How Likely Are You To Have Sciatic Pain? (Piriformis Syndrome)

Piriformis syndrome is a neuromuscular issue that can be felt as pain at the buttocks and hip. The piriformis muscle is a deep rotator (internal and external) of the leg. The piriformis also plays an important role in the stabilisation of the sacroiliac joint (SIJ).
Piriformis syndrome can be an under-diagnosed condition as the symptoms can be similar to that of lumbar radiculopathy, primary sacral dysfunction, or innominate dysfunction.

What is piriformis syndrome?

The piriformis muscle originates from the anterior surface of the sacrum and attaches to the greater trochanter of the femur. If the piriformis is hypertrophied it can compress the sciatic nerve (which is typically underneath the piriformis), causing piriformis syndrome. This is similar to the compression of the median nerve by the pronator teres, known as pronator teres syndrome.

I’ve had many clients over the years who have suffered from piriformis syndrome. A study had found that more than 16% of all adult work disability work evaluations performed were linked to lower back pain. (Centers for Disease Control and Prevention. Prevalence of disabilities and associated health conditions among adults—United States, 1999 [published correction appears in MMWR Morb Mortal Wkly Rep. 2001;50:149]. MMWR Morb Mortal Wkly Rep. 2001;50:120-125.)

Diagnosis had shown that over 6% of those who suffered with lower back pain actually had piriformis syndrome. (Hallin RP. Sciatic pain and the piriformis muscle. Postgrad Med. 1983;74:69-72.)

So it is clear that piriformis syndrome can be a debilitating experience for people. Like many issues in the body, a person’s lifestyle (sports, movement patterns, postures, emotions) can be the cause to these issues. But are some people more likely to suffer with piriformis syndrome due of their genetics?

Sciatic nerve and piriformis genetic variations

The genetic variations of the sciatic nerve and piriformis are:

  1. Sciatic nerve passing under the piriformis (top).
  2. Sciatic nerve passing through the piriformis and the tibial nerve passing under (bottom left).
  3. Sciatic nerve passing under the piriformis and the tibial nerve passing over the piriformis (middle)
  4. Sciatic nerve passing straight throw the piriformis.

Based on the research done on cadavers the sciatic nerve passing underneath the piriformis is the common variation, about 90%. The variations where the sciatic nerve passes through the piriformis may leave someone more likely to experience sciatica in their life. It is clear with these genetic variations that sciatic treatment is not the same for everyone.

Sciatica can also be caused by other factors other than the piriformis so this is not a straightforward situation to treat.

Improving piriformis function

As mentioned earlier the piriformis is an external rotator for leg. When you go into 45-60 degree of hip flexion, the piriformis will become an internal rotator. It reverses it’s action on the leg. This means that in the cross legged position we can resist internal rotation of the thigh and perform a muscle energy technique (MET) on the piriformis and the other muscles that internally rotate the leg. This can help with improving the piriformis’s capacity to contract which in some of you can alleviate compression at the sciatic nerve (assuming the piriformis is overly compressing your sciatic nerve in the first place). I’m not saying this is a cure for sciatica but it can definitely alleviate neural tension in some people as I have witnessed this when performing this exercise on clients.

Here is the exercise…

4 sign

  1. Press your knee into your hands (internal rotation)
  2. Pressure from the knee is only 20% of you maximum. No movement – isometric contraction.
  3. Hold for 20 seconds.
  4. Repeat 4 times. Then swap legs.

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Tom Waldron

Why You Keep Getting Injured

The statistics of people who suffer from recurrent injuries are unfortunately high. A study had shown that hamstring strains (common running injury) is a recurrent injury in 84% of people who suffer from the injury… That’s a lot!

Now there are usually many factors that lead to injury in the first place and this is the same for recurrent injuries. The human body is really complex so to be dogmatic about what causes what for all situations and bodies is an incredibly limited paradigm. We usually need to break things down into categories and talk about things in isolation for the purpose of education. If we always educated people and spoke of things in big tapestries (although more accurate), it is very unlikely that any real value would be received when sharing information and only the absolute ‘gurus’ of the body would be able to converse. I suppose the ultimate goal is to understand topics (anatomy, biomechanics, therapy ect…) at first as isolated islands and once a decent level of knowledge is acquired, then how these topics relate and intertwine with one another can be appreciated and better understood. You could say that we can start to develop the connective tissue that connects the understanding of different topics together. This process (in my humble opinion) takes decades of practice, hard work and study – the path to mastery.

