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Do Your Feet Turn Out When Squatting or Running?

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You and Your Feet

The foot is most stable when it is straight. When your feet are turned out, the integrity of your foot's arch is not being maintained. The further out you rotate your foot, inherently it tends to get less stable. As you stress out the plantar fascia, the flat connective tissues (ligaments) that connects the heel bone to your toes, the transverse and longitude arch will collapse without external rotation.

It is important to keep your feet pointing forward when you're walking and stable while lifting. If turned out of alignment, the knee and ankle will be open and the hip therefore be unstable. Instability can lead to hip, knee, ankle problems or even skeletal issues like bunions or chronic knee and/or back pain.

Hips or Feet?

Is the root of the issue coming from your hips or feet being turned out? A simple test can be performed by looking performing at the single leg squat.

  1. Set up a camera straight on

  2. Stand on one leg and drop into a single leg squat.

  3. Repeat on the other side.

Start by looking if any knee rotation occurs in or out but your feet appear relatively set. If so, the problem may be coming from your hips.

Do your knees remain stable, but your foot rotates in or out? Then it’s likely due to your feet.

Possibilities also include poor motor control, tight calves or an issue with your anterior tibialis (the muscle next to your shin).

The majority of cases I work with have exhibit some combination of the two.

The Good News

The good news is that you can fix muscular imbalances and improve subsequent motor control discrepancies.

Walking

The most common way doctors choose to remedy this problem is with the use of orthotics. They artificially create stability though the feet, which works great until you have to shell out a good chunk of change for a new pair. An expensive solution to a problem that can be remedied by training the intrinsic foot muscles and improving internal hip rotation.

Below is a whole post I created on Instagram around the topic:

View this post on Instagram

Build Stronger Feet 👣 - The initial shot shows maintaining a short foot-arch versus allowing the transverse arch to collapse. Collapse isn’t an issue, rather it’s uncontrollable collapse that is a problem. - Toe Control The ability to control your toes says a lot about the overall health of your feet and the muscles that cross the area. First begin by tapping the big toe up and down while maintaining the other four up. Then switch! Aim for controlled reps of 10. - Single Leg Balance Frontal Swings Taking the position from before maintaining your arch, now we add in movement making it more reactive in nature. Because the motion comes from the side, it’ll challenges you more dynamically. And dynamic stabilization is much more important because eventually you’ll have to test it out by running and cutting but initially this is where you begin building those intrinsic foot muscles. - Single Leg Balance and Reach An extension of the last exercise is a forward, side and backwards reach with the free leg. Good foot positioning allows the hip to do its job and by proxy aides proper alignment of the knee. - Concentrated Calf Raise Wall Nice and slow, we look to push through the ball of our foot up onto our toes, stabilizing via the big toe. If you can “stick” the position by pausing it’s a plus. - Single leg RDL w/ Band The band goes under the ball of your foot by the big toe. Proceed to add some tension to the band and perform SLRDLs. The goal is proper foot position, otherwise you’ll lose the band!

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It’s All in the Hips

Practice standing, walking, and running with neutral feet.  People watching in public places and see who walks/runs neutral and who has funky movement.  If you can spot the error in others than you will be more cognizant of your own movements. In most cases, being aware of the issue is more than half the battle.

Organizing our feet is easier if you are in a braced position as well.

1. Being Aware of Your Balance

A few key components to achieve neutral resting position (balanced posture) is the following:

1)  Engage your glutes (pelvis rotates posteriorly)
2)  Engage your abs (ribs rotate downward)
3)  Move your shoulders back and down (palms should be touching the side of your legs with thumbs pointing forward)
4)  Tuck you chin backwards (like a turtle retracting its head back into the shell or double-chin)
5) Weight distribution (tripod positioning, heel, ball of the foot and outside of the foot)Internal hip rotators

Tension is held in the following: Calf complex, peronal complex, bottom of feet.
Strength of: TFL, glute medius, glute minimus.

Keep in mind there is no perfect posture, the best one is a changing one

Keep in mind there is no perfect posture, the best one is a changing one

2) Strengthening the Hips

My favorite movement to use is the RNT split squat. It works to train both hip and foot muscles in one movement.

Place a band around your knee and have it pull you INTO collapse which will force the muscles to engage harder and thus help groove the motor pattern. You can load it with a dumbbell or kettlebell in a goblet position at chest level for added resistance.

