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April 25/26 2020 OTTAWA
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I just finished another foot workshop. I love doing them because they are literally your foundation and also the foundation of all the work that follows, typically the pelvic floor. So yes, next up is a pelvic floor workshop (my second!). I thought I’d write a post about how feet and the pelvic floor are related, and why you can’t really address one without the other.
Let’s establish some very basic anatomical details:
1. Your hip joint is made up of the ball and socket of the femur and the acetabulum. The femur is your thigh bone. It ends in a “ball” which sits in a rather deep socket made up of your pelvic bones.
2. Your knee is in the middle of your leg and this joint is formed by the bottom of the femur (thigh bone, see #1) and the top of the lower leg bones, specifically the tibia. The top of the tibia is like a plateau. In fact, it’s called the Tibial Plateau. Poetic eh? The back of the knee is what we’ll be looking at today.
3. Your ankle is at the bottom of the leg, between the lower leg and the foot, and it is made by the two lower leg bones (tibia, fibula) and the top bone in the foot called the talus. The talus is a magical wonderful bone. It has no muscular attachments (the only bone in the body with this distinction!). It supports your whole body like a keystone in architecture. The talus in turn sits on the heel bone (calcaneous).
4. Of course your foot is at the bottom of the leg and is comprised of 26 bones, 33 joints, and basically three arches; one arch on the inside of the foot (often collapsed or “pronated”), one on the outside and another one across the ball of the foot called the transverse arch. (This last one is often also collapsed.) The foot is considerably more complex than the hip or knee.
Let’s get personal. I’m going to introduce you to my pelvic floor. My pelvic floor has done a great job for me over the last 5+ decades. It has birthed two children and held in my internal organs pretty effectively. I’ve not had any really serious issues with my pelvic floor (no prolapses). I’ve had some incontinence following the birth of my kids, but only when I jump around on trampolines (not that often) or laugh really hard (unfortunately not that often) or sneeze really hard (about 100 times a day). I’m willing to bet that most of my female clients have some degree of the same issues and haven’t even mentioned it because “it’s normal.” Most people wouldn’t consider what I’ve just described as a Pelvic Floor Disorder. That has to be more complicated/severe/advanced/painful right? Well, that is incorrect. Peeing when you sneeze or laugh is not normal. It’s common, but not normal. So what if you have the same problems, or perhaps something more problematic, such as a prolapse (unfortunately very common as well) or pain in your pelvic floor? What has that got to do with your feet?
The soles are your connection to the earth, and that fact has many ramifications. For one, there is traction between your foot skin and the ground, unless you are in the nasty habit of wearing those contraptions otherwise known as “shoes.” Then your foot skin is in traction with a sock within a shoe. But whatever. How your foot meets the surface of what you are walking on will affect the joints listed above (ankle, knee, hip). The best biomechanical situation for your feet is with the feet facing straight forward in the direction you are going. This enables the ankle to articulate on it’s correct axis, or plane (which is forward and back, not side to side). But if you walk with your feet pointing out (even a few degrees) the movement that should occur at the ankle occurs below the ankle where the talus articulates with the foot bones, creating an overuse situation that may result in lax ligaments (ankle sprains anyone?).
The foot is made to articulate in all manners of ways with those 33 joints, to accommodate all manner of surface variants, so all these movements aren’t damage making in themselves, but in their frequency of use. Because we walk on flat surfaces pretty much 100% of the time, this turned out position will end up creating the shapes of the bones of the legs, and changing the orientation of the joints of the knee and hip as well as the ankle! Pretty radical eh?
Now the muscles of the pelvic floor are connected to the hip joint (both literally and figuratively) in that the position of the femur in the acetabulum (thigh bone in the hip socket) will change the resting tension of the pelvic floor. Add to that a chronic tail tucking position (which does NOT allow normal hip extension, which would engage the posterior butt muscles and create normal tensile loads on the sacrum – which is a heavy duty pelvic floor attachment site) and we’ve got some major mechanical flaws that will inevitably end up affecting the function of the pelvic floor.
Starting with the foot position, let’s get those feet facing straight ahead. And then have a gander at the back of the knees. You will notice that the grooves which are your hamstring tendon attachments are not facing straight back the way they should. They face more toward the sides, away from the midline, or laterally. So to get them facing back again, so the knee is also articulating on its correct axis, we need to externally rotate the femurs. This will end up affecting the foot position again – the medial (inside) border will lift off the ground. Only with diligent practice at mobility drills and walking on a variety of unlevel, uneven surfaces will the foot gain back the mobility it needs to evert the forefoot back to the ground – and VIOLA – ARCHES!
So there you have it, to get the arches back, and the resting tone in the pelvic floor, you need to start with the feet and work your way up to the hips. My foot workshops end with this external rotation, but it’s a concept that is very challenging to do without some guidance – the health of the knee can be compromised if done incorrectly. So please see a certified Restorative Exercise Specialist before you try it. There are also more detailed instructions in Katy Bowman’s books (links in sidebar).
By the way, it’s been 3 years since I corrected my foot orientation and began walking with correct hip extension. My pelvic floor is a lot stronger. I can sneeze 100+ times now and no leakage. Cool right? And that was accomplished without one kegel. Not one.
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