So this blog is highlighting a small piece that is part of bigger puzzle to why people suffer from recurrent injuries, definitely not the whole story. We can review other parts of the story for other blogs/videos in the future…

Phew long intro today, anyway let’s talk about muscle strength!

New Tissue

Once human tissue is damaged, the tissue healing process begins immediately. This healing process (that even the specialist admit they know little about) can be explained as 4 overlapping phases…

1. Bleeding
2. Inflammation
3. Proliferation
4. Maturation

These phases deserve there own 1000 page essay but we’re just going to acknowledge them here. The duration of the healing process depends on the location of the injury and how severe the injury is. Some areas of the body will heal at different speeds due to their blood supply. What I find incredibly interesting about how humans heal is the end product of new tissue from the healing process is never quite as strong as the original tissue. We don’t really know why (as this rule doesn’t apply to all animals) but the quality collagen fibres do have something to do with this.

Type 1 collagen fibres (which non damaged tissue has a lot of) has more cross bridges than type 3 collagen fibres. Having lots cross bridges makes the tissue more resilient to tensile forces. The more resilient your body is to tensile forces (in a variety of directions) the less likely you are to encounter injury (that’s the theory). Type 3 fibres is what your body produces at the end phase of the tissue healing process. Ideally your body starts to convert the type 3 collagen fibres into type 1 fibres to strengthen the tissue. Although the body does this, the end product just isn’t as tough as it used to be. Weak tissue is a good candidate for injury.

So how do we toughen up tissue that just isn’t cutting it?

Strength Work! Lot’s Of STRENGTH WORK!

The reality is that stress is good for you! A certain dosage of stress makes you stronger. If you don’t have evolutionary pressure then there is no need for there to be a change. Most change comes about because an organism needs to meet the new challenges of it’s ever changing environment. If the organism can’t adapt and embrace the evolutionary pressure of life, it’s chances of surviving and thriving are incredibly slim. Humans are just like any other organism! Stress and well being are inseparable, you need a certain dosage of stress to be healthy.

Strength Training is artificially creating evolutionary pressure. Having to move against resistance inspires strong tissue. A practical example of this is focusing on eccentric (lengthening) muscle work in the gym/studio. When a muscle or group of muscles are ready to be trained after injury, the purpose is to put resistance on the movements those muscles power in order to make the tissue more resilient to tensile forces. Strength training typically is an overlooked component in physical rehabilitation and so this can be one of the reasons people experience re-injury later.

If you’re working with a physical therapist / exercise coach, make sure there is a solid strength program in place that is progressive and relevant to your goals and needs.

I really enjoyed writing this blog so thanks for reading guys, apologies if it got too ‘sciency’ in places. Have a great day 🙂

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Tom Waldron

The BEST 3 Exercises To Mobilise Your Mid Back

The mid back (thoracic spine) is an area of the spine that most people struggle to articulate. The thoracic spine in most individuals consist of 12 vertebra. The transverse processes of the thoracic vertebra is where the ribs attach so a person’s inability to move their mid spine will most likely have a negative effect on the mechanics of the rib cage which will result in inhibited breathing…

As well as breathing the thoracic spine has a direct functional relationship with lumbar spine (lower back). The are many reasons why back pain can come about but a common reason from a mechanical perspective is when the mid back doesn’t have the capacity to move fully. If the facet joints of the thoracic spine don’t have the ability to move at full range when they need to it can result in excessive movement at the lower back.

Where there is lack of movement, there will be excessive movement somewhere else in the body to compensate.

This excessive movement can eventually result in wear and tear so it’s important that all areas of the body move well. Not just for the sake of movement but also so those areas can stabilise properly too.

Getting Your Mid Back Moving

Your thoracic spine has the ability to move in all planes of motion (some more than others). Rotation is the thoracic spine’s speciality (roughly 45-57 degrees of rotation is possible at the facet joints). From my experience when assessing clients, the mid spine’s capacity to rotate is normally lacking. This results in a person compensating with excessive rotation at the lumbar spine (not designed for too much rotation) and too much movement of the scapula on the ribcage – a great opportunity for shoulder tension!

