Foot Pronation

Here is an article about how foot pronation affects your lower back and pelvic region:

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Dynamic Chiropractic – September 1, 1993, Vol. 11, Issue 18

The Pronated Foot and the Lumbo-pelvic Area

By Keith Innes

One of the most common foot disorders is the pronated foot. It can be used as an example to illustrate how

alterations in its function can be followed by a series of biomechanical changes that produce a wide variety

of signs and symptoms through the interrelated structures and systems of the body.

The pronated foot presents with multiple site fixations that could include the posterior subtalar joint, the

calcaneotalonavicular complex, the cuboid, mortice joint and the first ray. Weight will be borne on the

medial structures and there will be an internal rotation of the entire lower extremity accompanied by an

increase of the normal anterior pelvic inclination. With internal rotation of the femur, the greater trochanter

moves anterior and the lesser trochanter moves posterior. These two bony processes are traction processes,

the former for attachment of gluteal muscles, and the latter for the tendon of the iliopsoas. In the case of the

internally rotated lower extremity, the tendon of the iliopsoas is tensed as it passes to the tractionation. It is

worth noting that this increased tension may cause pain over the anterior aspect of the hip joint from which

the tendon is separated by a bursa.

If the anterior pelvic inclination is increased, the posterior portion will be elevated, accompanied by an

abnormal stretching and tension of the hamstring muscles. In this group the biceps femorus holds the

greatest clinical interest. Although the long head originates from the ischium many of its fibers are directly

continuous with the sacrotuberous ligament. Traction of this muscle makes tense the entire ligament and the

coccyx is therefore made to move on the sacrum. Clinical importance of this relationship is significant. Just

anterior to the coccyx is the ganglion impar of the sympathetic trunk and the anorectal region with its

visceral branches to the hypogastric and pelvic plexuses. Tensions of this ligament should be kept in mind

when coccygodinia and the wide variety of perinopelvic disorders that may well be associated with pelvic

imbalance are encountered.

Elevation of the posterior part of the pelvis, coupled with the forward position of the greater trochanter, is

accompanied by increased tonicity of the piriformus muscle, upon which the sacral plexus of nerves lies

within the pelvis. The above situations of pelvic dysfunction may give rise to a sciatic pain that is secondary

to the postural change. At this point, I would like to remind the reader that the cause of this scenario is the

subtalar joint pronation; it is this that must be adjusted to fix the postural abnormalities and structural

compensations.

Increased lumbosacral junction angle is a common finding in those patients with pronation of the foot and

associated internal rotation of the lower extremity. The center of gravity falls anterior to its normal position

and a shearing force takes place at the L-S junction. Strain of the iliolumbar ligament usually results and a

lumbosacral junction subluxation is produced.

Unleveling of the sacral base must be followed by other changes since it is the body’s nature to compensate

for structural imbalance. The groundwork has now been laid for extensive spinal pathology from sacrum to

occiput.

The pelvis has been mentioned as the junction between the mobile spinal segments and the moveable lower

extremities. It is therefore important to remember that not only are the somatic structures involved but also

the genitourinary and gastrointestinal systems as well.

The soft tissues, the muscles, fascia, and ligaments functioning under abnormal stress and strain, in an effort

to keep the body in as near normal a position as is possible, are usually contracted, sometimes stretched, and

sometimes shortened. Generally speaking, the muscles, the origins of which have been brought closer to the

insertions due to the postural change, are the ones that will undergo shortening. The opposite relations

produce stretching: both may be painful upon palpation. These areas are found in relation to the postural

groups concerned. The principal ones are: (1) the plantar fascia and muscles; (2) the gastrocnemius and

soleus forming the calf of the leg, where the most tender point is at the site of injunction of the tendinous

portions of the two muscles at the middle of the calf; (3) the iliotibial band of the fascia lata on the lateral

aspect of the thigh where the tensor fascia lata and the gluteus maximus enter about its middle, the origin of

the satorius at and below the anterior superior iliac spine, a muscle that undergoes shortening in this

condition and which helps to maintain the anterior inclination of the pelvis; (4) the fleshy origin of the

gluteal muscles associated with the dorsum illi; and (5) the area over the extrapelvic portion of the

piriformis muscle. The last named point requires definite location which can be reached midway on a line

drawn from the tuberosity of the ischium to the greater trochanter of the femur. At this point where the

sciatic nerve passes downward into the thigh and immediately above it, the painful piriformis spasm can be

elicited.

