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Hip Mobility

When it comes to mobility training, the hips and shoulders are often primary areas of focus. There’s good reason for that: they are the only ball-and-socket joints in the body, and thus are primed for mobility by design. So when our hips are not moving well, it should be cause for concern. For most of us, the ability to adequately use our hips leaves a lot left to be desired, and unfortunately a lack of adequate movement in the hip joint can be a precursor to lower back pain, knee pain, and increased susceptibility to injury, particularly during athletic endeavors.

In order to most effectively improve and maintain mobility in our hips, we need to understand some basic hip anatomy, some of the potential reasons our hips tend to lose mobility, and then have some tools in our back pocket to be able to directly address what is causing our lack of hip mobility. I am of the opinion that mobility training has become way too complicated over the years, particularly with the age of social media. You don’t need hundreds of different exercises to improve hip function. More important than having hundreds of tools to address immobile hips is the skillful and appropriate application of these tools based on thorough understanding. It’s not the tool, it’s effectively you can use that tool. The purpose of today’s article is to breakdown some of the primary factors that affect the mobility of our hips, whether structural, functional, or otherwise, and ultimately how to effectively improve and maintain the health of our hips through a combination of exercises, drills, and training protocols.

Anatomy of the Hip Joint

The hip joint is made up of two primary articulating structures, the acetabulum (socket) and the head of the femur (ball). The acetabulum is a conglomerate of the bones of the pelvis:  the ilium, ischium, and pubis. Depending on how our bones develop over our lifetime (combination of genetics and lifestyle), the anatomy of our hip sockets can vary from person. Some peoples’ hip sockets are shallow while others’ are deeper. Some face more forward while others might be positioned more laterally.

In addition to having individual variation between people in regards to hip socket anatomy, we also see a ton of variation between individuals in regards to the head (ball) and neck of the femur. See the pictures below to get a better visual of all of these potential anatomical variations within the hips.

The shallowness or depth of the acetabulum leaves more or less room for movement in the hip.

The shallowness or depth of the acetabulum leaves more or less room for movement in the hip.

Notice how the different angles of the neck of the femur can affect force transmission through the pelvis.

Notice how the different angles of the neck of the femur can affect force transmission through the pelvis.

Notice the variation between femurs: length, torsion, neck angle, size of the femoral head, etc.

Notice the variation between femurs: length, torsion, neck angle, size of the femoral head, etc.

We can clearly see that structure alone can have a huge impact on the movement capacity of our hips. Some of us naturally have better mobility in our hips than others. Some of us are better suited to squat deeply than others. Some of us might be more suited for deadlifting. Some might prefer a narrower stance while others might benefit more from a wider stance. Some of us need to work diligently and regularly on mobility in order to maintain it, while some have naturally mobile joints.

Utilizing a combination of passive and active mobility screens, as well as a myriad of different exercises and drills can help to provide an idea of what is most affecting our hip function,  whether positively or negatively.

Assessing Hip Mobility

There are two primary ways to categorize mobility in the context of an assessment. Passive mobility is range of motion assessed manually by the therapist, where the client is completely relaxed. Active mobility is assessed by asking the client to move through specified ranges of motion via their own voluntary muscular effort. There is almost always a discrepancy between the two. Just because the joints have structural capacity for range of motion does not inherently mean that we also have the muscular control and strength to effectively utilize that range of motion.

Passive mobility gives the therapist or practitioner a lot of information about whether or not the immobility is coming from structural or tissue limitations. If I take someone’s hip through passive range of motion assessments, I can feel if the ligaments, tendons, capsule, or bone on bone contact is what is creating the limitation in mobility, or if it feels like guarding and protective muscular tension is more likely the culprit.

Active mobility gives the therapist or practitioner information about how the client is able to create motion in the hips via their own ability to control muscular output. Structure does not always dictate function. While hardware can be physically manipulated to potentially improve mobility, neurological outputs are not as easy to manipulate to create predictable change. Motor control is the key to active mobility and owning your range of motion, and motor control can be compromised for any number of complex reasons. This is where deeper assessment skills are helpful.

In addition to assessing the hip joint directly, we also need to take into account how other areas of the body can potentially be affecting the hip. Often times a restriction in the hip, like any other joint, is simply a compensatory response to dysfunction (usually instability) somewhere else. Typically, the core/pelvis and the ankle/foot all play large roles in hip function.

Dean Somerset made a video that went viral (as viral as a video can go in the health and fitness industry at least), providing a good visual demonstration of how a lack of stability leads to compressed joints as compensation. Check it out here:

If we go back to the question I posed earlier, whether hip mobility is coming from a structural/anatomical limitation or if it is simply compensation for lack of stability elsewhere, giving the above protocol a shot might help illuminate this for you.

Hip mobility is a direct product of how stable your pelvis is, and how well your feet can provide your hips feedback during closed chain movements. The chances are high that your hips will move well and maintain good mobility if you have the requisite core/pelvic stability, functional and strong feet, and train your hips through various ranges of motion regularly.

Once you’ve got an idea of whether your hip dysfunction is mostly coming from lack of actual joint mobility, imbalanced muscular tension, or from a weak link somewhere else in the body, there are no shortage of hip mobility drills, programs, progressions, and sequences you can utilize to start restoring the mobility in your hips.

