Posterior Tibialis Tendinopathy = Aggravation x 10

Standard

The upside to adversity is that I get to learn something. If that’s true then I am an expert genius on problems with my left foot and lower-leg. I’ve fought various aches and pains in my left foot region and the war continues! I am grateful to be on the very tale end of a successful battle against posterior tibialis tendinopathy (PTT).

Ouch.

Ouch.

Why does a tendon hurt?

The injury mechanism is that the tissue has been stressed beyond its ability to recovery. Too much stress/too fast/too often is the problem. Thus, the tissue must be unloaded and rested enough that it heals. Tendons, compared to muscle and skin, don’t get much blood flow so they need longer to repair than blood-rich tissue.

Time off?!?!

I took the whole month of January off. Every runner — probably every athlete or fitness enthusiast in any discipline — shudders at the idea of taking time off, especially a whole month. “I’ll get out of shape!” or “But I have a race in X-number of weeks!” we say. Well, here’s some news for you: If you’re injured then you’re out of shape. Let’s say that together: IF YOU’RE INJURED THEN YOU. ARE. OUT. OF. SHAPE! You’re busted. Broke. Lame. Dead in the water. Out of the race. It’s the agonizing truth.

If you’re injured then you’ve dug your way into a hole. Trying to run your way out of a running injury is like trying to dig your way out of a hole.

You get what I’m saying? 

If you don’t want to prolong the condition, if you want to get back to serious training (as opposed to piecemeal, sporadic, painful, crappy training) sooner rather than later, then STOP RUNNING RIGHT NOW! Bite the feces-covered bullet and prepare to take several weeks off. This is a test of your discipline. You may think you’re disciplined because you do all this running but discipline isn’t doing what you like to do, discipline is doing what you need to do.

Or, just like me and a bunch of other runners, you can believe you’re the exception, you’re made of magic, you’re different from all the other humans and your PTT will resolve in miraculous fashion. I took a few days off, tried to keep running, and I was still hurt. I did that a couple of times. Reality, in all its brilliant, gruesome glory was sitting on my chest, trying to kill me. But January was a better month to take off than all the other months coming my way and I decided it was time to stop being stupid.

You’re a grownup. You’ll make your own decision but guess what: At some point you’ll stop running. You can either make the choice or it’ll be made for you.

(I’m an expert at dispensing this type of advice but it’s as painful and difficult for me to follow as it is for anyone else. Let me make the dumb mistakes so you don’t have to. Also, for a big pile of woe, read the Let’sRun.com forum on PTT, where you can read about people who’ve dealt with this curse for months and years. My bet is they haven’t taken sufficient time off. But if you read about those who overcame PTT, you’ll see most of them took a significant break from running.)

Fortunately, I could bike and lift. Those aren’t perfect substitutes for running but what is? I was able to keep my body in decent shape. I found peace of mind, and a sense that I wasn’t helpless. The good news is I improved my cycling and my numbers went up on the weights. Hooray me.

Some useful resources

Dr. Nick Studholme is always helpful when I’m hurt and can’t figure out why or what to do about it. He showed me how to use Dynamic Tape to help unload the tendon. He also provided me with the following two resources.

Return to Running Rules of Thumb – Are you ready? This contains specific bench marks that you should be able to hit before you return to running. Some of the terminology may not be familiar to you if you don’t have an education in kinesiology. Do your own research, contact me, or contact a physical therapist for help understanding this information. If you pass these tests then you’re ready for…

Zeren PT Return to Running Program. I like the specific, progressive instructions here. Even though I’m a fitness professional, it helps if I get outside guidance and rules to follow. As the saying goes, “The lawyer who represents himself has a fool for a client.” Might as well replace “lawyer” and “represents” with “coach” and “coaches.” If left to my own guidance then I’ll tend to do too much too soon too fast and I’ll get hurt again.

4 Ways to Prevent and Treat Posterior Tibial Tendonitis is from Runnersconnect.net. This is a thorough, well-researched article. In it you’ll find various strategies to address PTT including pictures, exercises, and specific exercise protocols. I used a lot of the information here.

Below is a taping strategy that can help unload the posterior tibialis and support the arch. Dr. Nick Studholme used Dynamic Tape on me. I’ve been taped with KT Tape and Rock Tape before and I can say for certain that Dynamic Tape provides more resistance than either of the other two and it stays on longer. Also, I tried doing it on my own and it doesn’t work. Get a friend to help or have your physiotherapist do it.

