Postural Health

Core Instability

Foot Health

Katy Bowman (Whole Body Barefoot) and Dr. Emily Splichal (Barefoot Strong). Foot researcher and nutritionist Norman Walker posits that if women consistently wear heels over 2 inches high, their digestive systems can be thrown out of alignment, contributing to constipation and poor digestive function. Pete Egoscue (Egoscue training program) teaches that feet are crucial to the normal function of the lymphatic system. Proper foot strength is crucial for balance, digestion, absorption, elimination, and bowel movements. Daniel Lieberman (grandfather of the barefoot running movement and human evolutionary biologist). Dr. Lynn T. Stahel pointed out in his paper Shoes for Children: A Review that optimal foot development can only occur with a barefoot, uncoddled foot environment from an early age.

25% of the body’s bones are in the feet and there are thousands of nerves in the soles that can affect nearly every organ in the body and part of the body. Studies have shown that reflexology can increase blood flow to the kidneys and the intestines, decrease blood pressure and anxiety, reduce pain in autoimmunity disease patients, control peripheral neuropathy due to diabetes mellitus, kidney stones, and osteoarthritis, and even stabilize blood sugar in type 2 diabetics.

Greenfield instructions for toe crowding and atrophied feet:

• Walk barefoot as much as possible, without socks. Allowing greater proprioceptive nerve endings on the bottoms of your feet
• Walk with your feet pointing straight ahead so you don’t interfere with proper use of muscles and ligaments in the feet, knees, and hips
• Choose shoes that are super flexible or minimalist (Xero, Vibram, Vivo Barefoot, Happy Little Soles, Bobux, Merrell, and Nike Free)
• Play foot games yourself or with kids to encourage motor skills and healthy foot development. You can pick up marbles with your toes or scrunch up a towel. Excellent for plantar fasciitis
• Get a foot massage. Chinese medical practitioners well versed in reflexology can work on feet too
• Roll your feet on a lacrosse or golf ball (TheraFlow)
• Throughout the day, lift and spread your toes, holding the position for 30-60s. This will help to develop stronger toe flexors
• If you live near a beach, run or walk barefoot in the sand

The Role of Feet

26 bones, 33 joints,19 muscles (make up 25% of the body’s total number of muscles), and 107 ligaments in the human foot. The complex machinery of the feet are responsible for gait patterns and ankle stabilization, whole-body balance, nerve conduction, and cardiovascular circulation. Also, 80% of our plantar proprioceptors are sensitive to vibration.

Smaller nerves in the feet play a role in postural stance and upright stability. If you wear socks and shoes, you block these highly sensitive small nerves on the bottom of the foot. Any blocking causes a delay in response time and creates a greater reliance on the larger and slower nerves in the ankle and lower leg. This is especially apparent as it relates to our ability to load impact forces during walking.

The foot can adapt to uneven terrain and also generate up to eight times our body weight in elastic forces. The joint responsible for these elastic forces is the subtalar joint (STJ). The stability of this joint dictates how we transfer forces and load potential energy between heel strike and push off.

Walking

Walking is a series of falls onto a single leg stance in which foot contact is followed by a rapid peak in ground reaction forces. Because our body seeks to conserve as much energy as possible it is actually designed to use these impact forces as energy to take the next step.

These impact forces are perceived as vibrations, which our muscles are programmed to respond to. 80% of our plantar receptors are sensitive to vibration, which allows us to determine if a surface is hard, soft, slippery, etc. We also use vibrations to maintain balance as well as using them as potential energy when we walk.

As the vibrations enter the muscle compartment, the muscles respond by contracting isometrically, which dampen the vibrations from vibrating the bones. Like touching a vibrating tuning fork. If this does not occur, stress fractures become more likely. Weak muscles in the foot area common cause of shin splints and stress fractures.

Shoes and fatigue can delay the dampening response by blocking the receptors on the bottom of the feet. Any small delay will have a negative effect. Shoes with cushions make our feet weaker and lazy. Fatigue will delay reaction time. Warming up barefoot can delay muscle fatigue and decrease injury risk.

After dampening impact forces, your body converts these vibrations into potential energy, which is later used as elastic energy to drive the next step. Fascia is able to slide over the isometrically contracted muscle and move with the joints, stretching it like a rubber band. The elastic energy comes from this release as soon as we lift our heel, recoiling the leg forward. With each step, the ability to load and unload our fascia increases until our connective tissue is able to generate twice as much elastic energy relative to the amount of impact forces that were encountered (catapult effect).

Barefoot training creates anticipatory muscle contractions leading to faster loading responses.

By becoming conscious of how hard your foot strikes the ground or the degree of dorsiflexion upon heel strike, you can vastly alter the magnitude of impact forces entering the body. Feel how the foot strikes from the outside of the heel, rolls to the center of the foot and then off of the digits. Interestingly the less dorsiflexion you have in the ankle upon heel strike, the lower the impact forces you will encounter.

A tip for plantar fasciitis and Achilles tendonitis patients is to dorsiflex the great toe upon heel strike. The dorsiflexion of the great toe increases the stiffness of foot, allowing better transfer of vibrations. This is one of the reasons why impact injury rate is so high in flip-flops or thongs.

Why Shoes?

Shoes have been great for protection from the cold, avoiding wounds, long distance travel, etc. Like all technology, we end up paying a biological tax. Footwear’s origin dates back to 40000 BC. By the 12th and 13th Century footwear was seen as a status statement that was the beginning of footwear shifting away from function and towards fashion. In the 1950’s with the advance in industrial materials such as rubber and synthetic cloth, the first athletic footwear began to hit the market. Paralleled with the increased awareness towards health and fitness we began to see the first aerobics shoe by Reebok and the first running shoe by Nike. By the 1970’s Nike was at the forefront of athletic and running footwear. Just like today, in the 1970’s runners were experiencing a high rate of overuse impact-related injuries. As a result of this high injury rate Nike designed what we now associate with traditional athletic shoes – extra cushion and a heel toe drop.

