Latest Youtube video on "Feet anti-pronation exercise"

[Jim Pickles]

Very interested to see this new video - primarily for myself rather than my students (though I'm going to have a close look at foot pronation in the class in case it would be useful for anyone - and we'll do something similar anyway if I can fit it into the space available).

As Kit may know, I pronate on both feet, on one so badly that the tendon of the tibialis posterior ruptured. A surgical repair would mean reconstructing the foot - taking tendons from elsewhere and redirecting them. The surgeon (thankfully) did not want to do this - in fact they were impressed that I had as much function as I have.

I ascribe this to doing calf rises in ballet (though it was ballet that was the last straw in screwing it up in the first place). These are rather like faster versions of the exercise illustrated, though it starts from a flat foot and the rise was not usually held. However I am pleased to find that doing a few slower ones has led to a rapid improvement.

Thank you!

A couple of questions: 1. How important is it that you hold it till the muscle cramps? I can hold it quite a long time, and it gets tired, but does not cramp. Or am I just a wimp (i.e. giving up too soon)? Are a few repetitions held for a long time best, rather than the multiply repeated rapid "bobbing up" that I have been doing?

2. What then is the function of the posterior tibialis? It is often said that it is to "hold up the arch". However, I do not understand this from the geometry. As the p.t. tendon goes round the ankle, it runs forward horizontally (so at that point can only pull back) and then turns inwards to run almost horiztontally towards the midline of the foot. So here if anything it would seem to pull the arch medially - or I think more likely, the overall effect is instead to pull the ankle laterally in relation to the arch (rotating it laterally over the heel), helping to keep the arch and ankle in one line which is how they should be (i.e to stop the ankle collapsing inwards - to the body's midline). Could this be right?

3. What are the points that Kit mentioned in the video about alignment at the hips affecting pronation? How should we be aware of errors here? Please can we have more details on this point?

Anyway, greetings, many thanks, and best wishes,

Jim.

[Kit_L]

Hello Jim; great to hear from you.

A couple of questions: 1. How important is it that you hold it till the muscle cramps? I can hold it quite a long time, and it gets tired, but does not cramp. Or am I just a wimp (i.e. giving up too soon)? Are a few repetitions held for a long time best, rather than the multiply repeated rapid "bobbing up" that I have been doing?

Well, if you are not contracting hard enough, the muscles may not cramp. As well, because you have been doing ballet and ballet-like work for a long time now, this may not happen in your body. The main thing is, is the arch forming properly in your foot at the top of the exercise position? If so, no problems. If not, stronger methods will be needed.

So, regarding your tibialis posterior: my understanding is that, if this is not working, then it is hard for the arch to be formed. Or, was it a partial rupture, in which case it can fix itself?

The recommendation to "hold until it cramps" is instrumental: if cramping happens, the resulting contraction (and number of fibres involved) is greater than any voluntary contraction. Accordingly, the strengthening effect is greater, too.

2. What then is the function of the posterior tibialis? It is often said that it is to "hold up the arch". However, I do not understand this from the geometry. As the p.t. tendon goes round the ankle, it runs forward horizontally (so at that point can only pull back) and then turns inwards to run almost horiztontally towards the midline of the foot. So here if anything it would seem to pull the arch medially - or I think more likely, the overall effect is instead to pull the ankle laterally in relation to the arch (rotating it laterally over the heel), helping to keep the arch and ankle in one line which is how they should be (i.e to stop the ankle collapsing inwards - to the body's midline). Could this be right?

I am going to ask for others with more specialised anatomy to comment here. What I can say is that one muscle is almost never responsible for a function. As well, addressing the point below will be helpful here. As well, there are a number of other muscles involved; soleus in particular. The hardly-ever-mentioned fascia aspect is significant too, because anatomy texts can't show how these muscles can be fixed to each other at certain points.

3. What are the points that Kit mentioned in the video about alignment at the hips affecting pronation? How should we be aware of errors here? Please can we have more details on this point?

Anyway, greetings, many thanks, and best wishes,

Jim.