Clamshells are a great exercise, big coaching cue is to make sure you aren’t rocking backwards as your open the hips. Think about keeping the hips stacked on top of each other.

Glute bridge variants are fantastic, you can start with the basic two legged bridge and progress to a single leg version, before trying things like marching or incorporating sliders.

  • Improve general glute strength (single leg work like the RNT split squat, clamshells, Glute bridges)

  • Strength in plantar muscles

  • Strengthen dorsiflexors (mainly the anterior tibialis, shin muscle)

3) Begin Mobilizing and Incorporating gait patterning

Single Leg RDL: Fantastic movement to train the hip in multiple planes of motion. Problem? It’s usually too hard on balance and subsequently a lack of tension in the right places.

Here I’m performing a TRX assist SLRDL where as you hinge back, reach with your arms and hands forward and back. As you go further, you can spread the arms to widen your balance.

Seated 90/90 mobilizations: The full movement might be too difficult for some, you can work on the 90-90 shifts first

Split stance kneeling adductor mobilizations: Good adductor length is important in maintaining good balance during lower body strength exercises. While it may not directly influence hip and foot dynamics, it can still have an indirect negative effect.

Good ankle dorsiflexion: here is a whole post I made about this before.
First about good foot balance

View this post on Instagram

Foot Position and Improving Hip & Knee Stability - A follow up to last nights post about hip stability, tonight I’ll be tying in our feet to the equation. Our feet have the ability to help us drive up out of a squat or contour as an athlete dynamically cuts through a court or field. Our feet also have the ability to slow us down or decrease neural drive by losing ground contact. - •Our weight should be distributed somewhere between the ball of our foot to the heel. •Too much pronation, or loss of 4 outside toes decreases hamstring recruitment and shifts more onto the quads •Too much supination, or big toe off the ground and we get decreased quad recruitment with more work going to the hamstrings. - So where do you go after you improve intrinsic foot strength and/or hip stability: Loading it via resistance training. One way to check you’re ready for more is to change the angle of your feet - Start feet Straight Ahead •Start with the feet straight ahead, achieving subtalar neutral. •Squat down to a depth while keeping the ankle centered. •You’ll want to watch if the midfoot collapses inward during motion, squat to or beyond your desired depth. - Feet Turned out •Achieve a centered ankle position •Drop down to depth desired •This position is “easier” for your hips but often may come at the expense of foot or back position. In which case I’d argue this isn’t a good position for lifting •Hugely important during almost every sport which requires change of direction. - Feet Turned In •Turn the feet in with the ankle neutral •Drop down while paying attention to positioning of the knee throughout. •Important for athletics (a position many basketball players take off from when dunking) or weightlifting/CrossFit when athlete catch a barbell overhead during the jerk. - “Knees Out!” This is a really common cue. Instead coaches and lifters should focus on their feet. This is key because if your feet are neutral, you will automatically be using your hips to achieve that centered ankle position. Think about using your hips to help in getting to neutral, and often better knee-hip function will follow

A post shared by Gary Heshiki (@garyheshiki) on

Ankle PAILs and RAILs

  1. Start by placing the ankle in as deep of dorsiflexion as possible. Then relax for at minimum 1 minute

  2. Then start by contracting down towards the floor for 10 seconds as hard as you can manage (PAILs)

  3. Immediately without changing positions, try to pull your foot up towards your shin. Even if no movement occurs, continue pulling. It’s all about intent (RAILs)

  4. Then relax into the new end range and repeat 2 more times. You can begin the PAILs contraction once you feel like the tissues have “relaxed”

 

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Lack of Internal Hip Rotation Relates to Low Back & Hip Pain

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Improving internal hip rotation is important for a variety of reasons including:

  • It allows us to go into a deep squat position safely

  • Key contributor to knee and low back pain

  • Poor movement for rotation sport athletes like baseball or even golf

  • For runners, it doesn’t allow the athlete to extend the hip to engage the glute.

Hip IR should be tested in two positions, because different structures can limit your range of motion depending on whether the hip is extended or flexed. The second test is actually a mobilization for improving hip IR if and when progressed properly.

Testing Seated Internal Hip Rotation

Sit at the end of a table, with your knees bent over the side, and hold onto the table itself.

Now internally rotate the hip, without abducting or side bending, which is a sign of compensating with the lower back.

Generally speaking 35 degrees is good in the general fitness population and 40-45 degrees in competitive athletes.

