Tuesday, September 30, 2014

Part I: Putting Your Best Foot Foward

One of the easiest postural corrections I think we as humans can make is standing with our feet pointed straight ahead. Living in NYC I am privy to seemingly an endless number of opportunities to watch people walk and stand. Let me tell you folks, we have an epidemic on our hands. The dreaded turned-out foot has become adopted by so many people it's no wonder Dr. Scholl's and Icy Hot patches have their own sections in the drug store. 
                               Muscles of the hip

                               MUSCLES OF THE HIP

When we stand with our feet turned out, the hips follow, in a movement known as external rotation. In this position, the hip muscles are shortened and become tight, which leads to decreased hip strength and range of motion.
A muscle can only contract optimally if it can fully relax. Tight muscles are weak muscles, in that they are unable to fully lengthen and shorten as is required for generating maximum tension and strength. The role of the hip muscles, in addition to moving and stabilizing the femur (leg), is to stabilize the pelvis. As demonstrated in the picture below, the pelvis acts as a base on which the spine rests. When the glutes are tight and weak, they can no longer do their job of stabilizing the pelvis. If you've ever played Jenga, you understand the importance of having a sturdy base. When the glutes don’t stabilize the pelvis, it’s like playing Jenga in an earthquake. The pelvic instability caused by hip weakness creates excessive motion at the low back, which leads to, you guessed it, back pain.
From a movement perspective, the low back and hip are best friends with complementary roles. The hips, with their ball-and-socket design, allow for multidirectional movement (just ask Shakira), while the facet joints of the lumbar spine are designed for flexion and extension (forward and backward bending).
   The ball-and-socket configuration of the hip joint
           The lumbar spine as viewed from the Right
When those hips get tight and lose motion, they also lose their function, and suddenly the low back is left to pick up the slack. The low back, structurally suited for flexion-extension movement now has a job for which it is neither designed nor prepared. Enter again: low back pain! 
Check yo'self: Let your hips and back do what they were designed to do. Stand with your toes pointed forward, weight distributed equally between both feet, not leaning too far forward or backward. For those of you with a tendency to turn your feet outwards, standing with your feet pointing straight ahead will feel strange, and you may even feel like you’re pigeon-toed (toes pointed in). Suck it up. Look down and make sure that your knees are in line with your toes, and both are pointing straight ahead. If your knees are pointing inwards, gently contract your glutes (squeeze your butt) and notice how this causes your knees to rotate slightly outward and into a neutral position. This is proper standing position (from the hips down, anyway), and this is what I want you to focus on for the next week. Whenever you find yourself standing and waiting for the train or in line at Duane Reade waiting to buy your third pack of Icy Hot patches, make sure those feet are pointed straight ahead. Your body will thank you. 
 Tune in next week for Part II: Hips Don't Lie
C. Shante Cofield, PT, DPT, OCS, CSCS