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Movement is Key by APC's head podiatrist Colin Papworth

Movement. We take it for granted, until, that is, we can't do something. Then we are pulled up short. Like when we get a pain in our back or in our foot. All movement stops, we tense up, our bodies go rigid - this is our way of protecting ourselves. No movement equals no pain. This is what our bodies are designed to do. Our brains are fantastic, they protect us so much more than we think. Overriding our brains self protection mechanism is hard. How much effort does it take when we are trying for a sprint finish, we feel like we have given our all, we could give no more, we are totally spent. Then 5 minutes later we are up, walking about, chatting about our experience and queueing for a beer. Our brains have released their hold on us, our physiology has settled down and we are (nearly) ready to go again.

 This process of our bodies looking after us can happen really quickly as seen above, or it can happen slowly over a period of time. Almost without us knowing it is going on. We get a bit slower, can't stretch quite as far, notice that some movements are not quite so easy to do. This is a part of our natural ageing process but it can be speeded up in response to an injury or a change in an extrinsic factor. We may sprain an ankle and not fully regain full movement. This may be enough movement for day to day activity but restrict us when we want to do a bit more. If we change jobs and now spend a lot of our time sitting behind a desk, our bodies will respond to this new position; we may find our hip flexors (muscles in the front of our hip) are tighter when we try and stretch them. This may also start to affect our function - the way we move.
 
 

The main change we see, if this starts to happen, is that our stride length shortens as our hips do not move as much, this may then lead to us pulling our leg forward when we walk rather than pushing our leg out behind us. This will mean that we are not as strong in the push phase of our gait and we may feel that we have lost some of our 'spring' when walking, we overuse our hips to pull our leg forward. This new way of walking then becomes our normal way of walking. We may get some low back tightness and tension and you may be told your hips are tight and that you need to stretch them. But this is to no avail, because, unless you are able to lengthen your stride when walking the hip flexors will always remain short and tight and your back pain will remain. You have to change the way you are walking/using your hips to make the big changes you require to ease your back pain.

 

Bodies respond to the way they are used and they do this by adapting to their shortest functional length. So if you use muscles in a short range then this is all they will give you. Only doing static stretches for a short time is going to make very little difference, except maybe some short term relief. To make the big changes you need to know how you are moving and how to change this short movement pattern, so you can learn to use your hips through a longer range. Then you will use the muscles in a way that has the effect of stretching them whilst you walk or run.

 

Let's take a look at walking as an example. I see lots of people in the clinic and I spend a lot of time showing them how to walk again, how to use their bodies in a way that is more beneficial to them. This is key before we start moving onto looking at either making changes to running form or start to address specific rehab exercises. We all spend so much time walking and we can really help ourselves if we get this right. Walking is all about flowing movement and minimising the impact forces and maximising the push off force. We need to use our whole body in this process and this is often what I see that has been lost.

 

When we walk we should contact the ground with our heel and roll the foot onto the ground using the heel as a pivot. Our hip and knee bend to absorb the impact forces. This bending stretches out some muscles which store this impact as potential energy.

 
 We then roll through our ankle and the hip and knee straighten as our body moves over the planted foot. The stored energy in our quadriceps and calf muscles is returned to help this process. This stretching of the muscles and soft tissue is paramount to enable efficient walking. Once our body has moved over the planted foot it is important we carry on this stretch mechanism. This is the point where the problems with walking can begin.
 

As our body continues to move over the foot on the ground we ideally want to keep the supporting leg straight and use this to push off from. This means leaving the heel down on the ground, and stretching out the muscles and soft tissues behind us as we continue to move forward. As we move further forward, just before the swinging foot is about to touch the ground, our heel will lift and we roll forward onto the ball of the foot and toes. This process is aided by the contraction of the calf muscles to drive us forward.

 
 

Further up the body, the opposite arm to the standing leg should move behind us, so creating a natural arm swing that is opposite to the leg function. Our legs will follow our arms. This creates a stretch and tension through all the soft tissues from our standing big toe up our leg, across our pelvis and back to our opposite shoulder and hand. This in effect winds up our body, a bit like a golf swing, and releases the stored tension to make the next step. The same for the upper body, tension is released across one side of the body and created on the other side. This stretch and release way of walking means we have to put less energy in as we can use the stored potential energy from the stretch of the muscles and other soft tissues.

 
 
Issues can occur due to a number of reasons. The main one being that our push off leg does not come back behind us and so offers limited push. This can be due to a number of issues; the main one being that one of the three pivots (heel, ankle, ball of foot/toes) is not working properly. If we have a physical restriction such as a stiff ankle or big toe then we will find it hard to get past these. That is a whole different blog. Mostly these restrictions are functional, i.e. the joints do work, we just do not use them. This is the adaptive mechanism we mentioned at the beginning of this blog. This may be due to an injury, anywhere, and our body has compensated in some way. It may be due to a shortening of a muscle due to a new way of using them - such as a desk job or driving. The point is our body adapts to the way we use it and this then becomes the new normal. We do not allow our leg to drop out behind us, we stop pushing the ground away and we start pulling our leg forward through the swing phase. This is due to not having any stretch and, therefore, no potential energy stored in the soft tissues to help us and this 'pull' method of walking becomes our normal way of walking. Walking becomes harder, we shorten our stride and use less elastic return. A vicious circle soon starts to develop. That may lead to a variety of consequences. The classic gait pattern we see in clinic that shows that this is happening is an early bend of the knee into push off, so no straight leg, reduced arm swing and a side to side roll instead of a strong arm swing. People report tight calf muscles, low back pain / tension and not feeling as walking well - 'losing the spring in your step'!
 
 
So what can you do about it?
 
The big thing is to be aware of your posture. If you recognise any of the above issues, forever stretching out tight calves or hamstrings, tightness in the front of your hips or functional low back pain then how you are moving may well be a factor. Try to chang your walk. Stand tall, soft knees, let shoulders relax, shake your head - we hold so much tension in our shoulders and neck. A couple of deep breaths, just walk, keep tall, keep shoulders relaxed, let them go with the movement of your body, let your arms swing, keep breathing. Now the top of your body should be relaxed and moving think about the bottom bit - the leg bit. Think about pushing the ground away behind you, straightening your back leg to push you forward, don't tighten up in your shoulders and arms. Just keep them relaxed and swing.
It will feel strange, you may feel a bit silly, because it is so different to what you normal do when walking. Play around with the movements, exaggerate your arm swing, push away hard, do a skip or a little jump, have fun with moving again. There are no rules just play around with what you are doing. If you want to know more or how I can help then please get in touch. Have fun. #movemore #movementismedicine
 
 

 

 
 

Sunday 30th of August 2020

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