk and hips to follow without letting your feet come off the ground. What does your left foot do? SUPINATE.

I think Janda was very innovative, but we have to appreciate the tri-plane motion of the hips and how the transverse plane drives the feet.

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