Running technique

In the past, fixing my technique was the key to overcoming a collection of running-related problems and pains. I believe a regression in my technique is what brought on this PTT. I know how to run. I help my clients regain good running form — but I’m not perfect and I can’t watch myself run. My technique slipped and I didn’t know it until I got some expert eyes on the case.

I’m enormously grateful for the help of my new running coach, Andrew Simmons of Lifelong Endurance. Through his guidance I’ve shored up my technique. The first time we met he videoed me running and we saw some faults. I won’t go into the specifics here but he helped me bring awareness to what I was and wasn’t doing correctly and now I’m running better. I believe good technique will help keep my tendons healthy.

If you’re dealing with nagging running injuries then perhaps the way you’re running is the problem. I highly recommend time with a coach. You don’t know what you don’t know. The right coach does know. It’s money and time well spent.

Up next…

My PTT was similar in some regards to achilles problems I’ve had in the past, but it was different in its tenacity and response to treatment efforts. In the next post I’ll discuss my rigid arch and why I believe it has contributed to my foot problems. I’ll also demonstrate a mobility drill, foam rolling techniques, strength exercises that helped, and some running technique points.

Got Shoulders?

Standard

The shoulder joint is the most mobile joint in the body. That’s a good thing! When combined with good spine mobility, our shoulders allow our arms to reach, throw, pull, and push from all sorts of angles.

A consequence of being mobile is the possibility of being highly unstable. Instability, or the inability to control a limb, may lead to the common aches and pains that many of us experience in our shoulders, elbows, and possibly even the wrists. Why might instability and pain happen? (My answer will be limited to chronic pain, not acute injuries such as fractures and dislocations due to falls and other accidents.)

My belief is that shoulder problems (and most other movement problems) are rooted in a use-it-or-lose-it dynamic. Our modern lifestyle is characterized by limited movement. As adults, we rarely crawl on the ground. As modern humans, most of us don’t have to climb trees or pick up heavy things and put them overhead. We typically sit with our arms in front of us as we type on keyboards, drive cars, and operate TV remote controls. Thus our movement skills stagnate. Our brain and nervous system loses the ability to coordinate the many movements available to us. But then we might decide to swing a golf club, swim, lift weights, attempt pull-ups, pushups, throw a ball, or reach into the back seat from the front seat. Unfamiliar movements—especially if done with high force, high speed and/or done at end-range—may be too much to ask of our deconditioned shoulder complex. Then we get pain.

The following videos are designed to help restore mobility and stability to the shoulders. Pay attention to how you move as you do them. Don’t speed through them. Always be in control of the exercise, don’t let the exercise control you. If it hurts then back off or stop. None of these drills are guaranteed to fix any specific problem you may have. You may need to see a physical therapist or some other injury rehab specialist.

For the corner stretch, keep you eyes up a little bit. Don’t let your head and neck flop forward.

For the rotator cuff complex, use high reps, maybe 15-20 reps.

The halo can be varied in some ways not shown in the video. Try the halo while in a hip-hinge or deadlift-like position. Use a light weight.

The Best Know How to Rest

Standard

Our popular culture is filled with admonitions to “Just Do It” and “Push your limits.” We hear aggressively pompous questions like “What’s your excuse?” aimed at people who don’t adhere to some sort of arbitrary exercise pattern. A lot of this is good marketing but it’s not reflective of the reality behind truly great sports performance, career longevity, creativity, and good health. We don’t hear much about the massive importance of rest.

I’m very happy to see a discussion of rest in Sports IllustratedHow extended breaks in training help elite athletes—and why you should take them too is an excerpt from a book titled Peak Performance: Elevate Your Game, Avoid Burnout, and Thrive with the New Science of Success by Steve Magness and Brad Stulberg. They offer the example of 42-year-old Bernard Legat the multiple Olympic medalist and world champion runner:

But here’s the thing: If we never take “easy” periods, we are never able to go full throttle and the “hard” periods end up being not that hard at all. We get stuck in a gray zone, never really stressing ourselves but never really resting either. This vicious cycle is often referred to by a much less vicious name—“going through the motions”—but it’s a huge problem nonetheless. That’s because few people grow when they are going through the motions. In order to give it our all, and do so over a long time horizon without burning out, we’ve got to be more like Bernard Lagat: Every now and then, we’ve got to take it really easy. In addition to his year-end break, Lagat also takes an off-day at the end of every hard training week. On his off-days, Lagat doesn’t even think about running. Instead, he engages only in activities that relax and restore both his body and mind such as massage, light stretching, watching his favorite TV shows, drinking wine, and playing with his kids.

