Introduction & Shoes and Sitting
Systemic biomechanical issues
Evaluation of lower body dysfunction and corrections
Soft tissue optimization and corrections
Summing it up
Evaluation of lower body dysfunction and corrections
Table of Contents
Introduction
Muscle and connective tissues evaluations
Postural evaluations
Movement analysis
A bit on corrections
Introduction / To the top
Now that I have taken you extensively through common muscle, connective tissue, and joint problems associated with shoes and sitting we are going to discuss the ways to fix these dysfunctions.
Unfortunately, I do not have room to discuss all of these conditions that in depth because whole chapters in books are writing on single conditions that I have described. However, I will try to provide a basis with which you can systematically evaluate your own body to ensure that you have your muscles, posture, and biomechanics in the normal ranges. This will ensure a very low probability of developing such injury conditions or for fixing the ones you have.
There are three main ways that you can evaluate potential problem areas. These are muscular, postural and movement analysis. I am going to talk a bit about each.
You should know, however, that as much as I can give details about descriptions for how to do this, it only comes through experience. Just like you have to coach many people to be able to correctly refine your technique of evaluating movement, you also have to be able to look at someone closely and be able to examine muscular, postural, and movement deficiencies.
Physical therapists tend to have a leg up in this area as they do take courses on gait analysis and biomechanics. Although I cannot be sure of the effectiveness of either physical therapists or trainers to see such problems. People have different areas of expertise, and until you see someone you know who can evaluate well it is basically a shot in the dark. Ideally, you will be able to find competent physical therapists or trainers in the area by word of mouth. That tends to be the best way of ensuring quality that I know of.
However, I will do my best to educate you through this article.
Muscle and connective tissue evaluations / To the top
For most people muscular and connective tissue evaluations will be the easiest to do. This is because most of us know our bodies fairly well, and can tell when we have tight muscles, sore joints, or pain. Nonetheless, as we know from the previous few sections there are some things we can look out for to know some specific problem areas.
In particular,
Tight calves – look at plantar flexion and dorisflexion range of motion. Ideally, you should have a large range of motion in this area of at least 90-120 degrees of arc in the tibiotalar joint as defined by the angle made from the foot at the edge of its range of motion. If you can only obtain < 60-75 degrees of movement, you are at a more significant risk of injury.
Weak glutes – There are various ways you can evaluate this. First, one way you can identify this is through light jogging. If you feel your quads working at all while jogging and running, you have very weak glutes. Similarly, if you cannot properly execute a squatting movement facing a wall with your toes 3 inches from the wall you probably have weak glutes. Likewise, if glute bridges make your quads and hamstrings burn from exertion, you also have weak glutes.
Tight adductors – any sign of caving knees during movement is a universal sign for weak glutes and tight adductors. Also, this may be evaluated by attempting to go into a middle split. If you cannot obtain more than a 90 degree angle between your legs, you probably have very tight adductors.
Plantar foot muscles and ankle stabilizers – if you cannot reliably single leg balance with shoes and barefoot for > 30s you are deficient in this area. You may not wave your arms around to help maintain balance.
Quadriceps dominance and tightness – One of the ways to test the tightness of the quadriceps is to sit with your back against the wall on the ground. Then pull your leg towards you with your hands to the limit of its range of motion. After you let go with your hands, let your leg angle normalize which if you have tight quads it will probably start sliding away from you. Ideally, you should be able to get about 120-130 degrees of flexion or an angle of 50-60 degrees created with your knee. This is the minimum.
For dominance activation testing, use the gluteal methods of analysis. Since glute strength and function is almost universally correlated with quadriceps dominance, you can use these tests to see how quad dominant you are. Remember, this is because as the hip extensors become more inactive, the load is shifted to the knee extensors.
Tensor fasciae latae and IT band tightness – there are no reliable tests for this that I am aware of. However, you may be able to test to see how tight they are. Stand on one leg and keep a level pelvis, then try to adduct the other leg as far as possible past the other leg. If you cannot reliably get it more than a couple inches past the other leg, you are tight in the TFL and IT band especially if you feel them stretching.
Hamstring tightness – Lie supine on your back with everything relaxed and straight legs. You should be able to bring one leg up to 90 degrees comfortably without bending either leg. If not, your hamstrings are indeed probably very tight.
Deep butt muscle tightness – This stretch is a good test. If you cannot get your feet out more than a few inches away from the sides of your body then you are probably very tight. Work on improving the range of motion.
Actual injuries – flat feet, plantar fasciitis, achilles problems, shin splints, non-other person ACL trauma, IT band syndrome, patellofemoral syndrome, SI joint pain, lumbar back pain, or any of the other joint deformities such as hallux valgus/bunions, talipes valgus, genu valgum/knock knees, etc. also signify problems.
Other assessments
As I started rereading through The Neanderthal No More series they wrote a lot of lower body dysfunctions as well. In part two, they included a lot of other tests you can do for the lower body to see if you have problems. Read through this as well and take notes.
Write them down now…
Many of you will know by reading the above list and evaluating yourself that you have problems. Write them down and keep notes on what you need to work on. This is a good idea to add prehabilitation work focusing on improving these deficiencies which will improve muscle and connective tissue quality. This can be done in your warm ups or cool down times before and after your workouts respectively. For those that do not work out, you can do them whenever you have free time. This is encouraged for both the sedentary and athletes.
We will discuss in the next segment how to do soft tissue examination and optimization to correct many of these problems.
Postural evaluations / To the top
The anatomical position – Photo from emergencymedicaled
Proper orientation of the limbs
The first posture deficiency that we will look at is how the hips, knees, and ankles/feet are orientated. When you are relaxed in the standing position, optimally they should all be pointed forward. The hips should not be externally rotated (so that the knees and feet point out). The knees should always point forward in line with the feet. The ankles should be oriented forward like the hips.
Now, in movements such as squatting it may be necessary to externally rotate the hips to safely descend in a squat. 0-30 degrees tends to be fine. The knees and feet should still be in alignment and the knees should track over the toes.
However, in normal posture this should not be the case. Loss of ability to attain normal standing posture translates to poorer ability to move well in activities like sprinting or jumping. If everything is not aligned correctly, force output is marginalized.
Weight distribution
We naturally should have even weight distribution over each foot, and each foot will have even distribution of weight over the medially and lateral arches.
The anatomical leg posture should be easily noticed and fixed by a physical therapist. If this is not an option, you may be able to do it yourself. If you have tight muscles or previous injuries you may note that you are still compensating by favoring one foot or side or different muscles. One of the ways to accurately see if you are favoring a certain side is to get two scales side by side and then stand relaxed on the scales. If you see a deficiency favoring one side you know you have a problem.
The medial-lateral weight distribution on the foot can most easily be tested through two different ways. The first way we want to test is seated on a flat surface with the feet hanging relaxed off the edge. If we have accurate weight distribution on the foot, we should be able to see that the ankle is neutral and the ankle/foot complex does not pronate or supinate while the muscles are relaxed.
The second way to test this is through single leg balance. If you are consistently favoring a side of the foot while balancing or tend to fall over one way especially you know you have weight distribution issues as well as balance issues. This can be fixed with practice balancing with proper shoes and barefoot.