A quick check to see if you may simply have a "lazy" side if one leg has better hip IR than the other. Perform a side plank on the side that's lagging and reassess. It should improve if it's simply an activation problem, otherwise it helps to narrow down the problem to a structural/muscular or alignment (though not very common) problem. 

Mobilizations to Improve Hip IR

Kneeling Glute MOB

  • Set up on all fours with hands under the shoulders and knees under the hips.

  • Maintain a slight arch in the lower back and place your right foot on the back of your left knee.

  • With your back set sit back into your right hip and hold for a 1-2 count before moving back. Perform 5-10 reps on both sides.

Lying Knee Pull Ins

  • Lie on your back with your knees bent and your feet flat on the floor.

  • Exaggerate the width between your feet.

  • Think about trying to internally rotate your femurs which as a result have your knees touch together while keeping your feet on the floor. Hold for a two count and return to the starting position. The stretch should be felt in the hips and not the knees.

  • Perform 8-12 reps before working out.

  • Good for those with muscular restrictions.

Prone Windshield Wipers (TEST #2)

  • Lie on your stomach with your knees together and feet up in the air.

  • Keeping the knees together, let the feet fall out to the sides.

  • Hold for a two count and return to the starting position.

  • Perform 8-12 reps prior to workout.

  • This is great in particular for those with a capsular restriction.

Passive Internal Rotation Stretch

This goodie comes courtesy of Dean Somerset. This is more of an advanced stretch and would be sure to be able to knock out all the above aforementioned ones before using this one to help maintain proper hip IR.

  • Sit at the end of a table or elevated step and lift one leg back into internal rotation as shown.

  • Progressively work your work close to the table, and hold for 30 seconds.

  • Repeat on the other leg.

I hope that this post will help steer you in the right direction to improve your lifts in the gym and your times on the trail.

If you should have any specific questions please shoot me a message and I'll be happy to try and help out. If any of this information was insightful, helpful or funny please share it with a friend!

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Social Media: Where Pros Give Unsolicited "Advice"

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It's late one night and you're scrolling through a social media feed on your phone and come across some friends working out. Like most individuals you might give them a like or comment about how that's awesome or congratulating them on a new accomplishment in the gym.

You go to the comments and see:

"Not hitting depth, smh"
"I'd be careful, your back shouldn't be like that"
"Shoot your hips back more and focus on arching"
"Leg drive! Arch! You'll push more once you learn to do that"

The "Fit Pro" Commenth

You click on the profile of the individual who left one of these types of comments and discover they're trainers and coaches who've decided they know best on how EVERYBODY should train.

Now I'm not talking about the fitness enthusiast who fancies themselves an uncertified trainer because they have a six pack or competed in a powerlifting meet. I'm talking about a true "professional" who puts food on the table training others. These are the guys I have a gripe with. I used quotes because these "pros" aren't very professional. 

Here's why it's a load of bull for one fitness "professional" to call out another publicly on social media.

I'm ACE, NASM, NCSA, ISSA, ABC123 CPT

While you may not agree with what you're seeing, it's also not your job to be judge and jury for all things fitness simply because you passed the most rudimentary of Personal Training certifications. Nor does ripping off someone else's training philosophy and system suddenly make you an expert. As a professional it is your job to help YOUR clients and contribute to the fitness industry. It's easy to move on and not waste your time being the form police. Instead of tearing others down why not be a positive beacon building others up by reaching out. Don't try and hijack someone else's feed by putting them down and trying to show how superior you are and why they or their followers should add you, they won't.

Did it ever cross your mind that the person you're critiquing is the very person in the video, a person who is NOT a professional but a paying customer? Now I know what you're thinking, hey if that coach did a better job the client would be moving better. Heres the problem with that line of thinking. You have no context as to how long this client's been training and more importantly how much progress said client has made.

While you may be watching someone perform a squat to a less than desirable depth or deadlift with a slightly rounded back, you didn't know that the coach wanted the client to be focused on hip positioning today. They're crushing their hip position and in time I'm sure they'll fix that back position as well. This often can be the case for very untrained individuals because they can easily become overwhelmed with dozens of cues and checkmarks. A good coach breaks things down into easy manageable steps. Sharing progress is that, progress and not the final product. Critiquing the technique of a beginner is as ridiculous as over analyzing a T-ball swing, really man what are you doing?!