Conventional footwear has a small toe box, elevated heel, and is stiff and thick soled. Shoes can push toes together, weakening foot musculature, and affect nerve health. Elevated heels make full joint range of motion impossible, limiting hip and knee capacity. Creating adaptation to the deficit.

With the average heel toe drop being 12 – 14mm or ½ inch, the concept behind this feature was to take tension off of the Achilles tendon. Although a heel toe drop takes tension off of the Achilles tendon it ultimately impairs to foot’s ability to load impact forces. When our foot is placed in a heel toe drop, the ankle plantarflexes and the subtalar joint (STJ) inverts. In a neutral or inverted foot this STJ inversion locks the foot, impairing its ability to evert and load impact forces. In an everted foot this heel toe drop could actually be seen as beneficial as it puts the foot in a more stable position. In order to bring your head upright, while wearing heels, you have to move your body backward relative to your standing surface. The shin stays forward, with a backward motion from the knees and ribcage, creating an angle at the legs and spine. The higher the heel, the shorter the foot, and the taller the body, the more forward a body is projected. Meaning kid’s shoes magnify the detrimental effects as their heel is the same size of an adult’s shoe. Men’s heels are usually lower, feet are longer, but they are generally taller. Distorting their bodies more than a women’s.

Heeled shoes provide slack to the posterior muscle line that runs from the pelvis to the heel of the foot. Sitting and wearing heeled shoes causes the calf muscle running from the thigh to the Achilles to adapt by shortening. Taking pressure off the posterior leg muscles and the lower back when standing. Creating gradual atrophy. Each degree of motion lost creates muscle atrophy, which then affects the next part of the chain. Other joints compensate to make up for the deficit in another. Each step we take tends to be on an unnaturally flat surface, with a constantly elevated heel. Each step further engraining that expectation of environment.

If you’ve got achy, grippy toes, consider ditching clogs, mules, or flip-flops for shoes with a more attached upper part. If you’ve never worn positive-heeled shoes but still have weak feet, or ankles that pronate, you should benefit from strengthening and habitual positioning exercises.

Shoes suck, biomechanically speaking, due to a too-tight shoe box that prevents toe spreadage, the upper not connecting to the foot (flip-flops), or the sole being stiff and unyielding. Forcing the work of walking to come form the ankle rather than distributed across the foot.

Since we can’t naturally walk barefoot anymore, we kind of need shoes to buffer the repetitive strain of unnatural hard and flat surfaces. The hip weakness, from repetitive flatness, as well as lack of walking in general, has resulted in our entire legs being off their axes. Which means foot bones, soles of the feet, ankles, knees, and hips are orientated in a position that makes for wonky loads with each step. Shoes end up taking the role of shock absorption and there is less ground reactive force being applied to the feet. Resulting in less foot proprioception and loss of innervation up the kinetic chain. Creating dysfunctional movement patterns. The activation of skeletal foot muscles helps to absorb force, reducing stress on the tendons, ligaments, joints, and connective tissue.

Orthotics reinforce faulty foot mechanics by acting as a substitute for your muscles.

Blisters, corns, ingrown toe nails, bunions, general skin irritation of the feet, and many calluses can be traced to footwear and improper mechanics.

Flip-Flops

They allow greater sensory input in the form of air pressure and temperature, they are flat, and flexible. Unfortunately, they don’t connect to our feet. The toe-gripping action leads to shorter toe muscles, which can affect balance and foot arch strength, and lead to toe contractures (hammertoes).

Trying to grip while walking will affect how the toes bend and which parts of the foot connect with the ground. Curling some toe bones up and some down, creating higher than normal tension. Greek sandals are marginally better.

Minimalist Shoes

The barefoot shoe trend caused a host of injuries due to a lack of physical preparedness and improper use. The feet, ankles, and toes need to be trained first. Injury while wearing minimalist shoes is a good sign you have foot dysfunction of some sort.

Once the athlete is prepared, using minimalist footwear can build strength, create proper firing patterns, and optimal foot mechanics. Athletes should spend at least 50% of their training, practice, and skill work in barefoot or minimalist shoes. It may take weeks to months to progress.

Minimal shoes have:

• a sole that is thin and flexible enough for the tissues in the foot (and not just the ankle) to feel the ground below the foot and respond by articulating, innervating, contracting, releasing, etc.
• a heel that is neutral, or “zero-drop,” allowing all joints to work from a neutral baseline and enabling the full range of motion for all joints in the body
• an upper that fully connects the foot to the shoe, so there’s no need to grip the toes or the front of the shin to keep the shoe on while walking
• a spacious toe-box that allows enough room for the toes to extend and spread as necessary while walking, hiking, or climbing.

Ankle Schmear

Sitting and wearing shoes can lead to tight hamstrings and calves, or bunions and hammertoes, not to mention the more serious effect of our bodies collapsing at the hips and taking the ankle with them (ankle schmear). The difference between ankle pronation and the schmear is: pronation is a tri-planar motion that moves the shin inward, and the schmear is the effect of this tri-planar distortion on the lower leg as a whole.

The ankle joint is made up of the talocrural and subtalar joint. The talocrural joint is made up of articulations between the tibia, fibula, and talus. The subtalar joint is made up of an anterior, middle, and posterior facet, and is what allows for the tri-planar motion. The talocrural allows dorsiflexion and plantarflexion at the malleoli, but the subtalar acts more like a gyroscope, allowing the body to walk upright even when walking over varied terrain. Meaning, when that terrain is always flat and there is no room for variation, the subtalar potential is reduced.

