Wednesday, October 8, 2014

Part II: Hips Don't Lie

Last week I shared with you this piece highlighting the benefits of standing with your feet pointed straight ahead. This week we bring movement into the equation and discuss the merits of moving with those feet pointed straight ahead.
Image courtesy of

Let’s start at the ground and work our way up. When we walk, the foot has a characteristic pattern in which it’s supposed to contact the ground. If you look at the bottom of someone’s shoe who has an ‘ideal’ stride, you’ll notice a wear pattern that goes from the outside (lateral) portion of the heel area, travels forward, then appears under the 1st and 2nd toe. This wear pattern indicates an “ideal’ interaction of the foot with the ground, which allows the foot to perform its duties of shock absorption and propulsion. When this foot positioning gets altered by turning the foot out, the muscles, bones, and ligaments of the foot are put into positions that decrease the functionality of the foot.
The foot is one of my favorite body parts because of its incredible architecture that allows for both stability and shock absorption. Without getting too technical, the foot has an intricate arch system that is supported not only by muscles and ligaments, but also by the alignment of the bones of the foot. Turning the foot outward causes this alignment to change, decreasing the boney support and thereby placing excessive stress on the ligaments and muscles that act as slings to support the arch of the foot. When we walk with our feet pointed outwards, we take a structure that is supposed to be rigidly supported by the strength of our foot bones and turn it into something that would make the Viagra reps drool. The layman calls this being flat-footed, the runner knows this as over-pronation, and the podiatrist associates this with the sweet sound of a credit card being swiped to pay for yet another pair of custom orthotics.
Walking with our feet turned out forces our bodies to compensate to get the job of forward movement done. We begin pushing off through the side of our big toe, instead of the bottom, creating a bunion. We attempt to use only our tendons to support our arch and develop posterior tibialis tendonitis and shin splints. The collapsed arch places an uneven load at the achilles and we see achilles tendonitis. Running and jumping serves to expedite the appearance of these injuries as more force is transmitted through these structures and our bodies are required to figure out a way deal with it.
Proper hip-knee-foot alignment on the Left vs improper alignment with the foot turned out and subsequent collapse of the arch and knee on the Right

If one was to attempt more functional activities such as going up and down the stairs or squatting with the feet in this outwardly rotated position, the result would be a collapse of that arch, followed by a buckling inward of the knees, with excessive stress being placed at the inside (medial) aspect of the knee. Cue MCL sprains, meniscus tears, and runner’s knee”, aka patellofemoral syndrome or chondromalacia patella (big words that basically mean your knee hurts). One notable exception to the rule is that squatting with the feet slightly turned out is permissible at times, depending on the experience of the lifter and the anatomical variations present at the hip and lower extremity; but that’s a topic for another time.
At this point you may be thinking, ‘where do Shakira and her ‘hips don’t lie’ mantra play into all of this?’ Well, in reality perhaps I should have referenced Beyonc√© and those glutes, but that “hips” song is just so darn catchy. As I discussed in part one of this article, the glutes stabilize the pelvis and femur (thigh bone) and promote proper alignment at the knee, lower leg, and foot. When we point our feet straight ahead, we are able to generate more tension through the glutes, and subsequently greater stability and power at legs and pelvis. This allows for improved performance in all functional activities, from walking to power lifting, and decreased rates of injury.
Check yo’self: For the next week I challenge you to walk, go up and down the stairs, and stand up from/sit down in your chair with your feet pointed straight ahead. Bonus points if you’re able to incorporate this challenge into your exercise routine and higher-level activities during the week. Be sure to keep your knees tracking in line with your feet, preferably in-line with your 2nd and 3rd toe. By pointing your feet straight ahead and gently contracting your glutes you should notice your arches slightly elevating, while your toes and heels remain in contact with the ground. Be sure to avoid over-squeezing your glutes and walking around looking like you’ve got a stick up your derri√®re. Just like standing with your feet pointed straight ahead, this is going to feel strange, and new, and weird. Suck it up. Your body will thank you.
C. Shante Cofield, PT, DPT, OCS, CSCS