Social Media Crusader

Here's my biggest gripe I have with other fitness "professionals" criticizing other pros via social media: Your critique can be the sole reason another person loses business and is unable to keep the lights on in their home. Said client may read your comment and decide that maybe their trainer isn't good and decides to stop. While you may think you're doing a service to the industry, all you're doing is a being a jerk. I've meet thousands of trainers, some good and some needing more CEU's, but for the most part they've been good people. Judging others coaching abilities isn't up to you! Who are you to be reaching in and taking money out of somebody else's pockets?! Don't be upset with them, be upset you aren't better at marketing your services to help more people. 

I firmly believe the cream rises to the top. If a coach is good they'll succeed on their own, just like they'll run themselves out of business all the same if they don't deliver results. It shouldn't be because you're planting the seed of doubt into their client's head. Yes sometimes these coaches have their clients performing less than stellar technique on a regular basis but also remember that their poor training only highlights how good you are without saying a single word. 

If you really feel the need to criticize another coach, for all that is good and holy just send them a private message.

Lastly lets stop being lazy with these bot comments and copy+paste DM's. I get you're trying to build up your following but you're trying to do so by being lazy and trying to take a short cut. Some of these comments don't even make sense, I'd ask for a refund for that bot if I were you.

I continue working on my own social media presence, it takes work and if you're a true professional, you'll be working on it yourself. 

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Personal Training and Massage

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Walk through your local gym you'll see dozens of personal trainers stretching their clients. No doubt this has been going on forever, but is technically outside of the personal trainer's scope of practice.

Scope of Practice- Procedures, actions, and processes that a healthcare practitioner is permitted in undertaking. 

Scope of Practice for Personal Trainers (according to NSCA)

 "Developing and implementing appropriate exercise programs, assisting clients in setting and achieving realistic fitness goals, and teaching correct exercise methods and progression.” 

Nowhere in there does it mention any sort of muscle manipulating techniques.

Ouch That Hurts

Hey can you move back to that other spot...a little lower....YEAH! OUCH! You got it. 

This was a typical exploratory palpation session with clients whenever they were unable to release muscle on their own and so it made sense for me to get it out for them so we could get back to training. When I started doing bodywork I had already been a trainer for over 5 years and was decently versed on anatomy and biomechanics.

This all is a rationalize for what I was doing, which was outside the guidelines of my liability insurance and scope of practice. The results I got were positive across the board, but I also knew I wasn't allowed to do what I was doing. The more injuries I would encounter, the better I got at feeling healthy tissue and fibrous restrictions in the fascia and muscles. Though in the back of my mind I knew what I was doing was illegal.

I observe dozens of coaches, many of whom I see jam their elbows and fingers in areas where they shouldn't be. And not because now that I'm a manual therapist I'm on my high horse but because they're actually pressing down, rather hard I might add given the discoloration of the skin around said area, into a place where there's way too many nerves or organs.

Pot Meet Kettle

I will never tell any other coach they shouldn't be placing their hands on their clients, because that would make me a giant hypocrite. I do however advise these coaches to exercise ALOT of caution. In an effort to add value to sessions coaches range from the harmless assisted static stretching to downright dangerous let me dig my elbow into your anterior triangle. 

What I've Learned

I Didn't know WHY only how
A Manual therapist, massage therapist or LMT has undergone more extensive training than personal trainers where it pertains to understanding of how and more importantly WHY to work in a given area. They learn more manual muscle testing and specific assessments to address movement compensations. I could copy a technique but didn't fully grasp the methodology behind it.

Most trainers who perform assisted soft tissue via foam roller, ball or roller stick think: harder is better. It's not.

Getting work done on you doesn't in turn show you how to treat your clients
Copying a given technique performed on you might help YOU, but could injure your client. In the same way you wouldn't give a 65 year grandma the same exercise protocol a 25 year old would receive, the same goes for soft tissue manipulation. In the past I've seen coaches receive a quickie treatment only to see them performing the exact thing on their clients that same evening.

I hadn't earned the right to put my hands on clients. Trainers are not therapists.
Many colleagues who are both manual therapist and trainer had to juggle massage therapy school and a full slate of clients at the same time. Depending on where they're located, schooling can range from 500 hours to over 1000 hours. And while this may be a lot or a little depending on how you look at it, it's a large commitment for anyone with full time obligations. 

Trainers are not physical therapists. Most of the corrective exercises seen today don't work because the coach implementing them lack an understanding that the issue needs both manual therapy and corrective exercise.