Putting it All Together

With a better understanding of what our hip mobility can be affected by, it’s time to put that knowledge to good use and start the process of improving and maintaining functional and mobile hips for the long-haul.

Since there are literally hundreds if not thousands of potentially helpful exercises to improve hip mobility, rather than overwhelm you, I want to share just a few of my favorite go-to drills that I have used to great effect in helping restore clients’ hip function.

First, it is a good idea to have a movement that teaches the functional relationship between the lumbo-pelvic complex and the hip. As we’ve already shown, an unstable pelvis will almost always lock up the hip joint. I have three favorites to address this issue: Deadbugs, Birddogs, and Quadruped Rocking. Each of these exercises puts particular emphasis on maintaining isometric stability (preventing movement) through the lumbar area.

  • We are relying on our hip flexors controlling the hip joint.
  • Focus on feeling the motion exclusively through the hip joint.
  • Adjust the difficulty by shortening the leg by flexing or extending the knee.
  • Make sure you don’t need to hold your breath to accomplish pelvic stability.

  • This movement is essentially an inverted deadbug.

  • We are relying on our hip extensors controlling the hip joint.
  • Without feedback from the floor, the lower back is more susceptible to unwanted movement.
  • Try and minimize the shifting of your weight side to side; stay centered.

  • Great regression of the squat pattern.
  • The goal is to learn how to brace the core while accessing end-range closed-chain hip flexion.
  • 4 points of contact with the floor allows for good amount of tactile feedback.
  • If you can do these perfectly, but can’t squat standing, then your feet are likely the issue, not your core.

After we ensure we are able to differentiate between lumbar movement and hip movement, the next step is to start working on drills that are helpful for teaching us to feel the connection between our feet and our hips. In order to do that, we need to focus mostly on closed-chain (feet in contact with the floor) exercises.

  • Combines rotational stability of the lumbo-pelvic complex with multiplanar motion through the hip.
  • Focus should be on maintaining a neutrally grounded foot position throughout.
  • These are a great regression for the single-leg RDL.

  • Rotational resistance also provides tactile feedback to help orient and integrate rotation through the ankle/foot, knee, hip, and lumbo-pelvic complex.
  • This should feel really stable and fluid before attempting to load a single-leg RDL pattern.

  • This is a helpful drill to integrate the hip, knee, and foot together through all three planes of motion.
  • The goal is to minimize rotation through the spine, and promote most of the rotation through the hip.
  • The foot should be springy; don’t allow excessive unwanted movement, but don’t let the foot go rigid.

Conclusion

Hip mobility is an interesting topic. While there is no shortage of other considerations, exercises, and theorizing we could talk about in regards to hip mobility, I like keeping things simple. If your hip mobility is less than adequate, consider not only the tissues in the hip itself, but also the stability of the core and pelvis, as well as the functionality and loading capacity of the feet. If you are clicking on all cylinders as far as those things are concerned, your immobility hips will be a thing of the past.

The Function of the Knee

Outside of the lower back, the knee is one of the most common areas of the body we experience injuries and chronic pain. For professional athletes, more games are missed and money lost on knee injuries than almost any other type of injury. For recreational movers like you and I, it is just as common for knee issues to prevent us from staying on top of our fitness and physical activities. Understanding why we as humans commonly experience back pain makes sense: the lower back is essentially the crossroads of the body; tons of muscles, tissues, and kinetic chains feed through the lumbo-pelvic complex. It stands to reason that the low back has a large potential for things to go awry. But when it comes to the knee, why do so many of us experience symptoms and pain?

Anatomically, the knee is unfortunately predisposed to acute, sports-related injuries. The way the knee joint is set up structurally, I contend that a large part of what makes it so susceptible to injury is that it does not have many ways of compensating. Biomechanically, the knee is often at the mercy of how the foot and/or hip joints move and function. Core stability originates from the trunk and pelvis, ensuring optimal movement and loading through the hip joint, while closed-chain interaction with the ground starts with our feet, ensuring optimal movement and load through the ankles. The knee joint is situated right in the middle of the action as far as lower extremity movements go, and thus needs the capacity to dissipate, transmit, and tolerate large forces generated from the core and feet to keep everything communicating and functioning optimally.

Common acute knee injuries:

  • MCL/LCL/ACL/PCL sprains/tears
  • Meniscus-related issues
  • Hamstring strains

Common chronic knee symptoms:

  • Patellar tendonitis
  • Quad tendonitis
  • Popliteal pain
  • Patellar tracking issues

No matter the issue we might be dealing with in our knees, there are a few key concepts to understand in our attempts to better facilitate our treatments and training strategies. Understanding the 3 major roles the knee joint plays in movement gives a ton of insight into how to keep our knees healthy. They are:

  • screw-home mechanism and rotational stability
  • patellar tracking in relation to quad balance and ITB activity
  • transmission of GRF through the fibula/biceps femoris

Without further ado, let’s dive in!

The Screw-Home Mechanism

As I mentioned previously, we often associate the knee with flexion and extension, movements that predominantly occur in the sagittal (front to back movements) plane. What often goes underappreciated is how much rotation occurs at the knee, and what role that rotation plays in the function of our lower-extremity kinetic chains.

This is a good visual demonstration of how the knee locks and unlocks in rotation as it goes through flexion-extension moments:

When the knee is fully extended (straight), the femur rotates internally relative to the tibia, and the tibia rotates externally relative to the femur.