Uneven weight distribution may be due to other factors such as injury or slipped SI joint, so everything is not set in stone. If you suspect that something in your body is off and cannot identify it then you should probably get yourself evaluated by a good physical therapist or chiropractor.
Valgus postural correction
For those of you who have flat feet/collapsing arches or plantar fasciitis, you know you tend to put more weight on the medial edge of the foot.
In conjunction with restimulating the arch muscles and building up strength of the ankle stabilizers (which we will discuss in the next section), you need to start focusing on even weight distribution over the whole foot.
If you know specifically that the medial edge of the ankle tends to collapse down towards the floor and the tibia tilts inward then start your postural correction by holding the ankle in the inverted position. This will help lengthen the peroneals on the lateral side of the leg, and lengthen the inversion muscles on the medial side. Hold these positions for longer periods of time to help reset the muscle length just like static stretching.
Basically what we are doing is akin to postural realignment that you would do if you were trying to fix ‘caveman postural’ or shoulders forward. What you want to do is setup your posture into the correct position with shoulders back, head back, and chest out which will take a lot of energy at first until the body readapts to the correct posture. You will probably be sore if you are holding it at least 15-30 minutes a day, but once it improves you will notice a big difference.
Varus postural correction
One of the things we want to look for in the feet/ankles of supinators/varus stress is the muscles that are involved with inversion of the ankle are too short, the peroneals specifically for eversion are too long. When these muscles are out of balance, there is a strong tendency to roll and sprain the ankle. Ideally, the foot, when relaxed, should stay flat.
For example, when sitting down with the feet hanging off of the edge of a table you should be able to look down and see the foot oriented in the proper position. For supinators, the ankle will tend to invert by itself showing you more of the medial edge of the foot. This is the tendency for those that put more weight on the outside of the foot when walking or running and are likely candidates for inversion sprain.
To focus on correction of this specific postural issue the peroneals on the outside of the foot need to be made stronger, and the neutral foot position must be held longer. No padding shoes and barefoot condition ensure that the foot may not invert during activity.
Shoes with padding tend to exacerbate the problem because the padding with which we put the most weight on sinks down further thus making us put more weight on the lateral edge of the foot in a cyclical pattern. This encourages repetitive ankle sprains. Thus, it is important to avoid any shoes with padding in the foot if you are one who sprains your ankles a lot.
What I have done specifically when I am in class or sitting at a desk is focusing on contracting the my peroneals and holding the foot in neutral or in eversion position for longer periods of time. This ensures that my muscles are getting used to the proper postural correction. In my case, it has taking a fair bit of constant work, but my foot posture is getting much better, and I have not had a sprain for a long time.
Note: It is very important that if your shoes have improper wear patterns such as uneven depression of the padding inside the shoe or lateral/medial wear patterns on the tread that you obtain a new pair of shoes. These improper patterns will continue to exacerbate injuries and teach you incorrect movement.
Movement analysis / To the top
First, it is important to analyze correct gait to ensure proper movement patterns. I would strongly suggest minimal footwear such as vibrams or no footwear at all when performing movement as it usually helps fix problems, and it will show problems as well.
Squatting
Squatting is a fundamental movement that everyone should be doing regardless of whether you are an athlete or not. We use it to sit down to chairs, get off our beds, use the toilet, and get up from the floor. Thus, it is a useful tool to evaluate problematic areas of movement such as (1) excessive pronation and weight stress over the medial arch, (2) inward caving knees, and (3) too much external rotation in the hips with compromised muscle flexibility.
If these three dysfunctions are present in training it usually means they have been there for a long time. Thus, it is important, especially for athletes, to have cues such as “spread the floor with your legs” to discourage the pronation and inward collapsing knees. And correctly setting up proper stance for squatting without an excessive externally rotated hip as this also encouraged collapsing knees with limited flexibility.
Proper squatting should emphasize initiation of the movement with the butt coming back first so as to ensure that quad dominance does not kick in especially with female athletes. The chest should be erect, and the lumbar curve intact. For beginners box squatting is preferential as it will allow the patient or client to emphasize more gluteal and hamstring strength as opposed to having the knees track too far over the toes which increases quad activation. Full depth is preferable in the squat to maximally engage the hamstrings. From there drive the chest up out of the whole and contract the glutes to close the hip ankle. You should not focus on pushing with the knees, but drive your force through your glutes, hamstrings and through your heels.
Dave Tate teaches box squatting
If the person or you have limited mobility such that you cannot maintain proper form in the lumbar curvature, you should go down as far as possible without compromising form.
Sometimes cues for spreading the floor are not enough. This is where the use of bands wrapped around both knees in squatting position can be effective. Basically, the person exercising has to force the knees out into the band to keep them tracking out over the toes to avoid valgus stress. This is important for activating the abductors and glutes especially. Stretching out the hamstrings and adductors between sets may also help significantly.
The first thing we would have you do is get back to the basics. Relearn how to third world squat. This will provide an excellent basis from which strengthening can occur.
The series squat rx is probably one of the best to learn how to properly perform squats. I strongly suggest everyone watch this series whether you are a top level trainer or a complete newbie. Like wise, some books such as Starting Strength have > 40 pages dedicated to learning this movement properly. If you do not own this book, buy it and read it just for the squatting section.
(Note: if I said something incorrect or missed something please tell me).
I would strongly suggest that you lift barefoot if at all possible. Shoes with lots of padding especially make an instable base and limit not only the amount of weight you can lift but also do not train proper neural patterns because of the instability. There is a good case for unstable training, but it is better to be performed with bodyweight such as in balance work or on rings. With the heavier weights, barefoot is preferable if your gym does not kick you out and you are very careful about dropping weights on your feet.
Learning proper squatting technique from a qualified and competent trainer is optimal as they can see what you are doing wrong and provide the correct cues to correct improper movements.
The first step to correcting posture is knowing that you have a posture problem, and then constantly remind yourself not to allow it.
Gait in walking and running
Gait itself in both walking and running is an issue. Unfortunately, gait is hard to analyze without a very keen eye and usually it will take a physical therapist who has been trained to do this.
However, at higher intensities such as running and sprinting optimal technique tends to break down faster. Thus, it is important especially if you were a heel toe runner and/or have inward knee tracking or something out of alignment that you learn proper running technique.
The best way to ensure that you are running correctly is to do it barefoot in the grass. Start out with slow jogging. Incorrect foot contact and body movement is punished barefoot, and thus your body will usually naturally “revert” to correct technique. It would also be a good idea to video tape yourself to see if there are any movement patterns that your coaches or PTs can spot that are incorrect.
If you pronate or supinate it is imperative that you be constantly aware of this problem during exercise. You need to be vigilant to correctly maintaining form even when barefoot running as well.
Interestingly, in one study running pattern is changed with barefoot vs. shoes conditions in experienced runners. Vibram fivefingers running pattern is most similar to barefoot. This may be a good option to learn correct running patterns if you do not like bare feet.
There are various systems on how to learn proper running technique such as CHI or POSE running. These are not necessarily needed but can be helpful if you are still struggling.
Gait (walking) is actually a very complex set of patterns which is why I am trying to simplify it like I did above. If you are interested in more information on how to correctly analyze something like this see this article.