Sole + traction + external rotation can change the foot skin, the loads to the foot bones, and the axis of the ankle joints.

Ankle and Foot Pronation (Schmear):

Inward collapse of the foot (valgus foot collapse) or ankle pronation/eversion is common. Often accompanied by prominent medial malleoli, over-pronation, flat feet, fallen arches, overlapping toes, genu valgum (knock-knee), prominent scaphoid/navicular bone, bunions, and hallux valgus. Duck foot or pigeon toe mechanics are associated with these issues.

A neutral position is ideal. Reducing ACL tears, low back injuries, knee pain, osteoarthritis of the lower body joints, sever ankle injuries, pulls, tears, strains, sprains, and fractures. If there is trouble driving knees out during squats, or if the feet significantly flare, pronated feet and/or ankles may be the problem.

Ankle and Foot Supination:

Often seen in bow-legged people. Greater stress on the outer portion of the foot. Inflammation of the outer ankles, shins, and hips including the IT band, can be problems. Strengthen ankles by forcing them to assume proper alignment.

Experience Joint Coupling

Moving between inversion and eversion, there are knee, hip, and pelvis rotational movements too. These rotations that travel from the foot, up into the leg are referred to as joint coupling.

STJ eversion is coupled with internal rotation of the knee and hip and equals loading energy.

STJ inversion is coupled with external rotation of the knee and hip and equals unloading energy.

When we are not moving, our foot should be in a neutral position. Any deviation from neutral demonstrates different foot types.

The Neutral Foot

If your Achilles insertion is straight, or you do not notice any concavity on the inside or outside of the heel, your STJ position would be considered neutral.

To maintain optimal foot function the neutral foot would want to incorporate daily foot recovery and foot strengthening exercises.

The Inverted Foot

If the Achilles insertion is curved towards the inside of the foot, or there is concavity on the inside of the heel, then your position is inverted.

Functionally more rigid and more at risk of impact-related injury including stress fractures or Achilles tendonitis.

Daily foot mobility is key for optimal function.

The Everted Foot

If the Achilles insertion is curved towards the outside of the foot, or there is concavity on the outside of the heel.

Unlocked foot that is generally unstable, and has a hard time acting as a rigid lever or releasing potential energy. The ability to unlock and lock is necessary for peak performance.

Greater risk of diffuse foot pain, knee pain, and low back pain. Daily foot strengthening is key for optimal foot function.

Co-Activation Patterns

The firing of one muscle leads to a simultaneous firing of another muscle. From a functional perspective, co-activation patterns lead to faster stability allowing more efficient movements and improved performance.

Activation of the pelvic floor leads to co-activation of the transverse abdominus, which leads to co-activation of the multifidi, internal obliques and so on.

The co-activation between the feet and core is called the foot-to-core activation cascade.

Deep Hip Stability

Within milliseconds of foot contact, our hip must prepare for the single-leg stability needed during midstance (transitioning point during walking). Any delay in hip stability will result in improper knee and foot alignment which presents as IT band syndrome, patellofemoral pain syndrome or ankle sprains.

There are a group of muscles called the deep lateral rotators that surround the hip joint. Acting like the rotator cuff of the shoulder, these deep muscles suction the femoral head into the hip joint providing the first layer of deep hip stability. This activation leads to co-activation of the pelvic floor, the diaphragm, psoas major, and so forth, until our glutes are activated and we have optimal hip and core stability.

The foot actually drives this deep hip co-activation cascade.

Foot to Core Activation Cascade

Step 1. Foot Activation (Short Foot): Increases deep hip and pelvic floor activity. Specifically targets the abductor hallucis. Abducts the hallux/big toe. Also associated with neuromuscular co-activation of the deep lateral rotators and pelvic floor.

• Activating Short Foot: Stand barefoot and focus attention on one foot at a time. Find your foot tripod that is under your 1st metatarsal head, 5th metatarsal head, and heel. Lift your toes, spread them out, and place them back down onto the ground. To activate short foot, push the tip of your big toe down into the ground. You should feel the muscles of the arch engage. Hold for 10s before releasing.
• Achieving Short Foot with Flat Feet: First, de-rotate the lower leg before activating short foot. Externally rotating the lower leg will bring the heel bone into a more neutral position.
• Achieving Short Foot with a Bunion: In a bunion deformity, the abductor hallucis has been pulled from the side of the great toe to under the foot, shifting the pull of this muscle. Use kinesiology tape or athletic tape to pull the toe into a proper position.

Step 2. Deep Hip Activation: Starting on one foot, with a slight bend in the knee. Because short foot creates a locking mechanism to the foot and leg, you always want to start with a slight bend in the knee. This avoids torque to the meniscus. Hold short foot for 10s, but this time focus on the deep hip and pelvic floor. To increase the intensity, actively engage your pelvic floor and transverse abdominus.

Step 3. Glute Engagement: Back in the single-leg stance with a slight bend, test out single leg squats (don’t need to be deep) to experience slight knee flexion and extension. Hold your next rep on the bottom phase of the squat. This is where you should activate short foot to establish deep hip and core lock in and deep hip stability. Keep holding as you press out. Deep hip stabilizers are required for optimal strength from our glutes (mobilizers).

Fascia and Foot Function

Fascial connective tissue envelops our muscles, tendons, and bones, controlling and integrating every move we make. Our fascia is organized in fascial lines. We have a posterior fascial line that runs from the bottom of the foot, up the calves, through the hamstrings, all the way up to the top of the skull. We also have a lateral fascial line that runs from the bottom of the foot, along the side of our lower leg, up the ITB, all the way up through the skull. These lines create an integrated network through which tension is generated, stability is achieved and forces are transferred.