Below are 3 exercises that do a good job at ‘isolating’ the mid back during rotation. Why do we want to try to just exclusively rotate from the mid spine? So you can better rotate at your mid spine!

Hip Rolls

Arm Openings 

Spine Rotation With Pole

It’s very popular these days to only do full body integrated movements when exercising. The argument here is that the movements of the body in most sports and day to day activities are integrated. This totally makes sense and the end goal should be to make sure that all the different parts of the body can synchronise and work together. How ever if a certain area of the body just isn’t performing optimally (for example the facet joints of the mid spine not moving enough), there is a lot of value in isolating that area to improve it’s function. Once the area is working better then you can go back to integrated exercises with all areas of the body supporting each other.

There is definitely other arguments and perspectives on this matter so if you have a different opinion please comment below or message me to add to the discussion 🙂

Thanks for reading guys and I look forward to continuing this discussion with you 🙂

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Tom Waldron

How Your Gluteus Medius Affects Your Lower Back – Part 2

The gluteus medius is not as popular as it’s big brother the gluteus maximus (being a little brother myself I can empathise), never the less the gluteus medius is as important in terms of stability of the pelvis and movement at the hip. Because the gluteus medius doesn’t directly influence the sacroiliac joint like the gluteus maximus does, the gluteus medius stabilises the pelvis in a different way to the gluteus maximus.

This blog is part 2 of my blog last week How Your Gluteus Maximus Affects Your Lower Back so after reading this you should go back and read that blog too. Reading both will give you a well rounded understanding on how these muscles influence pelvis and lower back mechanics.

The Little Brother

The gluteus medius originates on the outer surface of the ilium (pelvis) in-between the posterior and anterior gluteal lines and inserts onto the lateral superior surface of the greater trochanter of the femur (top of the thigh).
The gluteus medius abducts the thigh (away from the midline), the anterior muscle fibres medially rotate the thigh and the posterior muscle fibres laterally rotate the thigh.

During gait the gluteus medius helps with the alignment of the legs, making sure they don’t adduct (towards the midline) too much. If the gluteus medius isn’t working properly it could manifest as the leg(s) going in too much when walking. The gluteus medius also helps with stabilising the pelvis when you’re balancing on one leg, very important for yoga and most sports!

So if the gluteus medius for what ever reason isn’t functioning properly, this can result in an unstable pelvis, especially when trying to balance one leg or when moving from one leg to the other. The foundation of the lower back is the pelvis (specifically the sacrum), if foundation is unstable, it’s very reasonable to assume that the structures (lower back discs / vertebrae) on top will be negatively influenced due to compensations up and down the kinetic chains.

Unstable Pelvis – Unstable Lower Back

A test you can do on yourself to assess your ability to stabilise your pelvis is the double to single leg stance test. Find a mirror and take one leg of the floor, what you’re looking for is if your pelvis is able to stay parallel to the mirror with one leg or if you have to shift or rotate your pelvis to balance. If you can’t maintain a parallel pelvis then you would score positive for a ‘weak’ gluteus medius.

Now of course there is much more going on in the body during this test that can prevent the pelvis from being parallel as we are not isolating the gluteus meduis (not that you can isolate a muscle) but for purpose of this blog we will continue as if the gluteus medius is the cause for not passing this test. If you would like more information on what else could be causing the pelvis to be unstable other than the gluteal muscles please private message me or comment below and we can continue this discussion.

Improving Gluteus Medius Function

The gluteus medius might be in spasm or fibrotic (tight) so using a massage ball or tennis ball to massage the muscle fibres is a good place to start. Seeing a Sports Therapist is a great idea if you can’t bare a tennis ball. The advantage of having a massage by a health professional is they can be more intentional and deliberate with their hands (or elbow!) than a ball. This is because a tennis ball doesn’t have a brain (that sentence sounded more profound in my head).

Like in last week’s blog with the gluteus maximus, you now want to improve the neuromuscular feedback and strength of the gluteus medius. There are a lot of fun and effective ways of doing this so here is just an example of what you can do the strengthen the gluteus medius.