When flexion is initiated at the knee, the femur rotates externally relative to the tibia, and the tibia rotates internally relative to the femur.

In gait, the external rotation of the tibia is coupled with supination of the foot and external rotation of the hip. The inverse is also true, whereby the internal rotation of the tibia is coupled with pronation of the foot and internal rotation of the hip. If any of these joint motions are not fully accessible, it could potentially lead to excessive motion at the other joints, increasing mechanical stress and creating symptoms. In order to fully understand and resolve our knee symptoms, we need to make sure that each of these coupled movements at the foot, knee, and hip are integrated well. Below are a couple examples of how these ideas might manifest as knee pain:

An immobile navicular bone in the foot is preventing full pronation in the foot. A lack of adequate pronation then leads to increased subtalar inversion, which shifts the talus position medially. The talus shifting medially then neurologically inhibits all the muscles in the lower extremity moving laterally. Decreased muscle strength of the glute medius, TFL, and other abductors then destabilizes the hip leading to an aggressive knee valgus, and the medial knee becomes painful. Our symptoms are at the knee, but in order to restore them we need to retrace the origins of the dysfunction and improve mobility and joint-loading capacity at the navicular bone.

OR

An unstable SI joint stuck in anterior torsion. This decreases the hip joint’s available external rotation. A lack of hip external rotation then becomes compensated for by increased external rotation of the tibia. Excessive external rotation of the tibia then leads to an imbalance between the lateral and medial hamstrings over time. The lateral hamstrings have more mechanical stress on them, and over time we start to get pain in the posterior lateral knee.

There are numerous potential ways in which any one person can compensate around dysfunction. The above are some hypothetical examples. The primary point is that rotation does in fact occur at the knee, and it is greatly affected by our both feet and our hips. In order to optimize our knee function, it is imperative that we consider rotational stability and how things are functioning above and below at the hip and foot respectively. Ensuring optimal stability at the pelvis and movement through the hip, as well as stability of the foot and movement in the ankle will allow the knee to stay within its optimal parameters for movement, reducing the likelihood of symptoms.

Patellar Tracking

The patella being one of the primary structures involved in knee mechanics, it is important to have an understanding of the role the patella plays in movement, as well as what muscles are involved in those movements.

IMG_2561.PNG

The patella is a sesamoid bone. We have just a few sesamoid bones in the entire body, the others are located in the flexor hallucis brevis muscle on the bottom of the foot. What characterizes a sesamoid bone is that it is embedded within the tendon. Sesamoid bones essentially act like pulleys, allowing for increased mechanical advantage and improve a tendon’s ability to transmit forces.

Our patella is the largest sesamoid bone in the body, and it is primarily acted upon by some very large and powerful muscles, the quadriceps. Optimized knee mechanics require balanced patellar tracking, and balanced patellar tracking is ultimately determined by balance in the quadriceps. We have 4 quad muscles (hence, “quads”), and each function just a bit differently. Take a look at them below.

 

 

Going clockwise from upper left:   Vastus Lateralis (outer quad), Vastus Medialis (inner quad), Vastus Intermedius (middle quad), and Rectus Femoris (two-joint quad, crossing both the knee and the hip).

 


Vastus Lateralis (Outer Quad)Vastus Medialis (Inner Quad)Vastus Intermedius (Middle Quad)Rectus Femoris (notice how it crosses the knee AND hip joints)

Common sense would tell us that if the lateral quad muscle fibers pull with too much tension relative to the medial quad fibers, the patella will track more laterally; the opposite is also true. We definitely want to make sure that our vastus lateralis and vastus medialis are working in harmony in order to keep our patellar tracking optimized.

However, what I find to be far more of a common problem in patellar tracking is the rectus femoris. The rectus femoris is the muscle you feel pulling tight when you the all-too common kneeling hip flexor stretch. It is the most superficial quad muscle, and has the most direct impact on patellar function due to uniqueness among the quads. As you might notice on the picture above, the rectus femoris crosses both the knee joint through the quad tendon, patella, and patellar tendon attaching on the tibia, but it also crosses the hip joint attaching on the ASIS. Because the muscle crosses two joints, the rectus femoris is both a hip flexor and a knee extensor. This makes it more susceptible to unwanted compensation.

Patellar tendonitis is perhaps the most common knee condition I treat regularly. It is sometimes also referred to as “Jumper’s Knee.” It is often characterized by a sharp pain occurring just below the patella during activities like squatting, walking up or down stairs, lunging, or other activities involving knee bending. The rectus femoris muscle is usually our prime suspect when it comes to patellar pain. Taking into account that the muscle crosses two joints, it is often important to appreciate the rectus femoris’ role on the hip, not just the knee. As I’ve mentioned several times already, the knee is often at the mercy of what is occuring at the hip and the feet. This is another piece to that puzzle. Appreciating the functional relationship between the hip flexors and knee extensors is the key to maintaining normal patellar tracking and patellar tendon health.

Shock Absorption & Dissipation of Ground Reaction Forces

When we’re talking about movements and functions of the knee, our conversations are usually focused on the previous two ideas we’ve covered. Far less understood is the role the knee plays in shock absorption and transfer of kinetic energy via ground reaction forces. What does all this mean? Keep reading to find out.