Starting from the bottom of the foot, the deep front line runs up the lower leg, up the inner thigh, and to the pelvic floor. When we engage short foot we are technically activating this deep fascia line and re-enforcing foot to core stability.

Correcting Posture

3-point foot contact:

1. Near the proximal phalange also known as proximal phalanx, hallux or more commonly the big toe.
2. The lateral upper portion of the foot or outer ball of the foot in line with the 5th metatarsal, baby toe area.
3. Heel or calcaneus

Stance Habits To Change

• Align your feet
• Feet pelvis-width apart
• Back your hips up
• Neutral femurs

Stretching Intrinsic Tissues of the Foot

• Passive toe spreading, using fingers between toes, toe spacers
• Standing foot massage
• Top of the foot stretch (one minute, but stop for cramping)

Stretching Extrinsic Tissues of the Foot

• Calf stretch – gastrocnemius (one minute each leg x 3)
• Calf stretch – soleus (one minute x as many times as you do the gastrocnemius stretch)
• Double calf stretch (one minute and repeat throughout the day)
• Strap stretch
• Catsuit stretch

Strengthening the Intrinsic Muscles of the Foot

• Toe abduction
• Toe lifts

Strengthen the Extrinsic Muscles of the Foot

• Single-leg balance (one minute x 3 each)
• Single-leg towel balance (one minute each)
• Pelvic list (one minute each)
• Next-level list (work up to six minutes total, alternating after every minute)
• Next-next-level list (work up to six minutes total, alternating after every minute)

Strengthening Your Walk

• Stone walking
• Walk on the pillow train
• Walking on varied terrain
• Calf elevators (twenty times, multiple times a day)

***See Whole Body Barefoot for Exercises***

Surfaces

All surfaces provide a certain frequency of vibrations when contacted by the foot. With the optimal frequency around 15-20 Hz, our neuromuscular system is designed to create a reflexive response to this input.

The repetitive movements of a step class or Zumba require a forgiving surface that will match the vibrations caused by thousands of foot to floor contacts in a 60-minute class. Similarly, the high velocity tumbling pass of a gymnast requires a surface that will match impact forces exceeding 10x body weight in less than 150 milliseconds.

Anticipation of Impact Forces

Research by Nigg et al. has shown that as we walk, by the 3rd or 4th step our nervous system has already pre-programmed a response to match the degree of impact forces.

This concept of anticipation is referred to pre-activation neuromuscular responses and is a key component to movement efficiency, and ultimately, movement longevity.

Eventually, what happens is the muscles begin to initiate a response to movement before the joint has moved. This anticipation contraction is in our deep stabilizers that were covered earlier. With walking, this pre-activation response is simply our foot and ankle muscles stiffening and contracting isometrically before foot strike. Pre-activation responses are the only way in which the foot can load impact forces fast enough – especially when they are entering the body between 50 and 150 milliseconds.

A mismatch between anticipated vibration frequency and loading response leads to injury.

Unnatural Surfaces Impair Efficient Movement

Most of the surfaces we encounter on a daily basis, including concrete, tile or marble, do not transmit vibrations well. Impact on these surfaces is still present but instead of vibrations being transmitted through the surface and through the body – all vibrations are transmitted proximally through the body. This increase in forces through the body alters the vibration frequency and therefore impairs the accuracy of the loading response.

These excess vibrations are carried over from the soft tissue into our bones and tendons – presenting as stress fractures or Achilles tendonitis.

Collagen in Skin, Fascia and Tendons

Collagen, the main element found in connective tissue, provides the structural foundation to skin, fascia and tendons. The soundness of these collagen units is determined by the stability of hydrogen bridges and covalent bonds referred to as crosslinks.

Even though crosslinks provide strength and stability, excessive or what are called non-specific crosslinks create stiffness and a lack of elastic recoil in the connective tissue. It is these non-specific crosslinks that we call fascial adhesions. These non-specific crosslinks are formed through a process known as glycation, which occurs in the presence of excessive glucose. The interaction of AGEs with tissue (fascia or nerves) is called glycation.

Glycation & AGEs

The stiffer the connective tissue (collagen), the increased risk of micro-tearing during dynamic movement. Even though micro-tearing is beneficial to building muscle mass and strength, micro-tears in our connective tissue is not so advantageous. Studies have shown that micro-tears in connective tissue are repaired with Collagen Type III vs. the normal Collagen Type I. Collagen Type III is characterized as less elastic and stiffer when compared to Collagen Type I. This creates a repetitive micro-trauma cycle and eventual tissue degradation we know as tendinosis.

Phase 1. Foot-Specific Programming

1. Foot Flexibility:

• Plantar foot release: Start by releasing the bottom of the foot with a golf ball, tennis ball or stick. The key to the plantar foot release is to not roll on the ball. Stand in various areas on the bottom, shifting to a new area every minute.
• Release the bottom of the foot for 5 minutes every morning, evening and before working out.
• For at least 5 minutes release the back of the calf (soleus), the front of the shin (tibialis anterior) and the side of the lower leg (peroneals).

Step 2. Foot Strength:

• Engage short foot 10 seconds x 5 repetitions per foot every morning or before working out.
• Another great exercise for barefoot strength is called toe-spread out. A study actually compared this exercise to short foot and found high abductor hallucis activation in toe spread out! Perform 10 repetitions per foot x 3 sets.
• Balance on one leg 30 seconds per side x 3 sets every morning.

Phase 2. Foot to Core Sequencing

Step 1. Hip Flexibility:

• Release the anterior hip and glutes 5 min per side at least 3 times a week and before working out.