So what do you treat? Obviously the foot, but more specifically the subtalar joint. The subtalar joint must be

examined for joint play motions in both a closed kinetic chain and an open kinetic chain as talar motion is

ONLY a function of the weight bearing foot. MPI’s new E1 Lower Extremity seminar details many new

examination and adjustment procedures that will enable you to become a more proficient doctor when it

comes to locating the CAUSE of your patient’s low back pain.

Keith Innes,

DC Scarborough, Ontario

Canada

Editor’s note: Dr. Innes will be conducting his next MPI seminars October 2-3 ("Upper Extremities") in

Toronto, Canada; Oct. 9-10 ("Lower Extremities") in Chicago, Illinois; and Oct. 16-17 ("Full Spine") in St.

Louis, Missouri. You may register by dialing 1 (800) 359-2289.

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Pelvic floor exercises

Here is some insight on developing the pelvic floor, one of the deepest layers of muscle:

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Reviewed by Dr Hilary McPherson, consultant obstetrician and gynaecologist and Dr Kate Patrick, specialist registrar

Pelvic floor exercises are sometimes called Kegel exercises, after the obstetrician who developed them. Another name for the exercises is pelvic floor muscle training (PFMT).

What kind of incontinence can they help?

Pelvic floor exercises are one of the first-line treatments for stress urinary incontinence (SUI).

There is no evidence they are effective for urge urinary incontinence.

How effective are they?

In 1998 Norwegian scientists carried out a six-month trial on different treatments for SUI:

• pelvic floor exercises
• electrical stimulation
• vaginal cones
• no treatment.

The women who did pelvic floor exercises showed the most improvement.

How do they help SUI?

The exercises are designed to:

• make your pelvic floor stronger
• make you more able to tighten your pelvic floor muscles before pressure increases in your abdomen, eg when you sneeze, cough or laugh.

How do you do the exercises?

Pelvic floor checklist

1. Identify the muscles.
2. Contract the muscles correctly.
3. Use fast and slow contractions

Pelvic floor exercises are best taught by a specialist, eg a continence adviser or physiotherapist.

Visit your GP or phone the Continence Foundation helpline on 0845 345 0615 for details of advisers in your area.

1. Identify the muscles

First you need to find your pelvic floor muscles.

Try to tighten your muscles around your vagina and back passage and lift up, as if you’re stopping yourself passing water and wind at the same time.

A quick way of finding the right muscles is by trying to stop the flow of urine when you’re in the toilet. Don’t do this regularly because you may start retaining urine.

Once you've found the muscles, make sure you relax and empty your bladder completely.

If you're not sure you are exercising the right muscles, put a couple of fingers into your vagina. You should feel a gentle squeeze when doing the exercise.

2. Contract the muscles correctly

The movement is an upward and inward contraction, not a bearing-down effort.

When you first start the exercises, check that you are doing them correctly. Put your hands on your abdomen and buttocks to make sure you can’t feel your belly, thighs, or buttocks moving.

• Don't hold your breath. You should be able to hold a conversation at the same time, or try counting aloud while you're doing the exercises.
• Don't tighten the tummy, thigh or buttock muscles - you'll be exercising the wrong muscle groups.
• Don't squeeze your legs together.

3. Fast and slow contractions

You need to train your pelvic floor muscles through repetition, in the same way as you would train a muscle group at the gym.