I of course will not fool myself thinking that I am anywhere near the level of a DPT (Doctor of Physical Therapy) either. I always had a firm grasp on anatomy, or so I thought. I came to see that I lacked a comprehensive understanding of:

  • Origin and Insertion sites
  • Layers above and below muscles
  • Feeling the difference between muscle and organ
  • Progressions for treatment
  • Contraindications with degenerative and acute diseases or injuries

I understand now I had not earned the right to put my hands on a single client because I had not committed to fully understanding the topics above. I had not put in the time, literally. I thought because I could recite muscles and actions off the top of my head that I could manipulate muscles. I was wrong. On one hand all the clients I've helped has allowed me to get a head start on my education in treating soft tissue restrictions but I also understand I probably shouldn't have ever laid a hand on a single person, no matter the outcome. 

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3 Reasons Your Lower Back Hurts That Has Nothing To Do With Your Back

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Lower back pain is something most of us will deal with at some point in our lives. You bend over to pick up your kids or tie your shoelaces and BAM! out of nowhere your back goes out. An overwhelming number of low back injuries stem from chronically poor body mechanics and even more likely from poor everday posture.

If you’re reading this on your phone, take a moment to sit up straight and pull the phone up so your neck isn't being cranked downwards.

Here are three things you need to know about back pain:

1. Back Pain Worse After Standing- Extension Based
 Back Pain Worse After Sitting- Flexion Based

For those who suffer from extension based back pain this is likely caused by: Short Hip flexors, poor glute activity and a lack of anterior core stabilization. The combination of weak glute function with shortened hip flexors often leads to lumbar extension substituting for hip extension during activities such as deadlifting, jumping, and running. Put simply if you aren’t putting your glutes into it, you back will be. 

A sure fire postural sign a person is a candidate for extension based back pain is viewed from the side via anterior pelvic tilt, or the back of your pelvis is higher than the front.

I meant to take a buttfie

I meant to take a buttfie

Flexion based back pain often afflicts those who sit for long periods of time like office workers or truck drivers. The main muscle that creates problems for these individuals is the Psoas. This is the only hip flexor that remains active once you draw your leg up above 90 degrees. Those seeking hip flexion like during a squat will get lower back rounding instead. Their problems are aggravated by a host of other factors such as: Poor glute function, cervical spine positioning, lack of thoracic spine extension and poor anterior core stability.

Someone with this type of back pain is in a catch-22. They need to stop sitting so much but they likely sit a lot due to work. For this individual I would recommend setting a timer to periodically stand up and stretch to break up the monotony. Along with taking time each day to use a foam roller or lacrosse ball to break up any soft tissue adhesions formed in the hip flexor muscles.

2.     Not All Back Pain is Due to “Tight” Hips

From an anatomical standpoint the hip flexors are a combination of muscles: illiopsoas, sartorius, and rectus femoris.

Lets focus on the Psoas.

The psoas attaches through the side of the lumbar spine and connects to the discs in the area of T12-L5. Because of this vertebral origin point, the psoas is also involved in 360 degrees of spine stabilization.

For those who believe they have chronically tight hip flexors, stretching them isn’t going to magically solve the problem because the underlying cause may not be tight hips but an unstable spine and poor core strength. If a muscle is short and tight, stretching it won’t release any neural tone which only leads to it tightening back up afterwards.

Their issues may be solved simply through core and glute activation.

A properly performed plank will solve all that ales you. Not only because by staying in a neutral position will you decrease recruitment of the illiopsoas but also by squeezing the glutes hard you’ll force the muscle to relax due to reciprocal inhibition.

Talking about hips and glutes leads me to the final point

3.     Poor Internal-External Hip Rotation

A quick screen for both:

Need Internal Rotation 35 degrees

External Rotation 45 degrees

Less than stellar results?

Corrections:

Need Internal Rotation- Side Plank

External Rotation- Prone Plank

The muscles that resist internal rotation are all located on the outside of the hip. By stimulating these muscles it forces them to all stabilize the spine and possibly allow your hips and core to work correctly.

On the other side of the equation are the muscles that resist external rotation found on the inside and anterior aspect of the hip. All these muscles co-mingle when it comes to core stability. Like in the aforementioned tip, when a properly performed prone plank is performed, the hip flexors are held in a tight stretched position to help the hips and spine stabilize.

Correcting these restrictions can bring relief to those suffering from chronic lower back pain. These screen are the beginning to figuring out if you need more mobilization or simply needed more stability.