Step 2. Hip and Core Activation:

• Pelvic Floor Activation: Start by lying on your back with your knees bent and your feet flat on the ground. Find a neutral spine and pelvis position. From here you want to imagine that your pelvic floor is like the face of a clock with 12 o’clock at your pubic symphysis, 6 o’clock at your tailbone, 3 o’clock at your right hip and 9 o’clock at your left hip. Using your pelvic floor muscles imagine drawing 12 o’clock to 6 o’clock and 3 o’clock to 9 o’clock. After drawing in the 4 corners of the clock you want to then imagine purse stringing or lifting the pelvic floor up. The sensation when doing this properly is similar to how it feels when you stop the flow of urine. Hold each repetition for 10 seconds x 5 sets. Do 3 times a week and before working out.
• Hip External Rotator Activation: You want to begin by lying on your side with your hips stacked. Bring your bottom leg forward, flex the knee to a 90 degree angle. Shift your top leg back and also bend the knee to 90 degrees. You may want to prop it up on a yoga block or mat to keep the hip stacked. Focusing on just the front, bottom leg you want to externally rotate the hip by lifting the foot up. Keep the knee on the ground while externally rotating the hip. Lift and hold for 10 secs before releasing x 5 reps per side. Do 3 x a week and before working out.

Step 3. Barefoot Balance Training:

• Perform 5 – 10 minutes of barefoot balance training 3x a week or before working out.

Phase 3. Total Body Integration

Step 1. Shoulder Flexibility:

• Myofascially Release the Pecs: Release for 30 secs and repeat on the other side. Do at least 3x a week or before working out. Use a lacrosse ball.

Step 2. Shoulder Activation:

• After shoulder mobilization we want to activate the shoulder stabilizers. For this we want to be in a pushup plank position. Keeping the elbows rotated forward and the shoulder blades down the back, hold for 10 seconds. Next move the hands into a diamond pushup position. Assume the same elbow rotation and shoulder stabilization before lifting into the pushup plank. Again hold 10 seconds and release. The final shoulder exercise would be shifting the hands wider than shoulder width. Assume the same position and hold 10 seconds. Shoulder activation should be done 3x a week or before working out.

Step 3. Barefoot Body Tension:

• Body tension follows fascial lines and the concept of tensegrity. The more tension created by the body the faster you can stabilize joints, generate force and improve performance. Start by standing on one leg with the knee slightly bent and proper upper body alignment. With the weights out to the side at 90 degrees you are going to push the weights into a military press at the same time as engaging short foot and the core. Relax the foot as you return the weights to the start position and repeat 8 times per leg. Additional total body exercises can be performed this way including rear deltoid rows, kettle bell swings, lateral shoulder raise. The trick is the integration between foot, core and scapular stabilization.

Performance Training

Squatting with weak ankles and feet contributes to faulty hip and knee mechanics, which indirectly affects the position of the spine. Associated with low back pain, neck impingement, shoulder injuries, and inhibition/weakness of the upper extremities.

Intramuscular, intermuscular coordination, and motor unit recruitment are compromised (“pseudo-arthrokinematic manipulation”) without foot and ankle support. Displayed as externally rotated feet, valgus ankle collapse, and toe crowding.

Performing heavy lifts without proper foot and ankle mechanics reinforces movement dysfunction.

Using excessively wide stance, along with exaggerated external rotation of the feet during squats and deadlifts, can contribute to dysfunction and cause damage to the hips and lower back. Assume a comfortable and minimal (10 degree toe flare) rotation.

With proper foot and ankle activation, greater spine stabilization and full body muscular activation is possible. The older you get, the harder it is to fix bad motor patterns and damage.

Stretching vs. Activation

There is greater value in addressing weakness in the anterior tibialis, posterior tibialis, peroneus longus, peroneus brevis, and extensor digitorum longus and brevis than by stretching the gastrocnemius and soleus. This can be done by various stabilization training, balance exercises, and arthrokinematic/osteokinematic manioulation (joint repositioning).

Establishing proper foot and ankle mechanics can greatly reduce the risk of Achilles injuries.

Shin splints are related to the weakness and dysfunction in the aforementioned muscles.

Bodybuilding

Do eccentric isometrics (slow eccentric followed by 2-7s holds at the bottom position) to alleviate some minor ankle deficiencies. Bodybuilders should find greater lower body development with greater foot and ankle neural activation.

Quads, glutes, hamstrings, and calves benefit. Learning to push through the outsides of the ankles, to avoid pronation, will help to build the outer quad swap.

Foot Mechanics During Upper Body Exercises

Straight foot position, knees pushed out slightly, weight more on the outside of the ankles, big toes pushed into the ground, and big toes spread out. Creates greater force production and neural drive to the upper musculature.

Flat Foot Syndrome and Misdiagnosis

Not a permanent genetic disorder. Ankles push-outs, single-leg stand variations, single leg swaps, contralateral single leg loaded exercises, and dysfunctional offsetting single leg drills are useful.

Foot and Ankle Mechanics in Relation to Squat Depth

With greater activation, the lifter will hit a more parallel position rather than an exaggerated depth with forced external rotation of the feet.

Long Distance Running

Long-term pavement punishment with faulty foot mechanics tends to contribute to pain, inflammation, injury, spasticity, and various forms of dysfunction. When switching to barefoot or minimal footwear, give underutilized muscle time to develop. Foot exercises before switching shoes, and continue them while doing whole-body training in less supportive shoes. Master shoeless walking before running. Run short distances first, on dirt or grass. Seek out experts on running form.