Every hard-exercising, hard-working person should read this and take this advice to heart. This doesn’t just pertain to high-end elite athletes. In fact, the article does a very good job discussing how the need for regular and at times extended rest periods applies to everyone in any field of work. Learn it. Know it. Live it.

Running Injuries and Running Performance: A Podcast and an Article

Standard

Injury and performance exist on a sliding scale. At one end we are completely broken down, hurt, and unable run/bike/swim/lift/fight/hike/etc. At the other end we’re performing at our peak. Probably every active person has been injured and I’m willing to bet that every active person would like to perform their very best. This post is for runners in either or both camps.

Runners are often injured. According to a review of literature in the British Journal of Sports Medicine, rates of lower-leg injury ranged from 19.4% to 79.3% among study subjects. The magic questions are 1)Why do we get injured? and 2) How do we overcome injuries?

I think it stands to reason that if we hurt while running then very likely it’s the way we run that’s the problem. Running requires complex coordination among many parts and systems. It is mind boggling to try and dissect running form, find the problems and then either teach or learn new, helpful techniques.

Meanwhile, if we’re not injured and we’re able to run, then we probably want to know how to run faster and more efficiently. How do we we achieve these goals? These questions aren’t easily answered. With all that in mind, I found two resources that may offer some very valuable information on these issues.

The first is the Physio Edge Podcast 049, Running From Injury with Dr. Rich Willy. At about the 20:30 mark Dr. Willy gives some good external cues to help promote running form that may help with IT band pain. The cues involve the knees and the hips:

  1. If the knees cave in too much while running: He puts brightly colored tape on the outside He has the patient run on a treadmill facing a mirror. He tells the patient to push the tape out toward the walls.
  2. If the hips are adducting too much: The runner runs on a treadmill facing a mirror with the waistband of their shorts clearly visible. He instructs the runner to keep the pelvis level by keeping their waistband level.

Listen to the podcast to get all the details.

Next is an article from the always informative Alex Hutchinson at the Sweat Science column at Runner’s WorldWhat Makes a Running Stride Efficient? Hutchinson discusses a study from Loughborough University in England that looked at biomechanical factors

“For running economy, three variables stood out: vertical oscillation (measured by the up-and-down motion of the pelvis; less is better); how bent your knee is when your foot hits the ground (more bent is better); and braking (also measured by looking at the motion of your pelvis; less slowdown as your foot hits the ground is better).

“Overall, these three variables explained 39.4 percent of the individual differences in running economy—and the vast majority of that (27.7 percent) came from vertical oscillation.

“For running performance, four variables stood out: braking (as above); the angle of the shin when your foot hits the ground (closer to vertical is better); duty factor (basically a measure of how long your foot stays on the ground relative to your overall stride; quicker is better); and the forward lean of your trunk (more upright is better).

Overall, these four variables explained 30.5 percent of individual variation in race times, with shin angle (10 percent) and braking (9.9 percent) as the biggest contributors.”

Something I always appreciate about Hutchinson’s writing is that he lays out some of the errors in thinking that we might encounter when we assume that employing new running techniques will automatically equal better, faster, pain-free running. Are these characteristics of efficient runners chickens or eggs?

“For example, you could imagine a study that compared elite runners to ‘regular’ runners and found that the elite tend to have more highly defined calf muscles. It doesn’t necessarily follow that doing a whole bunch of hardcore calf exercises will make you faster. It’s more likely that a whole lot of training, combined with some genetics, has given elites more defined calves. Fixating on getting better calf muscles would be distraction that’s unlikely to help you, and takes away from things that really would make you faster, like running more.”

That said, (and he mentions this) it may well investigating new strategies based on these findings. From my experience in helping people with their running, aiming to achieve these biomechanical outcomes can help. (This post offers a few cues that I’ve found useful to use with runners.)

Ideally, you should be videoed while running.Trying to adjust your gait without knowing how you’re currently running might be near impossible. Video is a very powerful tool when it comes to making adjustments to sporting techniques and I highly recommend it.

Definitely read the article and listen to the podcast if you think you need help with your running or if you’re a coach who works with runners. And if doing it yourself isn’t getting you the results you want then I strongly suggest you employ some sort of running coach to help.