Here are training tips and technique for barefoot running from a Harvard University blog.
A bit on corrections / To the top
When correcting movement patterns as well as posture it is imperative that you be mindful. And what I mean by this is that you focus on it as often as possible. The easier you are able to hold correct posture and biomechanics, the easier it will be to get into the better groove for your body.
For instance, if you know that when you walk your knees tend to track in, it will often feel odd to have the correct form of knees tracking properly over the toes. Repeat the knees tracking over the toes often doing this mindfully. For posture it helps a lot to have stick notes in places where you are often such as on the computer reminding yourself to sit up straight, retract the scapulas, and hold the head back in proper position. The same is true with these lower body dysfunctions. Learn to hold your muscles in the proper position, and learn to move correctly by paying attention to everything you are doing.
As for desk placement if you have a desk job or are seated a lot. One of the recommendations that I have seen brought up in the comments which I totally agree with is getting a standing desk or a very low desk which forces a third world squat, or cross leg position on the ground. We would want to do this because both encourage better posture patterns.
Both of the lower positions — cross leg on the ground and third world squat — encourage MUCH better mobility of the lower body which is lacking with people who regularly use chairs. Similarly, proper posture while standing avoids the excessive amount of time in hip flexion that causes a lot of the hip dysfunction prevalent in our society. Find out what works better for you and modify it.
I have discussed how to be aware of certain problems above. This is the first step. Now you have to take what you know and apply it. If you are a trainer or gym owner I would strongly suggest that you add mobility work as well as postural awareness and movement correction work to your warm ups and cool downs.
In the the next segment we will discuss soft tissue work that will significantly help with the corrections listed in this section. However, the fact that soft tissue work alone may correct injury conditions does not mean that it will correct they underlying dysfunctions. The importance of getting to the root of these problems should not be underestimated. You have to reeducate proper posture and movement patterns to your body by yourself.
Conclusion
In conclusion, we learned how to examine our bodies and movement patterns to identify problem areas with our muscles, posture, and movement.
Specifically with the muscles we looked at optimal flexibility as well as how to identify weakness and dominance in the muscles. In posture we learned to look for correct orientation of the limbs when standing naturally relaxed, and we also learned to look for even weight distribution to both feet and on both feet as well. For movement patterns, we looked at how to see problems with the fundamental movement of squatting, and how to be aware of problems involved in walking and running.
We already learned to be mindful, which is the most important part of correcting posture and movement patterns.
In the next segment we will discuss soft tissue optimization and correction. This is fundamental to maintaining proper health, staying pain free, and improving athletic performance.
Part 4: Soft tissue optimization and corrections
thanks for this excellent article steven.
question. if with hel striking, the foot is in dorsiflexion, doesn’t this mean that the calves are in a stretched, not contracted position, most of the time?
Ah, I mentioned this.
“This study showed that “a significant increase in leg stiffness from the barefoot to the “cushioned” shoe condition was noted during hopping. When running shod, runners landed more dorsiflexed (foot tilted upward) but had less ankle motion than when running barefoot. [...] The primary kinematic difference was identified as running speed increased: runners landed in more knee flexion. At the ankle, barefoot runners increased ankle motion to a significantly greater extent than did shod runners as speed increased.” When running barefoot, the forefoot receives the ground* with less than 90 degrees of dorsiflexion. Thus, the comment above regarding dorsiflexion with shoes running is deceptive. Obviously, decreased range of motion is the big thing as I talked about above.”
Basically, in barefoot or minimalist shoes, the ankle receives the ground plantar flexioned then the calves are allowed to eccentrically work as the ankle bends and loads them. This means the ROM expressed is actually a large range of motion. You can try this moving in the grass sometime barefoot.
With a heel first strike, the foot is coming down and the foot is not being plantar flexed at all as the weight is shifted forward to the foot. If you do relax and let the foot strike down this is one of the key eccentrics on the anterior tibialis that leads to shin splints. So as I said the “flexed” foot in heel-toe running is very deceptive because there is actually a lot less net ROM and less overall dorsiflexion of the foot compared to barefoot/minimalist.
thanks for clarifying. I will have too read more closelyl next time! great work, all the articles i have read so far are top notch!
Steven – Had a question for you on the shoes/sitting essay you wrote. Excellent by the way. Like many I read “Born to Run” and was sold on barefoot running. Bought myself a pair of vibrams. Started running again. Loved it… no knee or hip pain like the previously times I had taken up running. Bought myself another pair of vibrams and started upping my distance. Ran one day when my calves were sore and compensated for the calf tightness by running more flat-footed. Ran only 3 miles but the next day both my feet had classic signs of plantar fasciitis, with pain mostly in the arches and the balls. I’m now on day 4 and still have some pain. Interestingly the only time I hurt is really when I’m shod and sitting. Walking, and even a test light jog yesterday seemed to illicit no pain. My question is, “do I need to treat these and not run until the pain is completely gone?” I would plan to run very short and let pain, if any, be my guide. Any thoughts you could share?
Running when the body is sore, or excessively in general is a good way to develop overuse injuries like plantar fasciitis.
I suggest to new people that they start off with < 200m per session, and increment by at most 100m per session. Reason being that your body is learning new movement patterns, and you honestly wouldn't go off and do hundreds of repetitions of new exercises… so why would you do the same with running?
Assuming someone is taking about 2m per stride with two feet that's 50 repetitions per leg per 200m. While it doesn't seem like a lot, it really is for learning new movements. At most I would do 400m if you really wanted to push the envelope. The main problem is that you don't "feel" the problem until it's too late when you're bombarded with massive soreness in the arches and calves the next day since running is so low intensity — but the muscles from previous running have not properly adapted to the stresses.
3 miles on sore calves is definitely excessive, and since the calves wouldn't be able to absorb the impact properly your arches started to do that. When the intrinsic foot muscles get tired, the connective tissue starts bearing the brunt of the stress — namely your plantar fascia.
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I would back off for a bit even if there's no pain running or jogging. Walking at most.
1. Ice if it helps,
2. massage to the plantar aspect of the foot & calves — loosen stuff up,
3. anti-inflams (ibuprofin, etc.) are fine,
4. maintain your mobility in calves and arches by going to edge of ROM but don't push it too much. You just want to keep them active so that nothing tightens up on you.
Obviously, rest and work your way back in slowly. You don't want to develop overuse injuries or reaggravate your conditions.
You're on the right track though… just a little too much so far.
I’m interested in reading the full text shoes in Pediatrics. I’ve got a ten month old son and he is just beginning to walk. I’m avid that he should run around barefoot because that’s how it’s supposed to be, but I can’t seem to convince my wife. She’s, unfortunately, fallen in to that category where she puts shoes on our son because they are cute; not out of necessity or to serve any functional purpose. For my interest and my sons benefit please email the text. I’d greatly appreciate it.
Fantastic article BTW despite it’s length it was a really good read.
Shoot me an e-mail at “steve” at this website name.
Thanks for the compliments.
Wow! Great work, really!
Thanks so much for sharing this!
– A flat feeted, hallux valgused, genu varumed, glutes inactivated, hamstring tightened french guy
Steven,
Wow, what an amazingly comprehensive and useful article. I think it’s incredible that you devoted so much time and effort to writing all that, and putting in all the links, for our benefit.