FOOT, TOE, & ANKLE | 6 HOLISTIC EXERCISES

EXERCISE 1: STANDING FOOT MECHANICS WITH PERFECT POSTURE

Straight feet, no rotation, ankles pushed out or slightly supinated (unless already naturally supinated), more weight on the outside of the feet by pressing into the big toe, which prevents excess supination and engages toe muscles. Then focus on spreading the toes out as wide as they can while doing this exercise. Try to hold for 20-30s.

https://www.youtube.com/watch?v=oXjBmHYERlk

EXERCISE 2: STANDING ANKLE PUSH-OUTS

If you’re a pronator or have flat feet, this drill is useful. While standing, place load on the outside of the feet to drive ankles out forcefully. Keep the base of the big toe in contact with the ground. The outer hips and legs should feel tension.

Takes around 4-6 weeks to make this position natural during squats and deadlifts.

EXERCISE 3: TOE CURLS (DOUBLE OR SINGLE LEG)

While keeping weight on the outer portion of the ankles and heels, curl the toes up as high as possible, while keeping them spread, then reverse the position and curl them down. Holding each position for 2-3s and performed for 45-60s.

EXERCISE 4: UNSUPPORTED HEEL AND TOE RAISE

Great for activating muscles around the tibia while stretching areas prone to tightness around the calves. Focus on squeezing the tibialis anterior whilst doing a toe raise, then a heel raise whilst squeezing the calves. Ideally, this is performed with eyes closed for maximal stimulation and innervation. 10-12 reps of each. Single leg to increase intensity.

EXERCISE 5: ECCENTRIC ISOMETRIC CALVE RAISE

If you’re prone to tight Achilles or calves, or have trouble driving through the heels, spend plenty of time on eccentric isometric calve raises. Perform single leg variations for any imbalances.

EXERCISE 6: SHIN/TOE RAISES WITH RESISTANCE

Many individuals with flat feet, ankle pronation, tight calves, and externally rotated feet have weak shin muscles. Several sets of 10-12 reps with a several second pause at the stretched and contracted position is ideal.

UNIFORM STABILIZATION | 8 CORRECTIONAL EXERCISES

Each exercise can be performed on hard floor, semi-soft surface (exercise mat, carpet), and unstable surface (foam pad, Bosu Ball). Also, with eyes closed, there is greater proprioceptor and stabilizer challenge. Try to perform 2-3 times per day and progress slowly.

EXERCISE 1: TOE TOUCH INLINE STRIDE HOLD

Great for weak feet and ankles. Stand with one foot staggered directly in front of the other with the front heel and back toe touching each other, keeping both feet straight. Hold for 30s and swap. Excellent for reaching proper hip alignment.

EXERCISE 2: SINGLE LEG STAND

With tall posture, lift one leg 10-12 inches in front of the other. Keep both toes straight while maintaining balance for 30-60s. Close eyes for a greater challenge.

https://www.youtube.com/watch?v=zS2rvw6l72k

EXERCISE 3: OVERHEAD SINGLE LEG STAND

Hold a bar or dowel in the overhead snatch position while doing the previous exercise for 30s.

EXERCISE 4: SINGLE LEG OVERHEAD PRESS

EXERCISE 5: SINGLE LEG RDL AND ROW

2-3 rows per RDL for 3-5 RDLs each side.

EXERCISE 6: EYES CLOSED LUNGE

Slow negatives and a pause can make it more challenging. Perfect the dumbbell and barbell versions before moving on to overhead lunges on a soft surface. Holding the bottom position for 3-7s.

EXERCISE 7: SINGLE LEG POWER HOLD

Hold a heavy barbell load on the back and do a single leg stand with perfect alignment for 10-20s. Can also be done with dumbbells or kettlebells.

EXERCISE 8: SINGLE LEG BALL SUPPORTED ISOMETRIC GLUTE BRIDGE

Single leg bridge while lying on a ball.

DYSFUNCTIONAL OFFSETTING SINGLE LEG DRILLS (FEEDING DYSFUNCTION) | | 4 CORRECTIONAL EXERCISES

Specific foot issue exercises for pronation, flat feet, and supination.

EXERCISE 1: SINGLE LEG ANGLED HILL STAND

Stand on one leg laterally on a hill and hold your position. For pronated ankles and flat feet, the medial/portion of the planted foot should be on the decline.

https://www.youtube.com/watch?v=UT6mHflKIKM

Opposite side for the supinated.

EXERCISE 2: SINGLE ARM LOADED SINGLE LEG STAND

Hold a weight in the opposing arm to the planted leg. Good for anti-pronation. Same side for anti-supination.

EXERCISE 3: SINGLE LEG LEDGE STAND

Quite advanced. For pronated people, have the medial half portion of their foot hanging over the ledge for 20-30s while maintaining proper posture.

EXERCISE 4: SINGLE LEG PALLOF PRESS

Advanced all-in-one exercise for flat feet, ankle pronation, valgus ankle collapse, weakness, etc. Also works on core stabilization, anti-rotation, rotary stability, balance, scapular stabilization, spinal alignment, and postural control.

To perform, hold a standard Pallof press position and lift the inside leg.

https://www.youtube.com/watch?v=8ePuG_vHN5I

REACTIVE STABILIZATION | 5 CORRECTIONAL EXERCISES

Stabilization is good for performance and joint integrity. These exercises provide unpredictable oscillations to force the joints to deal with irregular stimuli.

EXERCISE 1: SINGLE LEG STAND WITH PARTNER PERTURBATION

While standing on one foot, have a partner gently push from varying directions, angles, and positions.

EXERCISE 2: EYES CLOSED ECCENTRIC ISOMETRIC SQUAT ON BOSU BALL

Proper squat technique is paramount. Hold a 3-5s squat at the bottom. Overhead squat is incredibly challenging.

