The foot bones’ connected to the hip bone
The Human Movement System, or Kinetic Chain, is composed of the:
- Muscular system
- Nervous system and ;
- Skeletal system
Under optimal circumstances, these systems work together to create neuromuscular efficiency (the ability of the neuromusculoskeletal system to produce force, reduce force and dynamically stabilize the kinetic chain in all three planes of motion.
The human body is constantly bombarded by stress e.g. aging, decreased recovery and regeneration following an activity, repetitive movement, lack of core strength, immobilization, cumulative trauma, and postural strain.
The body compensates to these stresses through predictable patterns of dysfunction called Movement Impairment Syndromes.
These imbalances are characterized by:
- Altered length-tension relationships of myofascial structures (muscles , tendons and fascia)
- Altered force-couple relationships by the nervous system (faulty recruitment patterns of muscles on either side of a joint)
- Altered arthrokinematics (Joint mobility or stability problems)
Many common movement impairment syndromes originate from hyper-pronation of the feet.
Some joint changes that may occur as a result of hyper-pronation of the foot
Hyper-pronation may cause misalignment of the lower extremity, frequently leading to structural and functional deficits both in standing and gait. Some of these can include:
1. Change in tibial (lower leg) alignment towards internal rotation.
2. Change in the thigh alignment towards internal rotation
3. Change in the pelvic alignment towards an anterior pelvic tilt
Wainner et al in his review on Regional Interdependence, describes how “seemingly unrelated impairments in a remote anatomical region may contribute to, or be associated with, the patient’s primary complaint.”
All too often the symptomatic joint becomes the focus during rehabilitation, when the joints above or below may be the cause of dysfunction. (Wainner, 2007)
Hyper-pronation of the foot can affect muscles, causing some to be overactive or short and others to be underactive or long.
Both Janda and Clark describe myofascial structures at the hip that would be lengthened and shortened as a result of hyper-pronation of the foot.
These are evident as part of the lower extremity postural distortion pattern and lumbo-pelvic-hip postural distortion pattern.
These imbalances can predispose an individual to certain injuries.
What specific injuries at the HIP (acute and/ or chronic) are likely to be seen as a result of hyperpronation of the foot?
The altered length-tension relationships, force-couple relationships and arthrokinetmatics that result from hyper-pronation of the foot can include:
Injury patterns of lower extremity postural distortion: Plantar fasciitis, Posterior tibialis tendonitis (shin splints), anterior knee pain, low back pain.
Injury patterns of lumbo-pelvic-hip postural distortion patterns: Hamstring strains, anterior knee pain, low back pain, trochanteric bursitis, piriformis syndrome and lumbar and hip mechanical dysfunction.
The Take home message:
Clinicians and patients should be aware that knee , hip and lower back dysfunction can be a result foot alignment and that if the foot is not addressed, these problems will not resolve.
Clark, Michael A., Lucett, Scott C. (2011). NASM Essentials of Corrective Exercise Training. Baltimore, MD: Lippincott Williams & Wilkins.
Page, Phil., Frank, Clare C., Lardner, Robert. (2010). Assessment and Treatment of Muscle Imbalance. The Janda Approach.Champaign, IL: Human Kinetics.
Wainner, Robert S. et al. Regional Interdependence: A Musculoskeletal Examination Model Whose Time Has Come. J Orthop Sports Phys Ther 2007;37(11):658-660.
Willson, John D., Lloyd Ireland, Mary., and Davis, Irene. Core Strength and Lower Extremity Alignment
during Single Leg Squats. Medicine & Science in Sports and Exercise. 0195-9131/06/3805-0945/0