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

We have extensively looked at the valgus conditions that are prevalent in modern society. These are because shoes and sitting lead to mechanical deficiency that allows problems to develop. Let’s review.

Shoes tends to cause the problems of

• Tight calves resulting in loss of 10-20 degrees of dorsi-flexion ROM in the calves.
• Inactivation of the muscles on the bottom of the foot and the ankle stabilizers
• Decreased proprioception of the lower limb

Sitting tends to cause the problems of

• Inactivation of the gluteal muscles.
• Tight hip flexors (iliopsoas, rectus femoris, sartorius, tensor fasciae latae (TFL), and adductors longus and brevis).

These problems tend to lead to inward tracking knees.

Inward tracking knees tends to cause the problems of:

• flat feet / collapsed arches / pes planus
• plantar fasciitis
• achilles tendonitis or rupture
• patellar tendonitis
• ACL sprain or rupture
• quadiceps dominance and tightness
• TFL and IT band tightness
• hamstring weakness and tightness
• joint deformities like bunions, collapsed arches, talipes valgus, knock knees, etc.

Remember, many people may have multiple symptoms described above, but usually they only manifest one injury. Only one or two parts may tend to “break” and cause a person pain before they can do enough damage to incapacitate other parts in the chain.

It is important that everyone evaluate their lower body posture and movement patterns to ensure that such things do not occur.

If you are starting to go barefoot after wearing shoes all your life be wary. Initially, there will be decreased ability to maintain balance. This is because our bodies have “adapted” to shoe use. However, once adaptation back to barefoot or near-barefoot conditions occurs, balance and gait should be significantly improved.

Learn to run and move correctly with minimalist shoes or barefoot. We previously talked about barefoot running in grass being a good alternative to start with. Any type of shoes with extremely thin soles are good as well, but they must have low cut sides that allow proper ankle mobility. Integrate this training with the foot drills and balance training.

Start VERY slow. Since most people’s feet are not adapted to moving around barefoot a lot doing anymore than 400m even in grass is questionable. When you are first starting to exercise you would not do 400 repetitions of pushups, so why would you do as many repetitions running?

Side note – weightlifting shoes are fine for weightlifting since ankle mobility needs to be good to lift well anyway.

As for the minimalist shoes we discussed this in the last segment. This is what we are looking for:

• Quadrangular, to conform to the normal foot configuration, with abundant space for the times.
• Flexible to allow free foot movement [especially at the ankle].
• Flat without elevation of the heel.
• Porous. Uppers should be made of leather or unsealed fabric to avoid skin maceration or fungal infections.
• Moderately tractive. Sole friction should be equivalent to that of the bare foot. Sole that are slippery (leather) or that create excessive friction (some rubber soles) should be avoided.
• Light weight to reduce energy expenditure.
• Extended above the ankle in the toddler to prevent shoe from slipping off during running.
• Acceptable in appearance because children are very sensitive about that.
• Reasonably priced. Medically satisfactory footwear need not be expensive.

I would clearly agree with all of the points except for the last two which need not be followed for proper foot health. Basically, what the study is describing is minimalist shoes. Vibram fivefingers are like that. There are also other minimalist shoes that are made for running such as Puma’s H-street/K-street brand that adhere to most of the points above. These are the types of shoes you should be looking for.

Obviously, we cannot eliminate sitting too much. Thus, it is important to be doing a lot of gluteal activation work as well as stretching out our hip flexors. Everyday if possible.

If you are someone who is reading this and exercises you can integrate them into your warmups and cooldowns.

If you are someone who does not exercise then you should exercise! Exercise is not only healthy but a good stress reliever. However, if you still refuse, it is still a good idea to do these exercises sometime in your day whenever you choose.

Now, for those of you looking to get ahead of the game: yes, you can do them at any time. It may be a good idea every 20-30 minutes if you have a desk job to stretch out the hip flexors and do some glute activation work. Just do not let anyone catch you doing glute bridges or other hip thrusting exercises on the floor otherwise it may be awkward. Stretching can probably be explained away though. :)

Now, hopefully most of us have competent trainers who knows correct movement patterns as well as the cues to correct them. However for a lot of people this is not the case.