EXERCISE 3: LUNGE WITH PARTNER PERTURBATION

EXERCISE 4: HANGING BAND LUNGES

Cleans up gait mechanics, hip alignment, and flawed movement mechanics.

https://www.youtube.com/watch?v=RFKf9THte0U

EXERCISE 5: SINGLE LEG POWER HOLD WITH HANGING BAND TECHNIQUE

Similar to the power hold but with weights hanging from bands on the bar.

RATE OF STABILIZATION DEVELOPMENT | 4 CORRECTIONAL EXERCISES

Previous exercises are good for recruiting high numbers of muscle fibers in the feet. The following do the same but with quick firing.

EXERCISE 1: MARCHING 3-STEP STOP AND HOLD

EXERCISE 2: SINGLE LEG HOP AND STABILIZE

With eyes closed, the body refuses to stabilize until it’s perfectly aligned. Hold each rep landing for 10s.

EXERCISE 3: SINGLE LEG MED BALL CHEST PASS

8-10 reps per leg. Easier with a partner.

EXERCISE 4: SINGLE LEG BOX JUMP-OVERS WITH STABILIZATION

Forces all the foot and ankle muscles to work in synchrony. Dangerous if you have bad stabilization and strength.

SINGLE LEG SWAPS | 10 CORRECTIONAL EXERCISE VARIATIONS

EXERCISE 1: THE BASIC SINGLE LEG SWAP (WITH KB OR PLATE)

Hold a KB or plate in one arm while on one leg, swap over hands 8-12 times after a 3-5s hold.

EXERCISE 2: RAPID SINGLE LEG SWAP

Do the previous quicker.

EXERCISE 3: TOE-TOUCH STRIDE HOLD KETTLEBELL SWAP

Good for those who struggle with the previous ones. Swapping while one foot is behind the other.

https://www.youtube.com/watch?v=Y7h-_CrcNvk

EXERCISE 4: ECCENTRIC ISOMETRIC LUNGE WITH KETTLEBELL SWAP

Pass the KB under the leg from side to side.

EXERCISE 5: SINGLE LEG SWAP WITH HANGING BAND TECHNIQUE (HBT)

https://www.youtube.com/watch?v=oP7Q4h194ac

EXERCISE 6: SINGLE LEG RDL SWAP

EXERCISE 7: LANDMINE SWAP

https://www.youtube.com/watch?v=3l7sEdH0peA

EXERCISE 8: BUMPER PLATE SWAP

Good for concurrent activation potentiation (CAP), where activation of the smallest muscles in the extremities increase neural drive throughout the entire body.

https://www.youtube.com/watch?v=ApEEaPJdS08

EXERCISE 9: OVERHEAD SWAP

https://www.youtube.com/watch?v=iPXJ_3L-VVM

EXERCISE 10: BULGARIAN SQUAT WITH KETTLEBELL SWAP

Pass between the legs. Painful.

10 ADDITIONAL BENEFITS OF THE SINGLE LEG SWAP

BENEFIT 1: WORKS FOR ALL TYPES OF FOOT, ANKLE, & HIP DEFICIENCIES

BENEFIT 2: IMPROVES ALIGNMENT FROM HEAD TO TOE

BENEFIT 3: ENHANCES FULL BODY STABILIZATION

BENEFIT 4: ELIMINATES ENERGY LEAKS

BENEFIT 5: ANT-ROTATION, ANTI-LATERAL FLEXION, & CORE STABILIZATION

BENEFIT 6: IMPROVED POSTURE AND SPINAL ALIGNMENT

BENEFIT 7: TEACHES MENTAL CONCENTRATION

BENEFIT 8: ENHANCED BODY AWARENESS AND PROPRIOCEPTION

BENEFIT 9: EASY TO COACH

BENEFIT 10: HIGHLY VERSATILE

20 ADDITIONAL BENEFITS & KEY NOTES

• Resolved foot and ankle issues.
• Addresses weakness and physical deformities in neuromuscular system and forces you to deal with them instead of using normal shoes as a crutch.
• Don’t restrict toe movement with tight socks.
• Avoid Olympic shoes unless you’re a high level competitive Olympic weightlifter.
• Lactic acid accumulation in the feet and ankles is likely. As well as cramping. Signs you are using underdeveloped areas.
• Can be performed anywhere.
• High-quality barefoot shoes: Skora, Topo, Merrell, New Balance, Vivo Barefoot, Pedestal Footwear, Vibram, Inov8, and Nike Free 1.0.
• Bosu Balls are useful for full body stimuli.
• Most individuals have one foot or ankle with greater issues. Note which side and fix the imbalance.
• Wear toe spacers occasionally if your toes overlap.
• Walk around the house barefoot as much as possible.
• Even if you haven’t displayed any direct issues you probably have dysfunction.
• Foot and ankle mechanics are a good gauge on muscle function and health.
• If feet and ankles aren’t working properly you undoubtedly have other issues too.
• Single legs require being almost perfectly in front of the other, pointed straight, no toe flare.
• He believes half the injuries we see in athletes are due to foot and ankle dysfunction.
• Feet and ankles require progression and a variety of stimuli like other muscles.
• Sports related ACL injuries can usually be traced to pronation, flat feet, and valgus ankle collapse.
• Lower limb exercises should be used to practice foot and ankle activation. Also, in between sets you can do single leg stands, swaps, shin raises, RDLs, etc.

FOOT AND ANKLE EXERCISE PROGRAM

FIRST STEPS FIRST: SELF-ASSESSMENT

Supinate or pronate? Stand in front of a mirror and examine the ankle. If feet and ankles cave in you pronate. Bodyweight squats amplify the issue if you’re having trouble.