Thank you!
I realize that you can’t answer detailed questions from every reader, but… I guess it can’t hurt to ask, so what the hell!
I got the maintainence staff at my office to jerry-rig a stand-up desk for me a few weeks ago. It’s great. No back pain at the end of the day, and my hip flexors seems to be less tight. It’s all good, except… my feet hurt from standing still in regular shoes for hours at a time.
My office is a pretty high-level department in the government. Dress shoes are basically required. No one has a problem with the standing desk, but if people saw me wearing just socks in my office, it would be regarded as inappropriate.
Any suggestions?
(Btw, stats are: 42, 6′, 200 lbs, 1RM squat = 375)
Well, the question is (1) how adapted are you to barefoot standing/movement, and (2) do you move around a lot during the day?
If you could just buy some flat soled dress shoes with ample foot room you can stand/move around in your office. Basically, you want to simulate barefoot condition with your shoes as much as possible. You could have your other dress shoes around for when you have to go out of the office for other stuff.
That’s just a guess at what your conditions are though so…
Feet are going to hurt if you’re not used to be being on them a lot though regardless of if you are bare foot or not if you haven’t done it for a long time, and if your weight is up there which it is. Heck, I’m under 140 lbs and my feet still hurt from standing up hours at a time. Hopefully, this will go away as you adapt better though.
Thanks!
Hey,
Great work in this article. I’m very impressed. I couldn’t agree more especially on the topic of shoes and the natural foot. I’m excited for you to finish your degree and working with you! We need more PTs of your caliber.
I have tight adductors and deep butt muscle tightness. To increase the ROM of these muscles, should I just practice middle splits and the stretch in the included picture everyday? Or are there other stretches that will help with this?
Also, I’ve had flat feet for as long as I can remember. I want to try and correct my posture and build up the strength to have an arch in my feet. All I need to do is simply strengthen the plantar aspect muscles correct? And this can be done by doing the mentioned exercise and http://hubpages.com/hub/Foot-Gymnastics-Exercises-and-Games-for-People-with-Flat-Feet/Us or anything similar?
The stretches provided are the ones I would do. That does not mean there are other stretches that may work as well. If you know of some better ones or want different ones feel free to use them.
Your second scenario is a little more difficult. It depends a lot if you can reform the muscles based on how long it’s been that way. There’s no harm in trying though. And, improving the plantar aspect muscle strength + rolling the plantar fascia and stretching out the calves and hamstrings should help get you there. (The fascia/connective tissue if it’s tight may not allow reformation of the arch thus why you need to do that in conjuction with the strengthening).
Hi Steven… fabulous article, that I just found today (1/6/10). I started barefoot running last year (during the warmer months) after correlating exactly what you said about the feet and legs. I miss it during the cold months; I’m in Maryland also, feeling the winter now. Perhaps not coincidentally, I have been also experiencing the tight hips and weak glutes – I diagnosed myself last week. Have started myself on rehab and improvements. Can’t wait to delve more deeply into the article! Have also passed your article along to not only friends but some colleagues. I also found an article on you in American Parkour (and saw the pics from Primal Fitness, which I recognize
.
Hey Steven,
I followed a link from the CF discussion board to this article. Good stuff. I have passed the link on to several parents from my daughter’s soccer team.
My daughter (age 12) suffers from Sever’s disease in her left heel. The recommended treatment is conservative – ice, stretching and padded shoes. She wears Superfeet inserts in her cleats. Much of her pain is caused by her calf muscle pulling on the growth plate in her heel, but I was wondering if a gradual introduction to barefoot walking/running might help her by strengthening the muscles in her feet and lower legs. What do you think?
Thanks!
Yep, stretching out the calves and hammies will go a long way to help. Similarly, strengthening the muscles of the plantar foot and balance work.
Barefoot may help in time once it calms down like Osgood Schlatter’s does. If it’s active I bet she won’t want to do anything regardless because of the pain.
Steve – do you know any places that sell Puma H-Street or Salohs online (haven’t had any luck finding places that stock them in Australia)? Also, what are your thoughts on Nike Frees as a running shoe?
I know they have some on amazon at the very least (H streets you’re basically outta luck unless you can find some rarely offered ones around… they do have K streets though which are very similar):
PUMA Men’s K-Street II Sneaker
Puma Men’s Saloh Ripstop
As far as Nike frees go too much heel padding for my taste. But if you like them sure.
I would tend to stay away from anything padded if possible. You want as little between your feet and the ground as possible both in the forefoot and the heel.
Make sure you have enough room for the toes as well.
Hi Steven!
You commented on one of my posts on the CF forum about a lower back injury, and I followed you here to this site and am learning a ton. I am living in Japan, and being able to read extensively about back injuries and narrow it down to an SI joint injury was super valuable when dealing with my doctor (in another language, medical terms are difficult.) Thank you.
Now I read this article and am reading Starting Strength, and I’m starting to think about getting some minimalist shoes. You make a convincing argument. I definitely have tight hammies/hips/all of the above. This, combined with some torn ligaments last year and my SI joint injury have me rethinking all of my mechanics, techniques, and outlooks on exercise.
On that note, since I have to build from scratch after injury anyways, would you recommend getting minimalist shoes and starting now? For Crossfit/everyday use, would it be better to get a pair of five fingers or one of the shoes geared towards running? Also, do you think even with a slightly sore lower back that working on walking barefoot etc. would be okay/safe/good to start right aways?
As always, your advice and input is much appreciated.
Of course. Minimalist shoes are good, but if you’re having problems I would definitely not run in them yet.
A couple weeks/months to get yourself acclimated, and do all of the necessarily prehab/rehab work (section 4) that you need to do to do before you start jogging/running in them.
Depending on where you are five fingers may be OK. If there’s a lot of uneven terrain or gravel or whatever else have you then it may be a better idea to get specific minimalist running shoes.
For flat feet: “For those of you who have flat feet/collapsing arches or plantar fasciitis, you know you tend to put more weight on the medial edge of the foot.”
Isn’t that the opposite of what I should be doing. Since my weight is already always medial which causes my arch to collapse. Shouldn’t more time be spent with my weight on the outer foot -5th MTP- (pinky bone)?
Yep. I said:
“you know you tend to put more weight on the medial edge of the foot.”
Which means that you know it happens, which means you want to distribute more weight to the lateral edge of the foot.
Thanks for catching that though I can definitely rewrite that to make it more clearer.
Steven,
I thought I had strong, healthy feet (I do hill sprints on grass with Vibrams once a week; lift in Puma’s), but maybe not!
I have a stand-up desk at work and kick off my shoes whenever I can. I brought in a golf ball today to roll under my feet. I was _shocked_ at how “lumpy” my plantar fascia felt, and how many very sensitive trigger points I have. Even mild pressure is painful on some spots. Is this normal!
Thanks for all your effort on this great blog, btw.
Yes, it’s normal if you’ve never done it before. Even in unsymptomatic laypeople and athletes.
Our bodies can tolerate a lot before they start to break down. When things start to become painful that means your body is letting you know that things are in very bad shape. Things can be in pretty bad shape without pain at all as exemplified by our poor posture with the shoulders and neck, in non-painful valgus conditions like flat feet and bunions, and other such orthopedic maladies.