If you visualise the pelvis from above, the balance of forces between external rotation (piriformis and the other four) and the adductors and hip flexors position the head of the femur at a particular, or habitual, angle when standing, walking, and running. This may simply be a habit, or way of holding the body). If you look

, at about the 2:11 mark, you will see that I am deliberately rolling my ankles in (pronation) and out (eversion); and I note that this control does not come from the feet. They simply respond to the internal/external rotation of the hip joint; this is absolutely critical in understand where most practitioners go wrong in their treatment of this common problem.

More: when you try this exercise you will find that the effort of internal rotation is identical, or very close to, the effort of external rotation. This is highly significant too, because it tells us that the point in the arc between full internal and external rotation which your body chooses to hold the hips at is a completely learned response. It can be unlearned or retrained if you know what to do, and that is what the work is about.

Cheers, KL

[Jim Pickles]

Kit - many thanks for your points.

1. I'll hold the foot longer to try and get it to cramp. In my case, on the bad side, the arch is nearly properly formed - the bones in the middle of the arch are still deviating a bit medially though. Nevertheless it has proved to be enormously helpful in a short time.

2. The tib post rupture was complete - MRI shows that the ends are many cm apart. There was a loud bang, a flicking feeling in my ankle, but no pain. At least I dont have to worry about it snapping now.

3. Thanks for drawing attention to the foot sequences video. I've donwloaded it all but not worked through it all yet (I want to work through it properly, but want to reply quickly). I find I can get my own feet (as I presume can everyone) to roll in and out by many different means - using the calf muscles, medial and lateral thigh muscles, external rotators of the hip. I guess I am concerned to do it the most "natural" way so that there is no strain on the knees - so that there is no twisting of the knee throughout the range of movement of walking. So I have been reticent to use muscles above the knee to control the pronation (my father had knee damage/replacement, maybe as a result of pronation, and it pretty much destroyed his quality of life for the last 20 years of his life, so I want to avoid that fate). I presume that issue is dealt with later on in the video and will try when I work through it.

Again many thanks for your help,

Jim.

[Jim Pickles]

Just seen the "correcting flat feet" thread as it was listed below.

In relation to: "Then, as you rise, transfer slightly more weight to the outside (this activated the peroneal tibialis posterior (thanks to slizzardman from Coach Sommer's forums for the correction)"-

so is it really tib post that should be referred to in the video? (not having one on one side, that makes a difference, though I can still do the exercise - but only just. I thought I could feel the peroneus contracting hard, pressing the outer edge of the foot down.)

Thanks, Jim.

[Admin]

Damn: yes, tibialis posterior.

What do I say in the video? I don't have time to remake it, but can add a correction in the description.

And to answer your earlier question, IF the arch is strong and properly formed, then the most natural/efficient way of provoking pronation and eversion is by simply internally and externally rotating the whole leg; this is done by the internal and external rotators of the hip and only the hip. OTOH, if the arch is not formed well, then what you describe are options (and I can make myself do this too, but it is not natural to me). I have tested this hypothesis with many people, so am reasonably sure it's operative.

(aside: in testing this, I never direct the students to particular muscles or functions; I say simply 'deliberately let the arch roll in; now try rolling out.... where does that control come from?". Try this with your own students, please and report back. In my view, unless retraining a function, feeling is a much more reliable guide than analysing which muscles are doing what, which should be doing what, and so on—this recommendation also describes the poorly understood role of fascia in fine-tuning movements, too.)

So, commenting on your q. 3, in my view the orthodox thinking on pronation (and reflected in your question) is simply inaccurate. So, my understanding is that foot alignment in the sense we are discussing (and we are talking here about over-pronation, where the area under the curve that represents the time spent the medial side of the foot is much greater than time spent on the lateral side of the foot).

How can we know whether we are over-pronating? Simply by looking at the degree of the thickening of the skin or callousing of the skin on the inside of the food (on the medial side/bottom of the big toe and on the medial side of the big toe joint) versus callousing on the outside of the foot. This is an undeniable physical effect. If you have more callousing on the medial side of the food then you spend more time on the medial side of the foot or do more work on the medial side of the foot—callouses do not grow without this kind of provocation.