For the people who do not have anyone to correct their technique during exercise it is a very good idea to invest in a video camera and find a good online fitness community who is willing to take a look at others’ exercises and help them correct any flaws.

Investing in books or reading material online about correct technique for exercises is imperative for anyone who exercises. Books such as Starting Strength have extensive chapters on technique alone to make everything as safe and effective as possible. The best way to improve very quickly is perfect technique because it allows you to lift the most weight or perform at the highest intensity effectively.

You have to know when to listen to your body. Pain is your body telling you that something is wrong. This means you need to stop working out and address the problem.

If you do notice that certain movement patterns are askew, then it is a good idea to get yourself evaluated by a good trainer or get evaluated by a good physical therapist who knows a lot about exercise.

If you have developed a condition, it is not an all or nothing proposition. You do not have to completely stop working out – you can keep doing skill work, upper body, or core work if you have a lower body injury. But you definitely should not be pushing through the pain with a “no pain no gain” attitude.

One last thing that is a very important reminder that I have stated earlier as well. One thing I have noticed in the physical therapy clinic I currently work at is that often those people with darker skin are more prone to pronation in the foot and collapsed arches. This is due to Vitamin D deficiency. If levels of Vitamin D in the blood are low, proper bone growth and mineral density is decreased. Thus, this leads to bones that are softer and more likely to deform to the stresses we put on them. Couple this with the valgus stress of shoes and sitting, and you have an increased likelihood to develop flat feet, plantar fasciitis, and talipes valgus.

Basically if there was one key take home point I would want you to have learned from this series it is this bit of information.

• Shoes and sitting tend to lead to the loss of ankle and hip strength, proprioception, and mobility translates to increased stress at the foot arches, knees, and SI joint/lower back. This leads to lower body dysfunctions.

Essentially, your arch, knee, and lower back problems can be solved by (1) focusing on stability and proprioceptive work at the painful joints in question, and (2) improving your strength and mobility in the hips and ankles. Point 2 is one of the most critical points that is often overlooked by most coaches as well as physical therapists. Remember, I have referenced studies and logically walked you through the physiology that shows arch, knee, and lower back pain can be cured or will show significant improvement through increasing flexibility/mobility and strength in the ankles and hips.

Thus, shoes and sitting are universally detrimental to the development of chronic lower body conditions. Counteracting these stimuli should be focused on restoring proper ankle and hip function, and focusing on stability at the arches, knees, and SI joint/lower back.

• Do mobility work, soft tissue massage, and strengthen/stretch the appropriate musculature.
• Be mindful about posture and your movement patterns.

These two steps are the key to your improvement and overall health. Prehabilitation work is always better than getting an injury have having to take time off out of your schedule to do rehabilitation. If you are rehabilitating, then do everything you can in your power to get back to good health. No one likes to be injured.

Hopefully, this series taught you how to prevent and rehabilitate lower body dysfunctions.

Finally, there are some other articles that discuss some of the physiology and corrective nature of the work I am talking about above. If you have more that are useful feel free to post them in the comments, and I will add them.

Neanderthal no more 1-5 (both shoulder and lower body issues):
Part 1
Part 2
Part 3
Part 4
Part 5

Trigger points, More trigger points

flat feet, Flat feet

Sacroiliac mobilization I, Sacroiliac mobilization II

The low back
Bulletproof that back

lower back savers I, lower back savers II

Pain free lower body posture

ACL Injuries & Young Female Athletes
Preventing Hamstring Injuries
The Female Knee, the Athletic Knee
Solving Anterior Knee Pain
Healing the Hips
Teach them to land first

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Disclaimer: Any information contained herein is not professional medical or physical therapy advice. Always consult your doctor or physical therapist before using such information. For more details see our full site terms and conditions.

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