Like most clinicians, I see my fair share of foot and lower leg pain. At the collegiate level, plantar fasciitis, posterior Tib pain, and Tibial stress fractures occur much more than I would like. We have seen a reduction over the last 8-10 years in these injury rates due to a better understanding of the causes, superior training techniques, improved nutrition and better patient education on when to seek help. But despite these efforts, due to the rigorous demands placed on college athletes, these ailments continue to plague some of our athletes.
One thing that I know about foot and lower leg pain is that they are rarely caused by the foot or lower leg. It seems that with only a few rare exceptions, the problem is somewhere else up the kinetic chain. Our job as clinicians is find the dysfunction and fix it.
Over the past couple of years, I have been toying with t
he idea of treating the foot and lower leg via Thomas Myers’ Spiral Line. When you look at the Myers Spiral model, you find that it creates a stirrup on the bottom of the foot, moving from medial to lateral. Myers’ approach also states that we can affect the fascial line anywhere along its path. If both of those items are true, then training in rotation will facilitate the more anterior portion of the line, while releasing the more posterior aspect of the line will, in theory, inhibit that part of the line. Thus, we can use the stirrup effect of the spiral line to assist the body in creating foot structure and unloading the medial aspect of the lower leg.
While I have toyed with the concept in the past, it wasn’t until recently that I have gone “all in” with it. I have had a run of athletes from various sports who have come to me with a long history of foot or medial lower leg pain, most of which date back to their days as a high school athlete.
Treatment has initially involved taping their spiral lines to both confirm my theory (by upregulating the nervous system in that area) and to provide an open window for corrective exercise to make faster and larger improvements. All patients have reported immediate and significant improvements in their symptoms with one even stating that she “hasn’t felt this good in 3 years” after her first treatment session.
Now that we know we are headed in the right direction, the corrective exercise portion of their therapy is pretty straightforward. It begins with anti-rotation exercises. One important item to keep in mind is that a person must first know how to resist poor rotation before they can create high quali
ty, authentic rotational movements.
Movements such as the Pallof Press, Rotational Bridge variations, and a plethora of carrying and crawling patterns make up the bulk of their therapy in the first few treatments. As they demonstrate postural control in an anti-rotation environment, dynamic rotational movements are incorporated. At this point, they typically rely less and less on tape outside of their training sessions, so the amount and frequency of using tape are reduced and eventually eliminated.
Obviously this is not the fix all for all foot pain. But, I do find that even high-end athletes struggle to move well in the transverse plane. Our training programs tend to focus on movements in the frontal and sagittal planes, thus making even mild improvements with rotation can make large improvements in the kinetic chain.
Overall, I constantly marvel at the human body and its complexity. Understanding the concept of regional interdependence is not always easy or convenient. But, if we are truly going to solve what ails our patients, we must play the detective to identify and correct their true dysfunction.
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