The knee actually has 4 bones associated with it. Most of us know of the femur (leg bone), tibia (shin bone), and patella (knee cap), but what we often fail to appreciate is the role the fibula (outer lower leg bone) plays in knee mechanics.

IMG_2566.PNG

The fibula has two primary roles within the knee joint. First, the distal end helps to form the talocrural (true ankle) joint, while the proximal end provides additional stability for the knee joint and helps to transmit force from the lateral foot through the lateral hamstrings and into the pelvis. We are mostly focused on the proximal portion and how it helps to transmit force through the lower extremity.

As part of the deep longitudinal subsystem, the tibiofibular joint is incredibly important for providing the knee with additional stability for activities like running and jumping that require a lot of force to be transferring through multiple joints in sequence. In gait, as we heel strike, the energy upon contacting the ground is sent through the heel, then the ankle, then the fibula and knee joint, through the hamstrings, and into the pelvis. If we lose our ability to respond to load in the tibio-fibular joint, then we are likely to experience knee symptoms, chronic hamstring tightness/irritation, and dysfunctional compensation further upstream or downstream in the hips or ankles.

Take a quick glance at the feathery connective tissue between the fibula and tibia. Notice the oblique direction of the interosseous membrane. This tissue plays a significant role in shock absorption in the lower leg.

Wrapping Up

The knee is a more complex joint than most of us give it credit for. Symptoms in the knee are incredibly common, and we need to have better ways of understanding, assessing, and correcting dysfunctions in the knee.

Often times we must consider the function of the joints above and below the knee, as well as how the muscles acting on the knee are functioning. We must appreciate that the knee joint has several important roles, and that each must be working optimally to minimize our risk of injury. The knee plays an important role by providing:

  • Rotational stability in athletic movements
  • Optimized tracking of our patella
  • Absorption and dissipation of ground reaction forces in athletic movement

Make sure that you are assessing the knee through several different lenses, understanding there are more functions in the knee than just flexion and extension. As we work our way up through the body, we are going to take a closer look at the hips and what the most important factors are when it comes to hip function and movement.

The Ankle and the Pronation-Supination Continuum

In this next installment of our foot series, we are going to be taking a look at the anatomy of the ankle, the biomechanics of the ankle with particular emphasis on the talus and rearfoot tripod (yes, we have another tripod in the foot!), and the role these structures play in our ability to supinate, pronate, and ultimately integrate our feet with the rest of the body.

Anatomy of the Ankle

First, let’s review the anatomy of the ankle. The ankle is comprised of two primary joints, the subtalar joint and the talocrural joint. Just briefly watch a few seconds of the video below to get a visual of the structures involved.

What is important to notice when it comes to these two joints is that they have one key component in common: the talus. The talus is a very unique bone in the body in that it has no muscular attachments, and because of this, it provides a very specific type of proprioceptive feedback to the rest of the body. The talus serves as a gyroscope of sorts. Check this out:

Pretty crazy right? What this means is that ankle function is of utmost importance. If our talus is malpositioned or unstable, it will adversely affect how muscles not only in the lower extremity, but throughout the entire body function. In order to restore and maintain optimal position and movement of the talus, we need to make sure to have adequate control through the pronation-supination continuum. We need to ensure that not only do the talocrural and subtalar joints of the ankle function well, but also ensure that the midfoot integrates with the ankle as well.

The Second [Less Often Talked About] Foot Tripod

In a previous article [CLICK HERE], we went over the forefoot tripod, and the role it plays in foot function. What we didn’t talk about is that there is technically another tripod within the foot. The two are intrinsically linked together. The three points in the rearfoot tripod are the:

CalcaneusNavicularCuboid

If you read the previous foot tripod article, you might remember that we briefly talked about the importance of these joints and how to mobilize them. The ability to respond to load in these joints has a drastic effect on the talus and vice versa. Because we know the talus has large-scale effects on proprioceptive input and neuromuscular control, maintaining optimal foot function must involve the integration of the forefoot tripod, rearfoot tripod, and ankle joints. This is what will ultimately allow for the fluid control of pronation and supination in the foot and ankle.


Supination vs Pronation

When we are talking about pronation and supination, we mostly associate these joint motions with walking gait. Pronation and supination allow the foot to have the dynamic stability required for shock absorption, as well as allow for the storing and releasing of kinetic energy through the lower extremities. The feet are highly involved in the Deep Longitudinal, Lateral, Anterior and Posterior Spiral kinetic chains. It at all starts with the feet.

One simple way to think about supination is to liken it to inversion, or simply the foot pointing down-and-in. We mostly utilize the foot in a supinated position in gait when we are pushing off and extending through the hips. Pronation is simply the opposite; liken it to eversion, or the foot turning out and up.

Our conversation around ankle mobility is most often centered around the idea of restoring dorsiflexion, which is primarily motion happening at the talocrural joint. Adequate ankle dorsiflexion is an important component for deep squats and activities like olympic lifting. However, as important as talocrural joint-focused ankle mobility is, we need to also appreciate the importance of subtalar joint function. I don’t think we talk enough about the rotational and lateral motions that also occur at the ankle when it comes to performance.

Chronic instability or lack of mobility in the subtalar joint will often lead to issues like knee pain and hip immobility. This has implications with almost any athletic endeavor.