  • Leg abductions with cable.
  • Single leg lifts – Pilates.
  • Hip hitching

As well as strength work, proprioceptive centred exercises will also be good practice. This is basically anything that requires balance and co-ordination.

Your Deepest Lower Back Muscle – Quadratus Lumborum

The human body is an integrated system, so the story doesn’t start and end with the gluteus medius. There is a direct functional pattern between the gluteus medius and the quadratus lumborum (QL) on the other side.

As you can see in the picture to the side if the right gluteus medius is ‘weak’ the left QL (contralateral side) will be ‘tight’ or in spasm. Potentially the reason why the gluteus medius is not working optimally in the first place is because the QL is ‘tight’ (maybe due to lifestyle or a past injury). Not addressing the QL can prevent the pelvis from being stable. The inner thigh muscles on the side (ipsilateral side) of the ‘weak’ gluteus medius is also another area to check for strength and function as the adductors of the hip are the antagonists to the gluteus medius.

I’m just highlighting an example of how a ‘weakeness’ in the body can actually be a compensation due to a biomechanical issue somewhere else in the body.

Don’t treat symptoms and finish there. Treat symptoms and work on the rest of the body to help maintain that change. You can’t produce a long term change in the nervous system with a single input.

If you want to continue this discussion please comment or message me.

As always thanks for reading guys and have a great day 🙂

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Tom Waldron

How Your Glute Max Affects Your Lower Back (Exercises Included)

The gluteus maximus is such a popular muscle these days, especially on Instagram! Pretty much every one’s fitness instagram profile has 100’s of photos of them showing off their defined gluteals and their squat techqniue!

Despite the glute max being so popular, I sometimes wonder how many people really understand this muscle that they devote so much time to. Most muscles have a variety of functions and this is definitely the case for the glute max. It’s mostly known as an extensor of the hip but in reality (similar to the deltoid) it provides many more functions. If a muscle has a variety of functions, it would be intelligent to train that muscle in a variety of ways, stimulating and working all the muscle fibres. One of the interesting things about the glute max is how the upper fibres continue into the thick fascia of the lower back. The glute max also helps with sacroiliac stability (the joint between the sacrum and ilia). The mechanics of the sacrum will directly influence the lumbar vertebra (lower back) above.

There has even been research into the relationship of lower back pain and glute max inhibition. A study had shown that glute max activation during hip extension was delayed in people with a history of lower back pain.
It has been shown that hip – spine interaction is disturbed in patients with lower back pain during saggital trunk flexion and extension.

(Leinonen V, Kankaapää M, Airaksinen O and Hanninen O (2000): Back and hip extensor activities during trunk flexion/extension: effects of low back pain and rehabilitation. Archives of Physical Medical Rehabilitation 81, 32-37).

So potentially there may be a link to glute max activation and lower back pain in some people as the glute max helps with the stability of the scaroiliac joint (SIJ) and lower back. Of course there are many other factors that can contribute to lower back pain other than the gluteal muscles.

Knowing this connection to the lower back fascia and SIJ stability, you’d assume that people who exercise their gluteal muscles must have great lower backs – in stability terms anyway. In my experience this is not the case. When I perform the Gilliets test on clients (which is to assess independent movement of the SIJ on one side of the pelvis), it’s very often that people don’t pass the test first time round, even the ones with great bums!… Sorry I mean defined gluteals.

So what’s going on here? How can a person exercise a muscle but not improve the function of the surrounding areas?

Weak Glutes Or Strong Glutes?

There have been countless blogs/articles debunking the myth that a person’s glutes are ‘weak’ and therefore need to be ‘strengthened’. We know now that this is rarely the case and that glutes that test ‘weak’ are normally just inhibited and once their function has been improved (through a theraputic intervention or through certain exercises), when re-tested the muscle scored as ‘strong’ or pass.

So does strength work make a muscle strong if the muscle is inhibited (poor neuromuscular feedback), in spasm (dehydrated) or fibrotic (muscle tissue becomes more ligaments – tight) when being exercised? MAYBE not (big emphasis on maybe).

If a muscle is not activating at the right time then we need to improve the neuromuscular feedback to the muscle (brain to muscle connection). Performing strength exercises for the glute max won’t necessarily improve the neuromuscular feedback.

