From Foot to Finish Line: A NYC Sports Chiropractor’s Perspective on Lower Extremity Biomechanics

As a NYC Sports Chiropractor the foundation of your stability and mobility starts in the foot. Common repetitive stress injuries found up the kinematic chain actually originate in the foot. (think🦵: ankle ➡️ knee ➡️ hip)

The source of common running injuries like chronic ankle sprains, shin splints, posterior tibialis tendinitis, patellofemoral syndrome, heel pain, stress fractures, and even hip pain can be due to altered foot mechanics.

Think how efficient and effective the lower extremity is to be able to absorb shock or produce force when walking down the block or going the distance in a marathon.  

Pronation is normal

During normal motion the primary shock absorber is foot pronation.  That’s right, pronation is “normal.”  Pronation can be a problem if it happens too fast, too much, too little, or not at the right time.  The primary muscle that controls pronation is the posterior tibialis muscle.  This muscle does not function by shortening(concentric contraction), but by slowing down elongation(eccentric contraction).  The end result is the arch of the foot lowering gently to the ground instead of slapping the ground.  The secondary shock absorbers are knee flexion and then internal rotation of the hip.  

Supination is normal

Walking and running is truly a dynamic motion meaning movement happens in the X, Y, and Z axis. Our bone and joint structure facilitates this process.  A great example of generating force in all three planes of motion is when you have someone lift your great toe while standing.  That toe transmits force to the plantar fascia; note what happens to the foot, knee, and leg.  Upon loading that big toe into extension the whole lower limb externally rotates and the arch of the foot raises into supination turning on the powerful muscles of the hip to propel the body forward.  

Normal transition from pronation to supination

The gait cycle when working properly is really elegant because as the one side of the body supinates and externally rotates to produce force the other pronates and internally rotates storing elastic energy to make the process more efficient and effective.  With each step pronation allows shock absorption and the center of gravity to move over the ankle so the hip muscles can produce force to spring into extension.

Free strength and energy leaks

It is common for athletes to push beyond their capacity, work through a minor injury, or not properly rehab an old injury leading them to work around a problem or compensate.  Often, the body learns to only absorb shock or generate force on one side and the athlete will lose that “free strength” and balanced energy transfer.  The inability to transmit force through this process is considered an “energy leak.”  Instead of proportional force absorption through the kinematic chain one area can take a beating.  It is ok to limp if your foot hurts, however, it is not wise to run a marathon while limping.

Fix your injuries

All the magic happens when you smooth out the transition from pronation to supination.  By training the ability of your feet to alternately absorb shock and then transmitting that force into power production you can fix your chronic repetitive sprain/strain injuries of the lower extremity.

Chiropractic Adjustment of the foot/ankle

“Doc, can you pull my leg?”

Static posture and assessments on the table are a window into gait analysis.  We are constantly asking, Does the body have the ability to get into normal ROM? Once a misalignment or compensation is found our chiropractors will use an adjustment to normalize joint mechanics. 

A chiropractic adjustment of the foot is a powerful reset to the system that then needs to be reinforced with ROM and then reloaded with strength.  We can adjust the subtalar joint into pronation or supination.

Rocker/Wobble Board to decrease ankle/foot pain

After adjusting the subtalar joint we need to restore normal ROM.  The ankle joint normally rolls “out” twice as much as it rolls in.  Usually, there is an obvious loss of specific ROM or insufficiency when we use the wobble board. We train this ROM using a rocker or wobble board one leg at a time first while seated, then with weight, then with body weight.  We go clockwise circles 25x then counterclockwise.  If you don’t have a wobble board at your gym, you can easily make one using a lacrosse ball in the center of a 5-10 lb bumper plate.

As a sports chiropractor, common mistakes I see are people making their dysfunctions stronger by squat training on a bosu ball before they can get in and out of pronation on one leg at a time.

Graston/ART of the foot/ankle addresses the soft tissue and muscle movement patterns. When muscles learn compensations they take shortcuts and become tight, stiff and fibrous holding our body in an altered state.  Even after our time sues heal our body learns altered movement patterns. Soft tissue work of the posterior tibialis, fibularis longus/brevis, and ligaments of the foot and ankle restores the ability of the foot to pronate and supinate through full ROM so the body can re-learn a good pattern.  We start on the table and progress to functional patterns.

Self-massage is a great way to reinforce proper movement patterns and prepare you for your next workout.  After you have identified your key trigger points(posterior tibialis is usually a big culprit)-releasing them on your own with a foam roll or massage ball every 3 days will ensure you re-in force good movement and can give you feedback about how you are doing.  Less pain and more ROM indicate you are decreasing the use of that dysfunctional movement pattern.

Strength and balance of the foot/ankle: standing on one foot attach a low band directly behind you and kick that leg forward from the hip.(You are actually working the stance leg)  Remember to keep your hips square and even.   Then turn 180 degrees and kick your leg across your body.  We use reps of 25 at a light resistance to start.  If you can’t keep the hips level try leaning forward onto a wall.

3 ways to improve posture from the ground up

1.  Vele forward lean maneuver hold 5 seconds repeat 20x daily;  progress to performing while holding  5 percent of body weight and then shifting weight from one side to other.
2. Modified warrior pose: classic warrior pose the trail leg is allowed to go into external rotation. We modify to to mimic gait patterns keep that back leg straight and pelvis square and level.
3. Heel raises on a stair: make sure you don’t roll out! Put pressure through your big toe.