At some stage or other, we have all probably had a foot issue of some kind. They are a hard-to-ignore kind of pain, due to the role they play in our everyday movements.
Imagine, (some reading this may not need to) if every step on either foot brought pain and discomfort, that only gets worse and worse as the workday progresses.
I would like to tell you the story of “C”, a 60+ person who had endured foot and lower back related pain most of her adult life. At 16, she was taken by her mother to a health professional who made suggestions to assist her. The outcome of the visit was that she had very flat feet and genu valgum (knees that point toward each other). She felt that this first intervention helped a lot. However, life got in the way and she wasn’t doing too badly so she forgot about doing her exercises. Additionally, “C” had stopped active movement and exercise at the age of 17 on leaving high school, not for any particular reason, she just got on with life and work.
She started noticing back pain with her first pregnancy, then foot pain, but being young and resilient she kept going. Two more children and work filled her time, and like many wonderful parents, she put everyone else first.
Fast forwarding a number of years, I had already been working with “C” and things were going great for her feet and lower back. During the time that she felt good, she did not need me, which is great! But then a 12-week gym challenge offer popped up. She, with no training history and being in her early sixties, was encouraged to do plyometric box jumps in the first week of training. This did not end well. Her feet gave in and her back pain, whilst not as bad, returned intermittently.
Before I became a structural integrator, I had been and still am a Sports Coach and Fitness Trainer with a rehab background. I also taught those courses at diploma level for some time. So I will do my best to avoid the obvious, “what were they thinking?” question and focus on the “what do we do about it” process.
Before moving on, I would like to give you a brief idea of her BodyReading outcomes and medially tilted feet (pronated), the left more so. This includes tibialis anterior, tibialis posterior and Flexor hallucis longus and flexor digitorum longus, being positioned long (eccentrically loaded). Fibularis longus and brevis were positioned short (concentrically loaded), adding to the medial tilt. Severe navicular drop, to the point of almost developing protective skin callouses on both feet, the left foot more so. Here, think of the intrinsic muscles of the feet being weak or hypotonic. Both legs presented as “X” legs (genu valgum), adductor longus positioned short, and the abductors being hypotonic and positioned long, Lack of support from the whole deep front line, particularly the inner seam of the legs from the tarsum to the pelvis being generally hypotonic. Extreme anterior tilt of the pelvis, short proximal rectus femoris, TFL and pectineus. This influencing compression and hyperextension of the lumbar region, including short erector spinae in the lower lumbar vertebrae. Barely functioning hypotonic glutes and rectus abdominis, and most notably, very difficult foot function in gait. Overlay over all of that an altered and inhibited proprioceptive and interoceptive awareness.
What came first? I would be speculating, but possibly at the beginning of puberty it may have started with the feet, which in turn affected the knees then the pelvis and lower back. Over time this may have become a vicious circle where the pelvic position was also influencing the femur, knee joints, tibio-talar and subtalar joints and eventually the integrity of the foot intrinsics. I would rather not try to assume too much in these cases, as I can spend my time more wisely by being a part of the solution.
So here we have, 60+ person, injured whilst training, possessing little in the way of muscular integrity for us to work with, a long history of disfunction, and this wonderful person basically had no previous memory of what good function felt like in these areas.
Where do you start? At the very beginning!
“C” and I had done work together before. She was a great team member and participant in her own healing, that’s a major plus! I knew that she was resilient, from knowing a bit of her life story, another resource. So, we started with re-reading her global situation in static and in gait. Then we set about, getting some support in her body to get her out of the pain pattern she was in. We divided this into three phases with the first being Structural Integration.
Phase One – We approached her treatment like a modified three-series, working towards balancing the Anatomy Train lines.
Our main goals were:
- Lift the deep front line to support the feet, knees and lower back
- Support the navicular and deep tarsum of the feet
- Improve foot function
- Address the anterior tilt of the pelvis and give the lower back some breathing space
Phase Two – Manual and movement integration including the use of short foot exercises, and developing broader and improved movement patterns.
Phase Three – Start to progress the improved patterns and strengthen the system (I call it bullet proofing) in key areas, to provide her with a bank account of resilience.
Now you might say, she could have seen a podiatrist, or other professionals. We have many great examples of such professionals in our region. For the people that get success with those wonderful choices, they need to look no further as they have gotten their result. But for “C”, in her lifetime, particularly from 50 onwards, “C” had tried various interventions. However, in her particular case, with her individual combination of pain and pattern issues, she found that she wanted and needed a different approach, the Structural Integration approach.
She may never be a super athlete. That’s okay, she doesn’t want to be one. But “C” does not need me anymore, she knows where I am if she does. Most importantly, this dear and hard working person can get through a day’s work without pain and still have the energy to play with her grandchildren and that as Lou Benson says “Is a good day”.
Structural Integration works!
Chris Clayton – Certified Anatomy Trains Teacher