So maybe we need to prepare a muscle (or group of muscles) first before we exercise them. Giving the muscle full capacity to contract (both concentrically and eccentrically) and function optimally. Exercising with good biomechanics as a baseline will most likely make the experience of physical movement more enjoyable and fruitful.

Exercising the glute max in a manner that reinforces ‘ideal’ biomechanics can improve the function of the SIJ and there fore create a more stable foundation for the lower back.

Re-activating The Glute Max

So one technique we can try first is a Muscle Energy Technique (MET) for the hip extensors. This MET is called Leg Press. If we assume the glute max is in a state we call ‘sub clinical spasm’ then an MET can improve the glute max’s capacity to contract properly again.

Leg Press – Muscle Energy Technique:

Resist hip extension (isometric contraction – muscle contraction without movement).
Press leg into hands for 20% of your maximum effort (make sure knee is relaxed).
Hold for 20 seconds.
Repeat 4 times, then swap legs.

For more info on muscle energy techniques go to www.biomechanicseducation.com

Intelligent Conditioning For The Glute Max

Now that we’ve upgraded the neuromuscular connection to the hip extensors, we are now in a better mode to strengthen and condition the glute max. Now to define what is intelligent training is a little subjective. How a person should train is down to their goals, what sports they play, their lifestyle ect…

If you’re someone who doesn’t have a bias to a particular sport and you just want to have a great exercise routine for your glute max then in my opinion the most ideal way to train your glutes (and any part of your body) is in a varied fashion. This means changing your body positions, lines of pull and movements at the hip. The following are just a few ways to train the glute max.

Glute Max Exercise Suggestions

Squats
Romanian Deadlifts
Oysters – Pilates
Leg Lifts (lying on side / standing with a band around ankle or cable) – Pilates
Leg extension and external rotation with cable / band
Single Leg Bridges – Pilates
Hip Thursts
Walking Lunges
Squat Jumps

It’s Not All About The Glutes

Remember, one part of the body can effect other parts of the body. The glute max continues into the fascia of the back (thoracolumbar fascia), which continues the into latissimus dorsi, the latissimus dorsi inserts into the humerus. So the mechanics of the arm/shoulder can influence the gluteals (and vice versa). An issue with the shoulder can be what causes the glute max to appear ‘weak’ when assessed.
There is even a connection into the hamstrings from the glute max. For more info on the hamstrings read my blog Stop Stretching Your Hamstrings 

This is why it’s SO important to exercise your WHOLE body. Include isolated movements and integrated movements into your exercise routines. When you exercise your shoulders you are directly exercising and influencing your glutes. It makes no sense to exclude training certain parts of the body, especially if you’re exercising to be generally healthy and fit.

Happy glute training guys, I look forward to the Instagram posts!

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Tom Waldron

 

 

References:

Biomechanics Educationwww.biomechanicseducation.com

Leinonen V, Kankaapää M, Airaksinen O and Hanninen O (2000): Back and hip extensor activities during trunk flexion/extension: effects of low back pain and rehabilitation. Archives of Physical Medical Rehabilitation 81, 32-37

 

Can You Be Fit & Have Scoliosis? (Medical Scoliosis vs Functional Scoliosis)

‘I have scoliosis’ is something I hear a lot, at least once a week. The interesting thing about this medical or non medical ‘issue’ is that we all probably have it to some degree! The cause of scoliosis is unknown, how ever there are factors that can definitely contribute to this condition. Most people tend to live asymmetrical lives. We like to cross our arms a certain way, lean into one leg, have one bag over the same shoulder ect… People have patterns that they strengthen all day, every day. The result of these movement patterns can be that connective tissue develops in a way that adapts and changes to these holding/movement pattens. This can potentially be a problem down the line. Now I’m not saying that crossing your arms a certain way all the time is going to give you scoliosis, I’m just highlighting an example of everyday habits that can cause asymmetries.

Your spine, like of the rest of your body is responding to the loads and forces you place on it. Due to our life styles (and even the sports we play), these loads and forces can be bias to certain directions and can result in asymmetries. These asymmetries that are developed through movement patterns can lead to potential problems in the body (and mind) later down the line…

So the question is, what really is scoliosis and is it a problem?