In the case of the feet and ankles, my clinical experience has shown me that no matter what type of athlete you are, whether you are a weightlifter or runner, skier or cyclist, crossfitter or yogi, the feet and ankles are almost always in need of improvement. We usually get drastic improvements in strength, flexibility, power and overall athletic performance when we restore and maintain optimal foot and ankle function.


Integrating the Feet & Ankles

My usual approach foot and ankle integration is focused on simplicity. What will give us the most bang for our buck with our self-administered corrective protocols?

Focusing on restoring mobility in the requisite joints, and make sure that those joints have the ability to appropriately respond to load is a good place to start. I showed you a few drills in my Foot Tripod article that focused on three key joints of the foot tripod; here they are again in case you missed them:

Typically, if the joints feel stiff and achy while performing these drills, chances are that they need improvement. Doing them regularly and prior to any lower body training days will help to slowly progress the function of the joints over time.

Once we’ve mobilized the foot, the next step is to focus on integrating the foot and ankle with the knee, hip, and spine. There are many ways to do this depending on what your training goals are. However, I am of the opinion that the absolute best way to integrate the feet with the rest of the body is incredibly simple. The magic exercise that makes this happen that almost everyone needs to do more of is…..

…WALKING!!

Yes, you read that right. Walking is one of the most under-appreciated and under-utilized forms of exercise out there. Granted, not everyone’s gait pattern is a thing of beauty, but even then I recommend more walking for improved overall function. More minimal the footwear the better. Chances are high that if we ensure the feet and ankles are functioning well, and we then integrate our feet and ankles with our walking gait through copious amounts of walking, we will be well on our way to functioning and feeling a lot better. Sometimes it is that simple.

In order to further help integrate your walking gait, here are a handful of drills that can also help:

Rolling Patterns: Sequential rotation of the legs, hips, spine, and shoulders is incredibly important for walking gait. One of the primary problems that shows up in gait is a lack of rotation happening through the hips and thoracic spine. Rolling patterns are a great way to work on improving sequential rotation throughout the body, particularly because we can do so without loading the joints which helps to minimize compensation. I consider this to be a regression of walking. This drills does not allow you to use your large prime mover type muscles like your quads, lats, hamstrings, etc. and so you are forced to use your deeper stabilizing muscles predominantly.

Slow Gait Walking: With any exercise, one way to really make sure you are owning it and able to do it properly is by slowing it down. Slowing things down forces you to recognize and work through suboptimal compensation strategies. Performing a skill more slowly forces you own each phase or aspect of that skill.

By that logic, walking incredibly slowly will make it apparent to you where you might need to improve stability, or joint response, or load capacity. By slowing down, you can pay more attention to the areas that need improvement, and then incorporate additional drills that can improve upon and reintegrate the pieces that are not functioning optimally.

If rolling patterns and slow, gait-mechanics-focused walking are feeling good, go walk! Walk your dog! Walk to work! Walk a handful of miles a week at least. It’s one the simplest and most effective ways of improving overall biomechanical function.

Wrapping Up

The feet and ankles are one the most important key areas in the body when it comes to restoring and maintaining full-body biomechanical efficiency and movement capacity. The more efficiently we move and larger capacity we have for good movement, the smaller our chances are in regards to sustaining injuries, struggling with chronic pain, and greater our overall performance.

Hopefully this article gave you guys some good insights and understanding as well as some useful tools to help facilitate better function in your feet and ankles! Stay tuned, we’re just getting started. Over the coming weeks and months, I will be continuing to write articles like this going through every area of the body.

The Foot Tripod

The foot is a very complex structure that is suited to handle several key tasks involving human movement. With 28 bones, articulating joints between each of those bones, and many muscles acting on those bones and joints, the foot can be a bit overwhelming when attempting to understand its intricacies in movement.

When I work with clients, the feet are an area I am always paying attention to. Some of the most common dysfunctions and symptomatic presentations throughout the body often involve compromised function of the feet. If you think about how often we use our feet when we move, most of the time we are on our feet. Standing in line at the grocery store. Walking around the house cleaning. Commuting to work on foot. Going for a run. Hiking. Particularly with traditional strength training exercises like deadlifts, squats, and lunges, the feet are the foundation.

In my estimation, the feet have several major functions. First, the feet provide the foundation for gait. In gait, the foot needs to dynamically stabilize and oscillate between pronation and supination to feed into the kinetic chains upstream. Secondly, the feet are rich with receptors providing copious amounts of feedback about body position, the surfaces we are walking on, balance, etc. Lastly, the foot often acts as a tripod to provide isometric stability during many different closed-chain exercises, particularly those that are common within traditional strength training methodologies like squatting, deadlifting ,lunging, etc.

For the purposes of this article, we are focusing on the tripod function of the foot, briefly reviewing the anatomy, the role the foot tripod plays in providing a stable foundation for strength training, and some ways to improve the function of our foot tripod through exercises and drills.

Anatomy of the Tripod Foot

Let’s start by talking about the three-points that make up the foot tripod. First, we have the calcaneus (heel) as the first contact point. The medial contact point of the tripod is the first MTP joint or the first metatarsal head (ball of the foot). The lateral contact point is the head of the fifth MTP joint (base of the pinky toe). See the points highlighted below.

(Picture from Tony Gentilcore’s blog –https://tonygentilcore.com/2015/02/passive-vs-active-foot-squatting-performance/. Tony’s is an excellent blog to follow.)

