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knee pain

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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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