Medical Scoliosis

Medical scoliosis is when the spine curves or twists past 10 degree in one direction. Non medical scoliosis is when the spine has curves or twists in one direction but is less than 10 degrees. One is a medical diagnosis and the other isn’t (I’d like to add here that I’m not a clinician and I’m just commenting on the medical description of scoliosis).

The common issues that can arise from medical scoliosis is having too much compression in certain areas of the spine and too much stretch in others, lack of mobility in certain planes of motion and potentially pain.

Functional / Nonstructural Scoliosis

Functional or non structural scoliosis is when the spine has undergone a temporary change in the spinal curvature. This is generally in compensation to a biomechanical issue and/or inflammation somewhere else in the body. A common cause to functional scoliosis (at least in my expeience) is pelvic asymmetry. The sacrum acts as the base of the spine (L5 rests on the sacrum). If the sacrum is ‘off balance’ due to an issue at the sacroiliac joint, this can have a knock on effect higher up the kinetic chain. So this type of scoliosis is in response to something else going on in the body. Normally once the ‘root cause’ to the functional scoliosis has been addressed, spinal ‘alignement’ has also been improved.

Can You Be Fit And Have Medical Scoliosis?

Yes!… HELL YES!

You may or may not know that Usain Bolt, the fasted man on the planet, has scoliosis. He’s been very public about his struggles as a young man training with scoliosis. Despite any issues he may have faced he has clearly over come them and has become one of the top athletes of all time…

So this completely calls into question what we classify in the health and fitness world as ‘fit for purpose’. The old school of thought was you had to be conditioned in a way that made you biomechanically prepared and fit for your activity and sport to avoid injury and to optimise performance. While this paradigm is still relevant and beneficial to most of the population (and makes a lot of sense), our stereotypical definition of what is a ‘sound structure’ or a ‘fit/strong body’ for a sport or activity has to be revisited and updated. Yes of course we need to take asymmetries / imbalances into consideration, but these very things can be apart of a person’s genetics, not being a problem for them at all!

So Is Scoliosis A Problem?

As always depends on the individual. It can develop into a problem for some people while others will go through their whole life and never know they had it. The take away from this blog is that if you have an ‘issue’ it doesn’t mean you’re not fit and it doesn’t mean you’re not healthy. It’s something you have that may or may not be an issue. If you know (or suspect) you have some form of scoliosis, I definitely recommend you consult with your clinician to have a professional’s opinion on the best cause of action to take.

What can be harmful to an individual’s physical and mental health is if they are going through life with a label in their head that they either gave themselves from a self diagnosis on Google or by a clinician. A big part of an issue is your interpretation of that issue. Is that a ‘woo woo’ statement? No, it’s been proven again and again that how a person feels about their body will have a tremendous effect on the physiological state of their body.

I hope this gave you a little bit more info on scoliosis but more importantly I hope this stimulates some questions and ideas in your head about what it really means to be fit and healthy.

Thanks for reading and have a great day 🙂

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Tom Waldron

How Your Hamstrings Affect Your Feet

The inner mechanics of the feet are incredibly complicated and it’s an area in the world of biomechanics and movement that is still very much up for debate on how the bones and joints really work in movement (walking, squatting ect…). Taking into consideration that there are twice as many feet in the world than people… There’s definitely going to be a variety in terms of the intrinsic biomechanics of the feet. There is no one size fits all paradigm here! Despite there being no clear cut answer or black and white statements that hold true for all feet, there is one thing I’m sure all health and fitness professionals can agree with…

A ‘healthy’ and ‘functional’ foot should be adaptable to it’s ever changing environment!

What does this statement mean? Well it means that a foot should be able to be flexible and mobile when the environment demands it to be flexible and mobile, and it should be rigid and strong when the environment demands the foot to be rigid and strong. The genius design that is the foot is that within milliseconds your feet can go from a mobile system to a rigid system. This is incredibly important every time you take a step. Keeping your foot in one of these worlds too long (pun intended!), when the environment changes will most likely cause issues for the feet but also problems higher up the integrated system that is the human body.