Good stuff, thank you.
Steven, I am plagued with knee pain, my knee pain is in most areas of the knew except the outsides. Middle, top, front, bottoms all give me negative feed back when exercising. After reading this article I noticed my feet are always splayed outward at about 30-40 degrees angle when standing relaxed. They also turn outward when I am walking, but the Vibrams are helping a bit.
I was thinking I should just get a reverse hyper and go to town on my glutes every day while simultaneously stretching everything out. But what do you think would be best? The knee pain is definitely the biggest thing that slows my training progress down and I would like to eradicate it once and for all.
Do everything on page 4. Take notes see what helps and what hurts for a week. Whatever hurts drop for a bit and come back to it later. If it helps, then great keep doing that.
You should be able to figure out what helps and what doesn’t… but if you still can’t then post your notes here and we’ll discuss.
OK so I was doing some cleans the other day and the pain got pretty unbearable. I tried to do a pistol and I collapse from pain. I went to see a PT and he said I have chondromalacia. He told me I have the tightest hammys he had ever seen and I need to stretch them as well as strengthen my glutes. So pretty much the same thing you said.
I told him I have been working on my hammys for about an hour a day after reading this and I have not gotten so much as a millimeter out of them so far. He referred me to this thingamajig from hamstretch.com so I ordered 2.
Will update on knee pain but I don’t think the hammys will budge..been doing PNF a lot too.
Sometimes less is more.
What is your current routine for all of the days of the week?
Well it was CrossFit every day and maybe take Sunday off, but now…. Gonna work more on stamina for pull ups/pushups….press strength & glute strength. And of course hamstring flexibility (still have my doubts that they will actually loosen up).
I’m thinking of doing the strength exercises followed by some type of upper body metcon (this is going to be pretty limited variety w/o being able to bend my knees).
I will probably rotate chest&shoulder strength / pull up strength and core strength / glute strength on a three day cycle and follow each with a metcon of some sort. Foot drills, light glute work with hamstring and hip adductor stretching every day.
If you can put heat on your hammies before you stretch them. Also stretch everything in your posterior chain — plantar fascia, calves, hammies, glutes and low back.
Make sure you get enough magnesium too.
I really meant what are you doing for stretching? How long are the holds? How many sets? What type of PNF are you doing? What frequency?
I refuse to believe that if you are doing it correctly that you are making no progress.
“I really meant what are you doing for stretching? How long are the holds? How many sets? What type of PNF are you doing? What frequency?”
Daily Stretching
-Warm-up with rolling every part of my legs with “The Stick”
-Dynamic stretching with kick the hand drills…I can’t quit get up to chest height yet.
Calves – Put foot against a pole (as seen in Kstar’s your calves are tight BRO) with knee straight and get a deep stretch for 5 seconds then I flex the calve by pressing the ball of my foot into the pole (heel is on ground) for 5 seconds. As soon as I release the flex I immediately go into a deeper stretch for 10 seconds and after that I flex for 10 seconds…….I do this in 5 second increments until I get to 30 seconds. Once I complete this with each leg I do it again with the knee bent. Once I complete it with knee bent on each leg I do it a final time with leg straight once again.
Hamstrings – Feet together I bend down and give it everything I’ve got to try and touch my toes. I do 3 sets 30 seconds each. Then I get against a wall and sit with my feet together and push down on my knees to stretch the adductors for 5 seconds, then I resist for 5 seconds and so on up to 30 seconds. One set.
Then I kick my leg up on the desk (not an easy task) and stretch forward on it 5 five seconds, then I drive my heel into the desk with knees straight for five seconds and so on up to 30 seconds. I do 3 sets on each leg. The main thing that hurts when I do all these stretches is the tendons behind my knee more so than the muscles themselves. If I have some time I lay on the ground in supine position, one leg up with a rope tied around my foot and I pull it back as much as I can and do similar PNF just laying on the ground. I also ordered the devices from hamstretch.com to help with this.
That’s pretty much it. At the end of it all I can put my finger tips under my toes just barely, but when I wake up the next day I can’t even touch my toes.
The PNF is too short.
Leave the contraction phase at 5s, but let yourself stretch for 10-15 seconds.
You do not always have to do PNF either. I would alternate days where you just relax in your stretch and let your body normalize. 30-60s for the regular ones.
Too much PNF as you’ve found especially with short holds/contraction phases are counter productive.
OK thanks, I will try this and the heat and get back to you in a couple weeks with results.
Steven,
After searching through youtube for Hallux Valgus corrections, all I find are surgeries. Please tell me there’s something else I can do about it. So far I’ve been stretching them passively. If I try actively, all I get are my 2nd to 5th MTPs rising. The toe doesn’t move!
It’s possible you can get orthotics to fix some stuff. But if it’s really bad and immobile (at the joint itself)… then you’re likely going to have to get surgery for it. IF the muscles are atrophied then maybe not.
There’s stuff like toe spreaders that may help. If the arched is collapsed then you have to fix that first though.
Hi Steven,
I just have a quick question about shoes. What about running on concrete or any other hard surfaces? Would a minimalist shoe, like the above mentioned Puma be suitable to run on concrete? Wouldn’t it be too hard on the joints?
Great site BTW! Lots of excellent info!
Thanks in advance!
If your muscles are working properly they should absorb the force.
The only reason your joints would be taking the force is if you are running heel-toe.
Like the studies have shown (that I linked) there are more forces involved with running poorly than running with minimalist shoes.
I’ve been searching for dress shoes I can wear to work and I finally found some that are working well for me. I just take the inserts out so you can see the green on the bottom inside of the shoe and they feel pretty good. I need to dress professionally but work at a job where I am on my feet 8 hours a day and walking multiple miles, so I’m glad I finally found something. Just thought I’d share in case anyone else was looking because I haven’t really found anything else that would work.
http://www1.macys.com/catalog/product/index.ognc?ID=448092&PseudoCat=se-xx-xx-xx.esn_results
I hope its ok to post this link, if not feel free to take it down
Nice find. Hopefully that will be helpful to others.
Brendan, thanks for that link!
Hi Steven,
First off, awesome article! Really comprehensive, the most comprehensive approach to this issue in a systems-based approach that I’ve seen!
I will take issue with one thing you’ve mentioned in this section, however. From my experience, squatting should be done first without load, and effort should be made to enable the individual to squat “naturally” (like this guy – http://tinyurl.com/2fxfuyh). That’s how most of the world “sits,” and how most humans, I would imagine, sat for most of our existence.
My next issue is with the “optimal desk arrangement.” I’d rather see people sit at a very-low desk (having to sit cross-legged or squat) or a standing desk. As Dr. Michael Leahy said a bunch of years ago in his “Law of Repetitive Motion” – the body conforms to the position its in the majority of the time. Fixing a desk-space doesn’t change the flexion of the hips…and remember that people sit like that in their cars and at home, too. Get them sitting on the floor more (like most of the world’s population still does)…I think that’s a better recommendation.
Finally, have you seen the book “Assessment and Treatment of Muscle Imbalance: The Janda Approach.” The reflex neuromotor aspect of gait that is disrupted by covering the surface of the foot has a huge impact on general body patterning as well…..