Easy enough to conceptualize and visualize, right? Understanding the structure of the tripod is important. We need each of these three points to be able to maintain contact with the ground. If one point cannot engage with the floor, then the rest of structure above (lower leg, knee, upper leg, hip) will have its alignment and function compromised during movement. For example, an inability to load the medial contact point typically leads to excessive pronation, which often creates a cascade of rotational compensation in the knee, hip, and pelvis.

In order to understand how to ensure each of these points is functioning to promote a strong tripod and stable foot, we need to also understand the primary muscles involved. These are:

  • Posterior Tibialis
  • Abductor Hallucis
  • Flexor Hallucis Longus
  • Extensor Hallucis Brevis

While there are more than just 4 muscles that have a direct impact on the structural integrity of the foot tripod, these are the main players. The posterior tibialis helps to supinate (think – “turn in”) the foot, which lifts the arch, facilitating inversion of the ankle. The abductor hallucis is key in controlling the “gripping” or “reaching” movement of the big toe through the midfoot. The extensor hallucis brevis is important in how it affects the first MTP joint, allowing the ball of the foot to settle onto the ground instead of the pad of the big toe simply just pressing into the floor. The flexor hallucis brevis runs through the sesamoid bones (for mechanical advantage) and ultimately helps the 1st metatarsal (big toe) to press down and engage with the floor, similarly to the abductor hallucis.

Each of these muscles help provide structural integrity of the foot arch. Being able to have a normal foot arch is paramount for having a stable and functional foot tripod. If there are dysfunctional relationships between the ankle, rearfoot, midfoot, forefoot, or toes, our arch and thus our tripod will function less than optimally.

Tripod Foot During Training

Other than low-back pain, knee pain might be the most common pain out there, for both sedentary folks and high level athletes alike. Not taking into consideration acute trauma to the knee, such as ACL sprains or meniscus tears, knee pain is most often a product of mechanical stress created by dysfunction in the feet or hips. Not spending enough time on our feet, coupled with the fact that the time we do spend on our feet is typically in cushioned footwear, is not a recipe for healthy and functional feet. When someone comes to see me with knee pain, 8 out of 10 times, improving their foot function resolves their knee issues.

When it comes to understanding the feet from a strength training perspective, here a few key principles to think about:

  • Inability to bear weight on outside of the foot will emphasize the medial quads, hamstrings, calves, and adductors.
  • Inability to bear weight on inside of the foot will emphasize the lateral quads, hamstrings, and calves.
  • Inability to load the forefoot will often lead to synergistic dominance of the toe extensors and lumbar erectors.
  • Inability to load the rearfoot (heel) will often lead to synergistic dominance of the distal quads and adductors.
  • An unstable foot tripod will lead to an inability to load at least one part of the foot.

For the sake of simplicity (foot mechanics are anything but simple), we are referring mostly to closed-chain (foot is in contact with the ground or a platform) exercises like squats, deadlifts, and lunges. An inability to load any given part of the foot is a problem when you’re working with appreciable loads. If you can’t efficiently distribute load through the whole foot, you will inevitably compensate somewhere further up in the kinetic chains. As previously mentioned, suboptimal compensation usually leads to mechanical stress on adjacent structures like the knees, hips, pelvis, and lower spine. The key to a functional capacity for lower body strength training starts with the foot.

Establishing a functional foot tripod is the first step in restoring and maintaining healthy feet. After we learn how to create isometric stability in our feet via our tripod, we can then branch out and start to explore the dynamic stability of our feet on the pronation-supination continuum. But we will save that for another day.

Strategies to Improve Function the Tripod Foot

Try this: Stand hip width apart with your glutes engaged so your pelvis is in neutral alignment, and lift just your toes off the ground. Can you feel the 2 forefoot tripod points? How about if you start to bend at the knees and hips to initiate a squat?

If not, there is a compromise in your ability to load either the inside of the outside of the foot properly. This will lead to inefficient loading in the primary leg and hip muscles.

In order to restore our foot tripod we need to improve mobility within the bones and joints of the foot. If the bones can’t move, it’s typically indicative that they do not have the capacity for load. If either the structural integrity of the joint, or the muscular support required to stabilize the joint during any given movement are not functioning optimally, the nervous system often creates compression in the joint in an attempt to create stability. This is a less than ideal compensation strategy. While it makes the joint more stable, it also decreases joint space, increases mechanical stress in the joint, and creates short-circuiting of the muscles (tight, painful, weak) that act on that joint.

In my experience, the quickest and most effective way to restore mobility in a joint is to specifically assess and correct neurological compensation via specific manual therapy techniques like P-DTR. Manual adjustments performed by a qualified professional can sometimes be helpful and necessary. Problem is that they often don’t stick. The way to make manual adjustments stick is to reinforce and integrate the adjustments or mobilizations with movement.

One of the best self-administered ways of improving joint mobility over time is through gentle joint flossing drills. By progressively subjecting the joints to mobilization techniques that allow the joints and muscles to adapt over time, both the structure and nervous system will process and manage the movements better.

Three key areas to ensure have the requisite bone-on-bone mobility are the calcaneus, cuboid, and navicular. Each of these midfoot bones’ ability to load is paramount for foot tripod function. Here are three drills that I have had tremendous success utilizing with myself and with clients to help restore mobility in the calcaneus, cuboid, and navicular bones of the feet.