PROGRAMMING OVERVIEW

• 6 intense workouts
• 3 Light workouts
• 1 General workout
• 1 Daily workout
• 1 Pronation workout
• 1 Supination workout

PROGRAMMING FOR BEGINNER TRAINEES

• Intense vs. Light workouts: For beginners, one should alternate between one intense and one light.
• Pronation vs. Supination: Every 4-5 days, one should do either pronation or supination depending on your assessment results.
• General workout: If you’re going to perform one strengthening routine for feet and ankles and don’t feel you need an in depth program this workout is ideal. Once every 3-5 days with intense and light routines. If there was a weakness exposed in the assessment, only do this exercise every 10-14 days.
• Daily workout: 1-3 times per day and good as a warm up.

PROGRAMMING FOR INTERMEDIATE & ADVANCED TRAINEES

• Intense versus Light Workouts: For intermediate to advanced trainees, one should alternate between two intense and one light workout.
• Pronation versus Supination Workouts: In addition, every 4-5 days, one should also perform either the pronation or supination workout depending on the results of your assessment.
• General Workout: If you’re only going to perform one strengthening routine for your feet and ankles and don’t feel the personal need perform an in depth program this workout is ideal. In addition this specific routine will work for all individuals regardless of the manner of foot and ankle deficiency. However it’s designed more so for those who don’t display significant levels of pronation or supination but desire general improvements in foot and ankle mechanics. Thus, if after the assessment above, neither pronation nor supination is prevalent this general workout can be performed once every 3-5 days in tandem with the intense and light workout routine described above. However, if the assessment exposes a specific weakness (i.e. pronation, eversion, supination etc.) then this workout would be performed once every 10-14 days.
• Daily Workout: This program can be performed by all individuals 1 to 3 times per day and is an excellent choice either as a warm-up or as a break from extended periods of sitting.

***See Advanced Human Performance book for programs described***

Tooth and Jaw Health

The front four teeth emerge from the neural crest when we are embryos and the back molars are directly connected to the brain. Even micro misalignments in the jaw can cause the trigeminal nerve to send a threat message to your ANS.

Excess stress causes the body to store more visceral fat, which is associated with insulin resistance and inhibits adiponectin, a hormone that regulates your levels of body fat. Too little adiponectin causes excess fat and levels decrease with visceral fat. Excess visceral fat leads to stiff arteries and inflammatory cytokines.

Relaxing your jaw can result in decreased musculoskeletal pain. Made possible with a bite guard.

P Is For Pain

The trigeminal nerve is highly sensitive and even the slightest dysfunction that puts pressure on the nerve leads to increased levels of substance P, which sends pain signals to the brain. Substance P is a primordial pain-signaling molecule, and a rise in substance P always causes inflammation. When you bite down and your top teeth on one side touch down first, this stimulates the release of substance P, which tells the brain it is under threat and triggers the release of inflammatory cytokines.

People with asthma, eczema, and psoriasis are often hypersensitive to substance P, meaning their bodies produce excess inflammatory cytokines. Also found in the colons of people with IBD and studies have shown that cancerous tumors overexpress substance P.

Substance P opens up cell membranes, making them less efficient and more vulnerable to toxins that can enter the cell and cause direct damage. Also, substance P plays a role in activating stem cells, so if levels are out of wack, you can’t replace cells that die, and tissues throughout the body will waste away.

Align Your Jaw With Your Life

Along with sleep apnea, the trigeminal nerve is involved with the brain’s reticular activating system, the part of the brain stem that keeps you awake. When you bite down, all your teeth should touch down at once for proper bite alignment.

Dr. Jennings believes that even inner ear infections in children can be explained by orthopedic jaw defects.

When you have an overbite you subconsciously have to slide your lower jaw forward to bite things off, to control your airflow, and to speak. As a result, you create hypermobility in this joint, which impacts the trigeminal system and leads to elevated levels of substance P. TMJ is also correlated with pain in other joints, like knee pain. The trigeminal nerve also plays a role in modulating blood flow to the brain. In particular, how much flows to the PFC. In times of survival, you want to shut down the PFC so you don’t think too much. Meaning, you can’t activate your PFC properly because you’re constantly shifting into fight or flight as a result of poor jaw alignment.

Dental Health Hacks

Cayenne Pepper:

• Capsaicin reduces levels of substance P in the body. The only downside of eating lots of peppers is that a lot of them belong to the nightshade family, which many people (about 20%) are sensitive to. If nightshades cause you inflammation, try pure vanilla bean instead. They both work by interacting with vanilloid receptors.

Oil Pulling:

• An Ayurvedic practice known to detoxify and clean the mouth and gums, reduce inflammation and halitosis, and make teeth whiter. Oil pulling pulls harmful viruses, bacteria, parasites, fungi, and all toxic waste products from the mouth, preventing them from seeping into your bloodstream. Oil binds to biofilm, or plaque on teeth and reduces the number of bacteria in the mouth. MCTs in coconut oil are good at attacking Streptococcus mutans, which cause cavities. Coconut oil is also naturally anti-inflammatory. Adding oregano oil is useful too since it is antifungal and antimicrobial.

Do these things:

• Test jaw alignment by opening your mouth, relaxing your muscles, and slowly biting down. What hit first? You want molars on both sides to hit evenly at the same time and for your front teeth to hit very lightly right after the molars. Buy a bite guard
• Eliminate sugar, try oil pulling, brush occasionally with activated charcoal to sop up toxins
• Find a dentist who will try transcutaneous electrical nerve stimulation or a cold laser if you suffer from TMJ dysfunction or jaw pain for any reason. Reducing substance P levels and taking pressure off the trigeminal nerve