So to have adaptable and happy feet, we have to exercise the feet in an adaptable manner. Dead simple right? Well yes and no. Yes, to have healthy feet (like any other part of the body), you need to exercise them weekly! The less simple aspect to how the body is so brilliantly designed is that one area of the body can effect another. If there is an issue in one area of the body it can effect the function of another part of the body, there is a functional connection. There are many areas that can directly influence the mechanics of the feet but I’m going to focus on the hamstrings (specifically the biceps femoris) in this blog as it’s been a recurrent connection with some clients I’ve been working with recently.

Foot Issues? Look At Your Leg!

The biceps femoris (your most lateral hamstring) originates from the tuberosity of the ischium at your pelvis (sit bone), attaches onto the femur (short head) and to the head of the fibula (long head). The fibula is the long narrow bone that lives next to the tibia (shin bone).

The interesting thing about the fibula is the distal end of the fibula (bottom end) forms part of the ankle joint. The ‘bony bit’ you can feel on the outside of your ankle is the fibula! The fibula plays a role in the stability and movement of the ankle and foot. Like the sacrum, the movements of the fibula are very small but very important to the function of the foot and lower leg. For example it is thought that when you dorsiflex your foot (the opposite of pointing your foot), the fibula moves up a little bit towards the knee.

So bearing in mind the attachments of the biceps femoris, if there are any issues at the muscle, let’s say for example a muscle spasm or strain (two very common issues of the biceps femoris), the movements of the fibula may be compromised which will in turn negatively effect the mechanics of the ankle and foot. This could limit movement at the foot or even give way to excessive movement at the foot. As we know the foot has MANY functions and so any ‘weaknesses’ in this system can be a mess. So let’s assume the hamstrings are in spasm (which is a common condition for many people’s hamstrings), we need to re-hydrate the muscle and improve the neuromuscular feedback of the muscle (brain to muscle communication) so the muscle has the capacity to fully contract (both concentrically and eccentrically).

Improving the function of the hamstrings can have a fantastic influence on the function of the feet, improving the mobility and strength of the feet but more importantly, improving the foot’s ability to absorb and redirect forces from the ground (ground reaction force). A lot of injuries come about when the body isn’t absorbing force properly so this is an important function of the feet.
How Can I Improve My Hamstrings If They’re In Spasm?

Most people experience ‘tight’ hamstrings so a good area to start is with massaging and stretching the hamstrings. You can increase the hydration and state of the muscle fibres by using a massage ball or by seeing your local sports massage therapist. From there you want to exercise and train your hamstrings. Exercises like bridges in pilates (normal bridges / single leg bridges) and the Nordic Hamstring Curls are fantastic ways to strengthen the hamstrings concentrically and eccentrically. Putting an emphasis on working the hamstrings in a eccentric (lengthening) manner is a good idea. This is because the hamstrings are working their hardest when eccentrically contracting (lenghtening) to decelerate the motion of the leading leg (during the swing phase) when walking and running,
something your hamstrings have to do everyday!

What If I Have A Hamstring Strain?

For a period of time you want to rest your hamstrings to allow the healing process to develop new collagen at the site of injury. The period of rest will be determined by the severity of the strain (if you have strained your hamstrings you should be consulting your physical therapist to aid in the healing process). When ready of course you need to strengthen the hamstrings to prevent future re-injury. New tissue is never quite as strong at the original product so strength work is incredibly important during rehabilitation. To reverse the discussion, you would now want to take into consideration your foot biomechanics and how it may have contributed to the hamstring being injured in the first place. Perhaps your feet need mobility work or strength work.

So Should I Forget About Exercising My Feet?

Of course not! Doing strength work and mobility work for your feet is fantastic for your feet so they can confidently carry you through life. What I’m proposing here is if you have a problem in your body, of course you want to improve how you use that part of your body, but also be aware and appreciative that the body is one organism! And that everything within that organism is communicating and influencing each other constantly. The hamstrings is a more clear and obvious connection which will make it easier for you to go away and play with….

Train your feet and your hamstrings in a complimentary way that supports the whole system.

Assessing and working on the mechanics of the pelvis and spine will of course be another layer to add to this discussion. I’ve written another blog Stop Stretching Your Hamstrings! that describes the continuation of the biceps femoris into the sacrotubrous ligament (ligament at the back of your pelvis) and how your back or shoulders can influence your leg and foot mecahnics.

As always thank you for checking out this blog guys and I’ll talk to you next week 🙂

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Tom Waldron