Sometimes It’s Simple

Standard

I’ve taken lots of courses, read lots of books and articles, listened to podcasts, and attended seminars dedicated to helping my clients move better and get out of pain. I’ve spent time and money learning about so-called corrective exercises. I’ve learned that rarely is the site of pain the site of the problem. I recognize that the body is a highly interconnected system of systems and that what happens at one end can have powerful effects way out at the other end. I’ve tried to absorb and apply all sorts of complex information and sometimes, my brain gets in the way and I overlook simple solutions.

Patty is one of my senior clients. We’ve worked together for several years. She has intermittent knee pain on both, but mostly her left knee. It’s not terrible but it bothers her after tennis games and often while climbing and descending stairs.

It’s important to recognize that the knee is caught between the hip and the ankle. Rarely is it the fault of the knee that’s causing the knee pain. (An obvious exception would be an acute injury like a ligament sprain or some sort of impact to the knee.)

I’ve had her do all sorts of exercises and mobility drills for her hips. We’ve done glute drills in all three planes of motion. We’ve done all sorts of lunges in all sorts of directions. We’ve done a bunch of ankle and foot mobility work too. In the past, I spent way too much time giving her a bunch of instructions to squeeze the glutes when she walks and to try and make her leg do this or that as she moves. (These are examples of intrinsic cues. They’re usually not the best cues.)

Sometimes her knee(s) feel better but for the past several weeks she’s reported fairly consistent knee pain, particularly on stairs. This was frustrating to me in that last week we did a variety of drills and exercises such that she was able to take the stairs without pain. I was hopeful though. If we could eliminate her pain last week then we could do it again.

We went to the stairs. I planned to review a couple of things we did the prior week. My mind filled with cornucopia of lunges, stepping drills, and ankle mobility exercises. How would I tweak the exercises? How would I load them? There were many options. My brain started to overheat as I tried to contemplate them all.

Then I paused and thought, “What’s the simplest possible way to find success?”

Coach her to walk the stairs differently. No drills, no exercises, nothing special. I would give her a minimum of instructions on how to walk the stairs in a different way than when she arrived.

There were two tactics from last week I wanted to try. If those didn’t work then we could move to all the wacky, exotic stuff. The two main instructions were these:

  1. Ascending: Lean forward a little. By leaning forward I expected the glutes to work more than if she stood fully upright. It didn’t need to be a big lean forward, just somewhat of a lean. Don’t think about the glutes either. Jus lean forward.
  2. Descending: Let the heel of the rear foot stay flat longer. That way the ankle would dorsiflex more thus taking some of the load from the knee. Also, try and descend softly. Try not to slam and clunk down to the next step. My hope was that this would prompt a controlled descent as opposed to a sort of lurching slam into the step.

(I’ve seen this ankle/knee relationship several times in the past. A few of my clients have presented with knee pain and limited ankle dorsiflexion. The knee pain diminished or vanished once dorsiflexion was restored and then used during gait.)

Both strategies worked immediately! How cool! For the next 5-10 minutes I had her practice the new stair walking strategies. The only time the knee pain popped up was when she let the heel rise too early during the descent.

I didn’t tell her anything about her glutes or her knee or any other muscles or joints. Just, “lean forward,” and “keep your heel down longer.” I need to remember that sometimes giving simple cues can do world of good. I don’t always need to go through a rigamarole of creative exercises to help someone move and feel better.

Reading & Learning: “Real Movement” by Adam Wolf, PT

Standard

I am reading with much enthusiasm the book Real Movement by physical therapist and massage therapist Adam Wolf, aka the Biomechanical Detective. In a big way, it’s like re-reading a very good book that I’ve enjoyed in the past. I am familiar with a lot of the concepts discussed by Adam and what I enjoy immensely is coming back and examining those concepts through his eyes and his experiences.

Wolf is among other things, a Fellow of Applied Functional Science (FAFS) by way of the Gray Institute. I also study and apply Gary Gray’s material. I always like to see how other practitioners apply the principles of 3D movement. I love gaining new perspectives on how to create functional exercises, or exercises that most translate to real life. You can see a lot of examples of this at the Adam Wolf, PT, Biomechanical Youtube Channel.

liebenson2_1_8896

If you ain’t got that sling then you ain’t got that swing.

Something I just learned is that Adam’s dad is Chuck Wolf, another functional exercise and movement professional. Many years ago I was introduced to the concept of Flexibility Highways at one of Chuck’s seminars. These highways aka muscle slings, aka myofascial lines, are networks of muscle and fascia that often  work together during real-world, whole-body movements. (“Real-life” movements are in contrast to many of the artificially isolated movements that we see in gyms, especially those performed on machines.) One example is the posterior oblique sling as used in a golf swing. Another example is the anterior oblique sling used when throwing.