Thanks for the great post!
Josh
Good addition…check out Deric Stockton’s foam roll sequence for opening the hips: http://www.youtube.com/watch?v=yXty_MpgQt4&feature=digest
he also has an article about his method in the most recent issue of PLUSA:
http://www.powerliftingusa.com/current_issue.php
Josh,
Hey yeah good stuff. I’ve actually been meaning to add a lot of other information to this and you brought up some I was going to add and some I didn’t even think about as well.
Definitely agree about the “third world squat” and the rest of it.
I’ll add in a lot of that shortly. Unfortunately, I have not read that book you mentioned; it sounds good though. I am quite short on money right now so I’m try to spare the expense of purchasing any extra things.
Hey Steven –
Love your stuff. I too have an undergrad degree in Biochem and am applying to PT school in the fall. Your approach makes a ton of sense to me.
Anyway, I poked around but couldn’t find too much on your take to piriformis syndrome. I have a couple of clients with diagnosed piriformis syndrome and I am wondering if there is self-treatment they can do in between trips to a PT? Piriformis stretching and SMR with a lacrosse/TriggerPoint type ball is given. I have had them do some hip capsule mobilization I picked up from Starrett’s mobility seminar. Anything else I’m missing?
Thanks again…I am always happy to send people to your site because of the quality of info and your responses to them.
Brandon
Piriformis syndrome is a bit tricky from what I’ve seen.
Sometime it’s actually the piriformis pinching down on the sciatic nerve, but sometimes the complications occur much higher up in the chain in the lumbar spine or SI joint. Length length discrepancy or rotated pelvis may be a good thing to check for as well (in regards to SI joint and such).
Check to see if they have tight hip flexors, rectus abdominus, quadratus lumborum, or paraspinals & erectors. Mobilize these muscles too and you might get some better results.
Also, I would also check how well they internally and externally rotate their hips. If one side is tight and affected that can tell you something as well.
Also, get the glutes firing correctly with bridging, etc. so the hip doesn’t have to have the piriformis lock up on you. The only reason the deep muscles such as piriformis get tight is if there is a problem stability-wise with the whole lumbo-pelvic area. It’s like the rotator cuff muscles and scapular muscles locking down the shoulder after something traumatic or instability from weak posterior scapular muscles.
Let me know if this helps any of your clients. Always looking for feedback on to what tends to help and what doesn’t because it’s sometimes a bit different from person to person especially with hip/pelvic dysfunction.
Steven –
Yes, with one the hip flexors are crazy tight; same side as the piriformis issue. Noticed it when I was doing a hip assessment and observed the tight side lower than the other.
Running is at least a correlative factor if not a causative one. Both clients have been 30+ lbs. overweight and running is the mythical treatment that each thinks has contributed greatly to their weightloss. Working on POSE with each but they are only about 50% POSE in a given run.
Regarding lumbar/other SI issues, yes they are tight and mobilization is a priority. Right now one can’t move well enough to stretch on his own.
I would assume the ramp-up to full activity needs to be a slow process after they are cleared for exercise?
Thanks,
Brandon
If you can get them to change shoes towards more flat soled ones that goes a long way to help correcting proper running technique. There’s absoultely no way you can heel-toe run with no padding.
To be honest though a lot of mobilization work with the foam roller and things such as third world squat mobility work ARE workouts in themselves especially for people that are overweight. It may be beneficial to use that as part of not just warm up but in skill work and possibly workouts if you can find a good way of integrating it.
Ramp up to activity is definitely recommended especially if they have orthopedic issues like you mentioned.
Do you think it’s enough to just squat (like the man in the image Josh showed) 8 hours a day without any tension in the hip flexors to make them tight? Or do you think there has to be tension in order to get tight muscles?
I read Esther Gokhale’s book and she wrote that women in burkina faso sit on the ground with the back against a wall for a long time every day. I suppose there is no tension in the psoas in this position. They don’t develop and back problems. That would suggest that the psoas won’t get short if there is no tension, even if it’s short for long periods of time. What do you think?
Most people who sit a lot have pretty tight psoas because of the extended periods in hip flexion. Tension is not required for this to happen.
For example, what happens when your muscles are in a cast? This is just like sitting down 8+ hours a day. Your muscles are immobilized and they start to tighten up. When you get the cast off, everything is extremely tight and you generally have to stretch repeatedly to get back range of motion and proper movement. The same is true with this.
Tight psoas themselves aren’t enough to cause back pain. There’s many females with insane amounts of anterior pelvic tilt with no pain. It’s when there’s multiple issues and they compound you get back pain.
Steven,
I’ve been working on my third-world squat, and find that when I’m in position there is a lot of stress on the muscles along my shins. Also, it feels as though my weight wants to sit out the outside edge of my feet. (No real stress in the quads, hamstrings or glutes.) Does this point to any particular tightness?
Thanks, and thanks for the interesting article.
Well, it’s likely a lot of your groin muscles are tight and inhibited proper stance. I would strongly suggest stretching everything in your hip area (hamstrings, adductors, abductions, etc.) as well as widening your stance a bit. Also, try to loosen up your flexors and extensors in your legs too. That should help.
Okay, I’ll continue to work on stretching the hips. (I think groins and some hip flexors are still pretty tight, since I often feel a burning/pinching sensation in the crease of my hips when squatting below parallel.) I hope all of this will help my knees, too, which have become pretty grumpy as I’ve switched to crossfit WODs during the last six months.
By the way, widening my stance to beyond shoulder width results in similar burning in the shin muscles (especially near the knee) and weight shifting to the *inside* of my foot. But all of this may clear up as my flexibility improves.
Hi Steven, as a follow up, my third-world squat has improved (in terms of depth and time I can hold it) quite a bit. But recently I’ve noticed that when I stand up from the squat there is pain on the medial aspect of my knee, and it remains for a while. I notice the same problem occasionally after deadlifts and (of course) squats. Any thoughts?
I don’t know if this is signficant or not, but I did recently notice that the “bump” at the top of my tibia sits somewhat laterally to the kneecap on the affected leg, but not on the other.
Pain on the medial-inferior aspect of the patella, or underneat in the patellofemoral groove, or where?
Remember, I addressed the rotated tibia problem as internal rotation of the femur (valgus knees). Make sure these get aligned properly when doing squats and other movements. If you have to massage tightened muscle tissues, and work on your hip and ankle mobility then so be it. Biceps femoris may also be tight.
Well, when I wrote my comment it was on the inside of the knee, not near the kneecap at all, probably centered on the groove where the femur and tibia slide over each other. The pain was a dull, burning ache that would last for several minutes. But yesterday I did a 5×5 squat workout, and during the last set I felt a sharp burning in the same knee. *This* pain is on the medial side of the kneecap itself; if I could “lift” the medial side of my kneecap, it feels like I could point to the most painful spot, just underneath. It doesn’t hurt when I’m walking around, but if I close the angle between my femur and tibia to less than about 45 degrees it lights up.
Perhaps different things, perhaps related, I don’t know. This knee has been troubling me since June. It all started with pain above and a laterally to the knee, somewhere around where the IT band attached into the knee… That’s when I started to foam roll, tennis ball roll, stretch everything in the leg and hips, third-world squat, etc. I suppose that has helped, but the knee continues to bother me.