And these observations are why I recommend against orthotics for the majority of people who have been diagnosed with "flat feet". The very stimulation that will required to change this state will be lost; again, this is the reason for recommending using the Vibram FFs with awareness of this weight distribution; I will elaborate on this if required.

The larger picture is, developmentally speaking now, the arch only develops if the soles of the feet are experiencing the right kind of stimulation. All babies as you know have flat feet. It is only the stimulation of the proprioreceptors in the soles of the feet that cause the arch to grow away/develop away from the surface of feet are walking on. Irene Dowd describes this beautifully in the title of her great book, "Taking root to fly".

In the same vain is often said that many dancers walking with a first class with flat feet but never end their careers with flat feet. Many muscles are involved but flat feet are what I consider to be a "lower energy configuration" of the body. As awareness increases and grace of movement is sought almost always do the arches improve. In my opinion one of the main virtues of the exercise described the video is simply the experience of transferring the body's weight from the medial side to the lateral side of the foot.

Finally, and I will video this, watch what happens in the whole body when you balance on one leg: external rotation of the hip joint; even distribution of the weight across the forefoot, etc. No one can balance unless this happens; and where we are balanced, we are balancing on the foot's tripod as discussed. No stable balance is possible in any other way. More: if you then deliberately provoke this balance (for example, by trying to apply a pushing force via the arm at right angles to gravity, this causes an even more intense seeking of this forefoot weight distribution. I have an exercise (using a cable machine) that literally creates all the internal neural activations for arch formation/balance acquisition, and I will try to shoot this next week.

[Jim Pickles]

>And to answer your earlier question, IF the arch is strong and properly formed, then the most natural/efficient way of provoking pronation and eversion is by simply internally and externally rotating the whole leg; this is done by the internal and external rotators of the hip and only the hip. OTOH, if the arch is not formed well, then what you describe are options (and I can make myself do this too, but it is not natural to me). I have tested this hypothesis with many people, so am reasonably sure it's operative.

Well, I can only experiment on myself and I am abnormal in a number of ways. But for me, the hip rotators have very little indeed to do with it (at least, I can slightly evert by externally rotating from the hip, but it is not a strong effect - it's much easier to do it by using muscles lower down the legs/ankles). And if I stand on one leg, the external rotators are not involved at all - all I have to do is to tighten my abs to keep the hips level - and as far as I can tell my external rotators can be completely relaxed, at least as far as I can tell by prodding my behind with a finger.

>And these observations are why I recommend against orthotics for the majority of people who have been diagnosed with "flat feet". The very stimulation that will required to change this state will be lost; ...

I dont disagree at all - though it must depend on the degree of pronation and for me orthotics are essential. But it is of course much better if the effect can be developed "naturally" through the techniques as you describe.

>In the same vain is often said that many dancers walking with a first class with flat feet but never end their careers with flat feet.

Margot Fonteyn was well known for starting with flat feet - she initially took up ballet I think to correct them (maybe that was another famous dancer though). Shay Green, a podiatrist in Brisbane I went to sells something called "arch angels" which are curved pieces that fit in ballet shoes, that press on the middle of the arch, to encourage the sort of feedback you are talking about to encourage ballet dancers.

For me, the things that help most are (1) rises such as you show in the video, and (2) a "standing" exercise which is I think standard in yoga, standing and putting the weight down so as to identify all the 3 arches you talk about and ensure even distribution of weight on the heels, and big toe and little toe balls of the feet. I use this with my students - it feels very good and firm.

In relation to transferring more of the weight to the outside of the foot - as far as I can tell (for me; and on my better side) the problem is that the arch tends to collapse inwards even when (if standing normally) there is even pressure on the inner and outer edges of the front of the foot. More pressure on the outer edge helps this, but the really good thing I find is then having done this to press the big toe ball of the foot down hard as well. This seems to lift and align the arch and ends up feeling not only a very strong position but a more natural one as well (though it is an effort to hold).

(All this is rather the same as the exercise you describe in "Correcting flat feet; in response to a q. from Coach Sommer").

Anyway, many thanks for your comments, all very helpful indeed,

Jim.