The anterior X sling is a big part of throwing, batting, golfing, running, punching and all sorts of things.

The anterior X sling is a big part of throwing, batting, golfing, running, punching and all sorts of things.

The fascial sling system was an interesting concept to me at the time but it has sort of faded from my thinking in recent years. Now, reading Adam’s book and watching his videos has brought those flexibility highways or slings to the front of my mind. These sling concepts are informing both the mobility work I’m doing with clients as well as my exercise selection. In working along and within these sling systems I feel like I’m capturing just about all of the movement we humans are capable of. Check out the following videos from Adam Wolf where he discusses how you can move better by following these fascial lines.

Hip Adduction Part II: Solutions to Mobility and Stability

Standard

In Part I of this series, I discussed what hip adduction is and why it’s crucial for good movement, balance and sports performance. In this post I’ll give some ways to self-assess your hip adduction and increase your hip adduction mobility, stability and power.

There are many ways to investigate and train hip adduction. I do not propose to cure what ails you with any of these exercises. If you’re in real pain then you need to see a physician.

(I realize now in watching the videos that I use the term “frontal plane” more than I say “hip adduction.” Please consider the terms interchangeable for the purpose of this post.)

Check your ability to move into hip adduction. Check both right and left sides. How do they compare?

Now check your stability. Can you control your hip adduction?

Try this mobility matrix to gain more hip adduction. You may need more on both sides. The great thing about this matrix is that you’re not only address the hip but you’ll also be mobilizing other joints in concert with the hip.

This movement series is a more aggressive way to challenge hip adduction while at the same time getting an upper body workout.

The next three exercises are a few ways to challenge and develop hip adduction mobility, stability and power. These can be used for athletic training purposes or simply as fun ways to tweak familiar exercises. All sorts of implements can be used:

Achilles Pain. Time to Take Action!

Standard

I’ve had periodic issues with my left Achilles tendon. I’ve never had trouble with my right Achilles until just lately. I felt a bit of soreness one morning and found some swelling. I knew it probably wouldn’t “work itself out” (I sort of hate when someone says that about something. Nothing “works itself out.” Someone has to put in work in order to see progress.) The upside to having had this problem before is that I know how to address it now.

I believe my trouble may have started because of the long trail run/hike I did a couple of weekends ago in Telluride. It was about 12 miles which was a sizable jump from my prior long run of 7 miles. (Sometimes I’m not smart.)

I have attacked the injury with a fairly conventional strategy of slow and controlled heel raises. Here’s what it looks like:

I’m doing these exercises frequently throughout the day. If I can hit 15 reps then I add weight. Fifteen reps isn’t a magic number by the way. Most importantly I work to a high level of exertion, pretty much to failure.

I’ve run several times since feeling pain and doing the calf raises and I feel fine. That’s a good sign. I probably don’t need to take time off from running.

This exercise is boring and I hate doing it. (Sounds like what a lot of people say about going to the gym.) I have shown a propensity for weakness in my Achilles tendons in the past though. This is exactly the type of thing I need to do and I should be doing continually. It’s easy to skip this stuff because I don’t enjoy it. My body doesn’t  though even though there are potential negative consequences to this course of non-action.

There are lots of things in life like that.

Running Technique: 3 Simple Cues

Standard

Running form is a frequently discussed topic among injured runners and runners looking to perform better. How should we run? Is there one ideal way to run? Should we run on the forefoot, mid-foot or heel? Does our core matter? What should our upper body do when we run?

There are many schools of thought in the running world and there doesn’t seem to be any ironclad consensus on any of these questions. If you’re running pain-free and you’re performing as well as you’d like then I don’t believe you should change your running form. In other words, if it ain’t broke, don’t fix it.

If, on the other hand, you experience pain when you run or if you’re not as fast as you’d like to be then some technique changes may be in order.

Run tall.

A lot of us run in a hunched type of posture that resembles the way we sit (and sit and sit…) in our work chairs or in our cars. This hunched position may be problematic and may be contributing to running problems. To address this issue:

Imagine a chain is attached to the top of your skull. That chain pulls you up. It lengthens your spine and makes you tall. See if you can feel this long, tall spine as you run. As part of this process, keep your gaze up and out toward the horizon. Don’t stare at the ground directly in front of you. This tall posture should help with some of our other running form considerations.