Tom,
The first one sounds like mensicus then… if that persists I would get that checked out by an orthopedic doc ASAP.
The latter sounds maybe some patellofemoral symptoms. If you have tight quads the patella can ride up and aggravate the femoral notch there. That’s a bit different than the PF I describe in the article, but the fix is essentially the same. Stretch out your quads and hip flexors, especially rectis femoris, take your fish oil, etc.
It seems like you may have enough problems that you might want to get that evaled by a doc or PT though. If you have any other issues with your feet or your back/hips it might be a good idea to have them evaluate your whole lower body.
This is familiar territory for me, but thanks for a well written article. Since this is from a year ago, are there any updates you’d care to add?
Thanks,
Steven
I need to add updates to about 80% of our articles.
As it is this one could be rewritten a bit clearer with more pictures to make it more accessible to the layperson but it’s pretty good stand alone.
I’m pretty much trying to focus on book work at this point.
Hi Steven, I just read this article and perused most of the associated links. I found this after coming across some of your posts on the CF injury forum. Very good information. Thanks for your research on this.
I have been struggling with a hamstring injury for over a year that worked itself into some hip problems. After a couple of MRIs, an SI joint injection (that did not help) and 4 months of PT, the hip/SI is doing a lot better but the hamstring problem persists and does not seem to have improved at all, although the PT said the weakened area of the hamstring was showing improvement in strength. I can’t run because of the pain and even t-mill walking is painful. Have been working on strengthening my glutes and abductors, which the PT found were weakened. I believe you are in Maryland. I wonder if you can recommend a good sports med doc and/or PT office in the area (I’m in Howard County) who would understand the needs of an athlete like myself. The PT I was working with was very dedicated and competent, but she is not athletic and discouraged things like deadlifts and box jumps. By the end of 4 months of PT, she seemed unsure as to what to try next. Wondering if there is someone who can help me get over this injury so I can get back to running. I have continued to cycle regularly and CF several times a week. But I’m a triathlete, so not running is killing me. Any suggestions? Thanks!
I’m sorry I don’t know anyone in your neck of the woods as I know no one in Howard County. And to be honest, I’m not sure of the better sports related people around even Maryland either. A bunch of the PTs at the clinics I worked as a tech for were good, but they weren’t geared towards more of the stuff I write about and will likely practice in (when the highest DBs you get to work with are 10 lbs that’s not much and no barbells).
It may be a good idea to call say Howard Community College sports department and ask them who they use as their orthopedic specialist and physical therapists. Any of the colleges in your area may work as well. I think that’s the best way to handle something like this.
Did your PT ever figure out why your hamstring was having issues in the first place and why it’s not responding to rehab as well as it should? It seems like some more systemic things are at work, maybe down in the feet or up in the lumbar spine region.
Thanks for replying to me. The intial injury occured during a race in Oct 2009 and I did not have it treated immediately (1st big mistake) and continued to try to train on it (2nd big mistake). It definitely started in the middle hamstring during the last few miles of a very hilly bike course and I continued the race despite cramping in the hamstring during the run. Anyway, the hip/SI/lumbar area started to get involved a few months later. The 1st MRI was to check for disc involvement in the lumbar region. It looked fine so we did 8 PT visits working mainly on the hamstring. After a couple of months of slight improvement in pain, the PT thought the pain might be referred from the SI joint, so I went back in for a 2nd MRI of the pelvis that showed a couple of non displaced tears in my hip labrum and some arthropathy of the SI joint. So we tried an SI joint injection, which only made me hurt worse for a week. After that, it was more therapy, this time focused on strengthening my abductors and glutes. She did not understand why the hamstring was not responding to the rehab as well as it should. I have maxed out my PT visits for now unless a doctor thinks I need more. I have not felt like going back for more visits when it seems I have not made any progress with the numerous visits and $$$$ I’ve spent. I’ve been doing Kelly Starrett’s mwod and am finding many tight spots. My hips are feeling much better than before but the hamstring still hurts sometimes when I am doing nothing. Running really seems to bother it. I would be willing to see docs in Baltimore city, PG or Montgomery counties if they are good. I already drive to see my rheumatologist in Montgomery Co, so its more important to me that the doc/PT be competent and understand where I am coming from (not going to be satisfied with a light workout but I’m willing to do whatever it takes to get back to normal) than be local. Thanks for the suggestion to call HCC’s sports department. When do you graduate? Going to set up clinic here when you are done? Seems there is a shortage of PTs with your perspective. Thanks.
Hah, I graduate in about 2.25 years. Unlikely clinic when I get out though.. have no capital and no clue what the market is like. I will probably be somewhere in the area though.
It might not be a bad idea to treat the hamstring like a strain and see how it responds with massage, heat, controlled weighted eccentrics, and light mobility work to see if that works in the meantime while you’re looking for something especially if it’s a more sore kind of hurting pain.
Thanks. One question, what would be controlled weighted eccentrics? And in the meantime, other than not running, are there other things I should be avoiding if I’m treating it like a hamstring strain?
So you can do assisted hamstring curls, and then slowly control the weight as it comes down (if you use an ankle weight) or slowly control it as it goes out if you use a machine. Something along those lines. Can be standing or prone with an ankle weight, generally seated with a machine.
If stretching hurts it then obviously don’t do that, but if mobility works helps to keep it loose and mobile then you do want to do that. For a strain, stretching tends to act on it negatively.
Same thing with ice or heat. Whatever helps use it. Generally, if it’s a contractile/hamstring strain issue heat will tend to work better.
It’s probably NOT a strain, but sometimes trigger pointed muscles or tight/irritable muscles respond well to strain rehab protocol so that’s why I’m suggesting that.
Thanks for the info on the eccentric exercises. What do you think about donkey kicks? Weighted donkey kicks? It seems like it gets bothered when it is in extension (not sure if that is the right word). But I noticed last week when I was practicing handstands it felt a bit aggravated from the kick up. I am now nursing a shoulder injury, so I won’t be doing handstands for awhile (or pullups, or push presses . . . )
Donkey kicks are fine for hams/glutes/posterior chain.
If they help then use them for sure.
I have work orthotics since I was a teenager, but still have problems with plantar faciitis, heel pain, etc. when I am active. I am 39, trying to be active, and would like to get my feeet arched and strong enough to no longer need orthotics. How can I achieve this? What sort of medical professional can I work with to help guide my process? The Podiatrist just wants me to pay for orthos for the rest of my life…
I do not even know where to start with this type of stuff online.
I have listed many good exercises that may be beneficial, but that can only go so far sometimes.
For an individualized case it is best if you found a physical therapist or chiropractor who believes in barefoot training and is willing to work with you to try to solve your issues.
On Q-angle – can’t you just spread your legs? I know there’s plenty of cultural pressure for women to keep their legs together, but I don’t see any biological reason for it.
Q-angle is not a product of culture and women holding their legs together.
Bringing the legs together or apart does not change the relationship of the angle at the knee in measurements — e.g. knee structure does not change whether your legs are together or apart.
Q-angle is greater in women because both ASIS are set farther apart from each other because women have structurally wider hips and the measurement is thusly reflected in the structure at the knees.