Utilizing these drills to “wake up” the foot and get the joints moving more freely is an effective first step in improving our foot tripod. After we mobilize the feet, we then need to integrate the feet with the ankles. Here’s one of many drills I like to work on this:

From here, there are no shortage of other drills you can use to specifically address whatever deficiencies your feet might have. To start, I suggest trying out the above drills, and then training bearfoot more often, especially on your lower body focused training days.

The feet can be understood and broken down so many different ways. Hopefully this perspective is helpful in better understanding the foot tripod. Plenty more information on the feet is in the works.

Biomechanics 101: Making Sense of the Human Machine in Movement

By Josh Landis

If you’ve been reading any of the articles I’ve written and shared over the last several months, you might have noticed that I’ve made it a point of emphasis to illustrate the importance of how many systems in our body, not just our tissues, contribute to neuromuscular function and consequently pain and performance. The term “neuromuscular” refers specifically to how our nervous system (brain, spinal cord, and peripheral nerves and receptors) controls how our muscles contract and relax. Our muscles function based on how our brain tells them to function; muscles are slaves to the orders given to them by the brain. How our muscles function determines how our joints move individually and in larger coordinated patterns to produce movement.

Even though muscle function and movement are ultimately determined by the outputs of the nervous system, understanding the components of the human machine and how things work together biomechanically is still important. The main problem I have found when it comes to understanding biomechanics and functional anatomy is that we have largely left out the “bio” part, and tend to focus too much on the “mechanical.” But I digress…

For the purposes of this post, I’m going to focus on what I consider to be some of the most important tenets and principles of biomechanics and functional anatomy as they relate to training and rehabilitation. There are a handful of principles that are at the forefront of what some the best coaches and therapists out there are utilizing. Three prevalent ideas that have come to really define higher-level assessment and correction strategies when it comes to training and rehabilitation are the “Joint-by-Joint Approach”, fascial slings, and kinetic chains. I’m going to break down each one and attempt to extrapolate the most useful tools that can be derived from each.

The Joint by Joint Approach

What is It?

When I first started out in this industry, I began as a personal trainer trying to get my hands on everything related to corrective exercise and functional training; I wanted to explore the depths to which strength and conditioning could be catered towards rehabilitation. The first foundational principle that really defined my training paradigm early was the “Joint by Joint Approach,” popularized by physical therapist Gray Cook and strength coach Michael Boyle.

The joint by joint approach is based on the idea that when it comes to movement, the body is essentially a series of joints working in sequence to produce movement, and that each of these joints has a specific function, and those functions generally alternate as follows (as broken down by Boyle):

 

  • Ankle–Mobility (sagittal)
  • Knee–Stability
  • Hip–Mobility (multi-planar)
  • Lumbar Spine–Stability
  • Thoracic Spine–Mobility
  • Scapula–Stability
  • Glenohumeral–Mobility

Some joints require more range of motion, some joints require less. Some primarily move in rotation (glenohumeral) while others might be more suited for flexion and extension (knee). If we lack mobility in a joint designed to be mobile, the next joint involved in the movement will often pick up the slack, and we may end up getting too much movement in a joint that is more suited to remain more fixed and stable. This can obviously cause problems. The joint-by-joint approach is a helpful principle for determining how one area of the body can potentially affect another.

How Do We Use It?

When we are utilizing the joint by joint approach in our clinical application and forming treatment and training strategies, we are largely breaking the body down into its components (joints in this case), determining which components are not working, and then provide treatment on those dysfunctional components in the hopes that with all the components working individually, we can improve how they work together synergistically.

An example would be something like this:

  1. Client squats.
  2. Client can’t squat deeply.
  3. We understand the involved joints to be the ankles, knees, and hips primarily.
  4. We assess each joint.
  5. The mobility in the ankles is limited, therefore a key component of the squat is not available.
  6. We mobilize the ankle.
  7. The client can now squat more deeply.

By working with this model, we can often determine where our clients are breaking down in large-scale movements like a squat, provide therapy or corrective strategies to the specific area that needs it, and then recheck our large-scale movement. We are operating on the idea that a chain is only as strong as its weakest link. If we fix the weak link, the whole chain improves.

Fascial Slings

Superficial Back Line.jpg

What are They?

Another incredibly viable and useful anatomical principle is the idea of continuities of connective tissue (fascia) spanning across areas of the body in long slings. This idea has been popularized by one of the predominant great minds in the world of fascia, Tom Myers. His book, Anatomy Trains, has had a huge influence on how movement professionals and therapists understand human movement.

If we take a look at a basic fascial sling, like the “Superficial Back Line,” we can see that instead of looking at the body as an alternating series of mobile and stable joints and how they interact, we are more so looking at longer lines of fascia and how these fascial continuities form groups or longer slings of muscles that work synergistically together. The superficial back line includes (from the bottom up) the plantar fascia, achilles, calf muscles, hamstrings, sacrotuberous ligament, sacrum, spinal erectors, and neck extensors. Even though there are multiple components throughout this “line,” the idea behind these fascial slings is that if there is a problem in one part, the rest of the line will be affected via fascial tension imbalances.

How Do We Use It?

When we are using the fascial slings as a guide, we must appreciate not only the fascia, but also the muscles and joints included along a fascial continuity. Thinking about a long chain of muscles as a singular functional unit can be helpful in the sense of understanding how one part of the chain is directly connected functionally AND anatomically to another part of the chain.

