Shoes, Sitting, and Lower Body Dysfunctions

Introduction & Shoes and Sitting
Systemic biomechanical issues
Evaluation of lower body dysfunction and corrections
Soft tissue optimization and corrections
Summing it up

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.

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.

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.

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 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.

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.

It is important to maintain proper posture in all position especially sitting. Photo from mybodyzone

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

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