Therefore, Q-angle reflects a purely anatomical difference between the sexes which unfortunately predisposes women to greater knee injuries because of greater potential for twisting torques at the knee joint. This is why proper strength and conditioning and technique is important for women in sports. ACL injuries rates between men and women in sports reflect why this is an important area to look at.
Hey, went back to check this post out, when I saw it linked to from the article on feet specifically. I’m still working through it, but noticed that you had implicated sitting as shortening the hip flexors. I was curious whether you’d seen this http://toddhargrove.wordpress.com/2011/05/29/does-excessive-sitting-shorten-the-hip-flexors/ and whether it had any effect on your assessment.
I actually read that when I came out.
I think it’s honestly multifactorial, and sitting is one factor.
No one doubts that high heels do damage to the body (chronic shortening of calves, etc.), but sitting likely does similar things even in dynamic vs. static positions.
When you look at the populations you see that women, on average, tend to have increased anterior pelvic tilt compared to males. However, on average, I do not expect to see a difference between women and men in regards to time spent sitting.
As you’ll read, women have increased Q-angle over males. Whether this ia causative factor for quadriceps dominance and related to chronic hip flexor shortening, gluteal weakness, hamstring lengthening, abdominal weakness, etc. is up for some debate. I think that sitting plays some role in all of this as it encourages a lot of the states of tissues above.
When you have a myriad of risk factors it is very hard to determine what may actually be the factor that sets it off. Maybe it’s a combination. Maybe it’s a single event. Do you see where I’m going with this?
I do agree that sitting is not a causative factor (but likely a significant risk factor or correlative factor — perhaps a causative in some) and will update that with my analysis once I have time.
Thanks for the comment.
Yeah, I see what you mean. And of course, it’s just a detail in the larger picture–there’s no arguing with the high morbidity rates, etc. associated with sitting, even if that’s just displacement–time spent sitting is not spent doing something, anything, just to keep the body moving.
And I’m 100% with you that ‘corrective shoe’ is an oxymoron. My dad has been wearing orthotics in his shoes for years, and is surprised he still has bursitis, tight calves, and a host of other things. It’s actually painful just to *look* at the man’s feet, and I’m convinced it has a lot to do with the fact that he only takes his shoes off to sleep, and sometimes not even then.
You can’t go around on crutches all day, and then wonder why your legs are stiff.
Hi. I get knee pain walking or running. I was accessed by a orthotic specialist, and prescribed insoles for my shoes, which apparently correct the way my feet land on the ground, which is the reason why I have apparently got knee pain. I am very tight in the muscles. I have two short questions. 1. If you say walking in bare feet is good, but my foot is naturally landing incorrectly on the ground, wouldn’t walking in bare feet be worse for me, than wearing shoes, with corrective orthotics fitted? Since I would still be landing incorrectly on the ground in bare feet. And, If I stretch a lot and become flexible, could the way my feet land on the ground change over time? Thank you
Jacob,
Because barefoot movement would be painful the way you’re currently automatically walking (and yes, worsen your situation), you are forced to fix the way you walk to make it less painful (and this usually consequently fixes the mechanics that are a major cause of the knee pain).
Proper stretching aimed at the correct musculature will be a generally beneficial thing to do since improved flexibility (along with knowledge of proper technique during both exercise and daily life activities) tends to be a MAJOR contributor to avoiding orthopedic issues throughout life.
Tangentially, the shoes you were prescribed will simply help fix the symptoms but not much of the root problem. This would be much like taping flashlights to the front of your car because your headlights are broken.
Jacob,
Pretty much what KC said.
Issues like these are often correctable by proper stretching and strengthening of certain muscles, and re-education and posture and gait. So yes, your mechanics can be changed over time to potentially remove orthotics completely.
Since you have pain now orthotics would be good to help control it, but that does not mean you shouldn’t be stretching/strengthening/working on proper mechanics. Unless you want to be in orthotics for the rest of your life.
I notice you have some core exercises up there and one of them are (planks with the pelvis posterior tilted), which teaches you to do the plank with a posterior pelvic tilt, but every other expert that I have read about so far, has told people to do the plank with a neutral pelvis, a slight lumbar curve. It was just interesting to see that your video says otherwise.
PPT planks focus more of the work onto the abdominals and less onto the hip flexors. Generally speaking, this is better for those who already have anteriorly rotated pelvises (tight hip flexors, weak abdominals) which is a hallmark of adaptations to sitting posture. This is consistent with what I have addressed in the article.
In a vacuum with no dysfunctions, then yes you would want to keep a neutral pelvis.
Steven,
I am an Olympic Weightlifter and I have been dealing with some pain when I squat. My low back (erectors) gets really tight in the hole as well as a sharp pain in the tendon where it attaches at the top and lateral part of the patella on my left leg only; my knee generally pops as well when I squat or catch it in the receiving position; I have tight hip flexors, hamstrings, and calves; Every now and then I get pain in my SI joint as well; and I sometimes get pain in the back of my knee (moreso the left)and top of my calve from doing posterior chain work (glute ham). I’m really struggling to find a proper corrective exercise strategy that caters to all of these ailments, which is keeping me from competeting as heavy as I ought to be. Keep in mind I am in college and I sit a fair amount during the day and that I use a lifting shoe with a .75 inch heel for training. I have good flexibility in the squat (ironically enough) and can go ATG while keeping my spine pretty vertical. If you can, I would greatly appreciate some ideas or pointing me in the right direction. Thanks!
P.S. My friend gave me a pair of vibrams, and when I wear them throughout the day, my lower extremities don’t seem to hurt as much compared to my regular tennis shoes.
The number stuff is what you probably need to do. Rest is just explanations.
1. I would definitely stick with the vibrams if they’re helping.
2. If you’re having trouble in the hole with weight it may be a good idea to back off the weight until you can work with it non-painfully.
Just from a general perspective the fact that calves and hammies are tight plus low back is getting tight deep in the hole tends to mean you’re not getting enough anterior rotation of the pelvis. To compensate your knees will come forwards more putting more quad emphasis at expense of glutes.
Glute ham — since the calves are also knee flexor, that means your hammies aren’t doing most of the work there. That probably also means they’re tight and weak which is generally a bad combination.
3. To emphasize more hammy/glute work I would go with some romanian deadlifts and cut the GHR for now. And work on a good hip hinge exercise such as good mornings or other variant.
4. Increase your mobility in calves/hammies. It also might be a good idea to look at your thoracic extension if low back is an issue. Use a foam roller for this. Also target your glutes to decrease quad emphasis with something like weighted hip thrusts although if you do have gluteal amnesia you should start with glute bridges and focus on activation and squeezing the muscles for 10s each rep for 20-30 reps and a couple sets.
There’s so many issues here it may be a good idea to get to a physical therapist to get them all sorted out regardless, but I think the above is a good place to start.
Thanks Steven, I really appreciate it. I think it’s great that this site available.
In response to keeping a posterior pelvic tilt in the plank exercise for people with an anterior pelvic tilt, do you think this would also translate to exercises such as bird dogs? Thanks, last post from me.
Since the main target of the bird dog is usually the back, glutes, etc. and not the abs I would generally say no. Keep a neutral spine (with slight lumbar arch) for these.