A good example of this, sticking with the “Superficial Back Line” as our functional unit, is plantar fasciitis. If you identify the involved components of the superficial back line, it includes the plantar fascia on the bottom of the foot as well as the gluteal muscles. Many times, we can make a direct connection between the glutes not contributing enough during movements involving the superficial back line (deadlifts, for example), and thus another area along the chain, in this case the plantar fascia, is getting overstimulated. Too much stimulation to any area can lead to mechanical stress over time and potentially pain. For a case like this, getting the glutes to work more efficiently can be the key to alleviating symptoms at the feet and resolving the plantar fasciitis.

Using this line of thinking and appreciation of how longer chains connect seemingly unrelated structures, we can operate with more possibilities for treatment and training strategies.

Kinetic Chains/Subsystems

What are They?

Another way to categorize and compartmentalize the body in order to facilitate our understanding of movement is to use kinetic chains and subsystems. Utilizing kinetic chains has become my preferred method for mapping out dysfunctions in the body over the years. Far and away the most comprehensive and useful system for understanding kinetic chains are the “5 Primary Kinetic Chains” as taught by Joseph Schwartz in his Dynamic Neuromuscular Assessment” course.

While there are many ways to organize the body biomechanically, the 5 primary kinetic chains are broken down in a way that is more specific to how humans are biologically designed to move. Not only is each chain important to consider in and of itself, but understanding how each chain interacts with and supports the others is an important underlying concept. The 5 primary kinetic chains are building blocks for assessing and restoring functional movement.

How Do We Use It?

Looking at kinetic chains is usually more helpful than simply considering how joints interact, or by how muscles are strung together via fascial lines. Understanding kinetic chains allows us to build a functional foundation from the inside out, taking into consideration all pieces of the chain; muscles, ligaments, joints, and fascia included.

5 Kinetic Chains'.png
  1. Intrinsic kinetic chain – Includes the muscles of the inner core and respiration. Breathing and core stability are the foundation of any movement. We must start here. Once our breathing and core are optimized…
  2. Deep Longitudinal kinetic chain – Includes the lower leg muscles, hamstrings, sacrum, and spinal erectors. The purpose of this chain is to allow us to dissipate ground reaction force and absorb shock. It begins to create axial stability to allow for the large more powerful muscles to produce force.
  3. Lateral Kinetic Chain – Includes lower leg muscles, adductors, abductors, and the QLs, and has the primary role of setting a foundation for our spiral kinetic chains to operate on. Stability of the pelvis and ribcage are paramount here.
  4. Posterior Spiral Kinetic Chain – Includes the toe and plantar flexor groups, ITB, glutes, SI joint, TL fascia, contralateral lats, and extensors of the shoulder and arm. The primary purpose is to store and release elastic energy through rotation.
  5. Anterior Spiral Kinetic Chain – Includes dorsiflexors, hamstrings, hip flexors, adductors, abdominals, pecs, and shoulder and elbow flexors. The primary purpose of the anterior spiral kinetic chain is to translate much of the elastic energy stored by the posterior chain. Think punching or throwing after a windup.

Understanding that each of these chains builds on the previous one, that they all have a distinct function, and that these chains play a role in almost every movement, we can utilize them to help guide our training and treatment protocols. If the core isn’t functioning well, that’s where we start. If we identify a lack of ability to absorb shock, we build on that. Then we assess how stable the axial skeleton can stay during stability challenges. Then we start to focus on build strength and power in rotation.

We parse out the pieces of these chains that are not able to participate or respond well to different movements, we treat those areas with any numbers of therapeutic interventions, and then we integrate the pieces back into their respective kinetic chains. Integration occurs are several levels; within each chain individually, between the chains relative to each other, and each corrective intervention should take into account the integration of various body systems.

Wrapping Up

All these models for understanding functional anatomy and biomechanics are helpful, but it’s also important to understand that our experience of movement and sometimes pain is always context specific. Certain principles or models for understanding movement have a lot of carryover. But we also need to make sure our training and therapy is helping us specifically for what we are trying to improve.

Biomechanics can be broken down many different ways. No matter what lens you are viewing the body through, there are a few key principles to appreciate. Firstly, we must understand how interconnected the body is, not just structurally, but also functionally. Dysfunction in one area of the body affects adjacent or other sometimes seemingly distant and unrelated areas of the body. Secondly, we should have some way to deconstruct global complex movements into its requisite parts in order to thoroughly assess the weak links. A chain is only as strong as its weakest link. Third and most important, no matter what model you use to assess and correct movement, remember while that biomechanics, anatomy, and structure are all important, that humans are more than just machines. There is a hierarchy that we must appreciate. Muscles, joints, and tissues are at the mercy of the nervous system. We are deeper and more complex than just a collection of mechanical parts. Yes, we are physical bodies, but with emotions, and thoughts, and feelings, and souls. Never forget to treat the person, not just the parts.

Hopefully this was a relatively helpful breakdown of some popular biomechanical models for understanding movement. These concepts can be applied many different ways. In the coming weeks, I will be taking these broader concepts and applying them to specific musculoskeletal issues. I’m sure some of you are antsy to finally get some specific breakdowns and have me dive into the meat and potatoes of the physical stuff. Let me know if there are any specific things you want me to breakdown!