Tight hip flexors may contribute to a hunched posture. The following stretch sequence may help.

Run light.

The impact of the foot hitting the ground is worth considering as it concerns injuries. Recent evidence suggests runners who hit the ground lightly are injured less than runners who hit the ground hard.

You may run with earphones and you may be unaware that you stomp and pound the ground with each footfall. So to run light, remove the earphones and pay attention to the sound you make.

Imagine you’re weightless. Your strides are feathery light, and energetic. You don’t pound the ground but rather you glide across gossamer.

Another way to run lightly comes through this skipping drill:

Use a short, quick gait.

One way to lighten the impact of running is to drop the foot very nearly under your hips. This should result in your shin being vertical or near-vertical. Look at the picture. Try running like #2. The skipping drill from above can help you feel that foot landing directly below your hips.

Runner #1 is pounding. Runner #2 is running lightly.

Want to run lightly? Run like #2.

Don’t concern yourself with whether or not you’re hitting on the heel, mid-foot or forefoot. Where the foot lands is more important than on what part of the foot hits first.

Quickening your cadence too much can be a problem. There is an obvious point at which gait can becomes too quick and inefficient. An excellent way to work on your cadence is to use a metronome. Kinetic Revolution has a great article that discusses research on cadence as well as how to introduce metronome running into your training. The article also links to a digital metronome that you can download.

Change takes work.

Running may seem like something we should all be able to do. In fact, most of us can execute some version of movement in which we rapidly put one foot in front of the other. Kids learn to run without detailed instruction and without much in the way of typical running injuries. Shouldn’t adults be able to do the same thing? Maybe or maybe not… If we hurt while running or if we think we’re too slow, then some sort of alteration to our running style may make sense.

Changing your gait takes some tinkering, some awareness and mindfulness. It won’t happen automatically. Physical therapist Rick Olderman helped me to change my running gait. He once said that “if it feels normal, then you’re doing it wrong.” He meant that in the early stages of changing how we move, it should feel weird and unnatural to us. Learning any new skill requires some struggle and awkwardness. If you practice frequently and work at it then things should improve at a reasonable rate.

Personally, I never listen to music while running. I pay attention to how I run, where my foot falls, how I move. I don’t want to fall back into bad habits.

Finally

I can’t guarantee that any of these changes will result in either a pain-free running experience or a podium finish in a race.Time with a physical therapist, podiatrist, chiropractor and/or a running coach may be what you need.  That said, these cues have helped my running as well as several of my clients’ running experience. I’ve also incorporated things like the short foot drill, ankle dorsiflexion work, and a wide variety of single-leg squats and lunges (here, here, here for instance) to improve my movement competence. Clearly, there are a lot of moving parts to consider when we run!

Got Dorsiflexion?

Standard

The toes, feet and ankles get no respect. I’m not sure a lot of people walk into the gym and say, “Okay, today is foot and ankle day! Gonna work those parts hard and make ’em strong!”  We throw shoes on them and ignore them. Think about this though: It’s only every single step that we need those obscure parts to work correctly.

If we look at the body as a kinetic chain then we start to see that the feet and ankles don’t live in isolation. Movement or lack there of at the feet and ankles may create problems all the way up through the legs, hips, spine and shoulders. If an athlete doesn’t have sufficient motion at the ankles then he or she may not perform at his or her best.

Similarly, limited foot and ankle motion may be a contributor to pain. I’m not just talking about foot pain either. Again, if we consider the interconnectedness of all the joints and limbs of the body then it may not surprise us that faulty foot/ankle movement could contribute to back knee pain, hip pain, back pain — even shoulder or neck pain!

image003

Dorsiflexion: There’s no substitution for it!

In my observing both my clients and myself, I see a lot of us don’t quite have optimal  dorsiflexion. It’s easy to overlook but as I’ve argued, it’s very important. I know in my case, my various plantar fasciitis/Achilles tendon issues have improved as I’ve worked on my dorsiflexion. (Strictly speaking, I don’t know if limited dorsiflexion was a cause or effect of my foot and Achilles pain. That said, working on improving dorsiflexion
has coincided with those problems fading out.)

Dorsiflexion is more than just forward and back motion. There is always a 3D aspect to movement and we want to consider that. Also, We have a couple of different muscles (well… more than a couple but we’re considering mainly just two) that cross at the ankle. The following drills emphasize both the gastrocnemius muscle (the straight-leg drills) and the soleus muscle (the bent knee drills.)