Slow contractions

Slow contractions help to increase the strength of your pelvic floor. They help your muscles to hold back the urine.

• Lift your pelvic floor muscles to a count of ten.
• Hold the muscles tight for 10 seconds.
• You may find at first that you can only hold the contraction for one or two seconds, so concentrate on lifting your muscles and holding the contraction for as long as you can.
• Gradually increase the time until you reach 10 seconds.
• Relax your muscles and rest for 10 seconds.
• Repeat the contractions up to 10 times.

Fast contractions

Fast contractions help your pelvic floor to cope with pressure, for example when you sneeze, cough or laugh. This works the muscles that quickly shut off the flow of urine.

• Lift your pelvic floor muscles quickly.
• Hold the contraction for one second.
• Relax the muscles and rest for one second.
• Repeat the contractions 10 times.

How often should I do the exercises?

Try to do one set of slow exercises and one set of fast contractions six times a day.

The Chartered Society of Physiotherapists also recommends that you do a quick contraction just before you cough, sneeze or laugh.

You may also find it useful to do a fast contraction just before you get out of a chair. This is because the movement of getting up puts pressure on your bladder and pelvic floor.

How do I know they are working?

You can test your muscle strength with the stop-start test. When you urinate, partially empty your bladder and then try to stop the flow of urine.

If you can’t stop it completely, slowing it is a good start. Try the test every two weeks or so to see if your muscles are getting stronger. Don't do the test more often than this.

The pros of pelvic floor exercises

• They’re simple.
• They’re cheap.
• They’re effective.
• You can do them when sitting, standing or lying down.
• You don’t need any special equipment, but until you get into the habit of doing them, you may find that a tick chart helps to remind you to do your exercises.
• You can do them with or without vaginal cones.

The downside of pelvic floor exercises

• You have to keep doing them for the rest of your life.
• It can take up to 15 weeks before you see any difference.
• If you haven’t noticed a difference after three months, see your continence adviser again to check whether you’re doing them correctly or if there's another problem.

References

Bo et al: Bo K, et al. Single blind, randomised controlled trial of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment in management of genuine stress incontinence in women. BMJ 1999;318(7182):487-93.

References

Bo et al: Bo K, et al. Single blind, randomised controlled trial of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment in management of genuine stress incontinence in women. BMJ 1999;318(7182):487-93.

Based on a text by Dr Dan Rutherford, GP

Stott Pilates: the five basic principles

This information is found on wikipedia. I recommend all my students to incorporate the 5 basic principles -- not only in your exercises, but also in everyday life!

The Stott Pilates method has exercises designed to restore the natural curves of the spine and rebalance the muscles^[5] around the joints. The Stott Pilates method places more emphasis on scapular stabilization than other methods do.^[6] The method focuses on the following five basic principles^[7]:

• Breathing
• Pelvic placement
• Ribcage placement
• Scapular movement
• Head and cervical spine placement

[edit]Breathing

The breath pattern^[8] used in the Stott Pilates method involves an expansion of the rib cage out to the sides and back without allowing the shoulders to lift. According to Stott Pilates, it is also important to breathe into the lower part of the lungs, because there is more efficient gas exchange.

[edit]Pelvic placement

Pelvic placement emphasizes stabilization of the pelvis and lumbar spine (lower back).^[9][10][11] in either a neutral or an imprinted position. Neutral placement maintains the normal curve of the lower back^[12]: when lying on one’s back, the front of hip bones and pubic bone should lie parallel to the mat, and the lower back should not be pressed into the mat. While breathingand engaging abdominals^[13] in this position no strain should be felt through the lower back^[14][15] In an imprinted position, the lower back is moving toward the mat.^[16]

[edit]Ribcage placement

The ribcage position affects the alignment of the thoracic (upper) spine. When lying on the back in a neutral position, maintain the sense of the weight of the ribs resting gently on the mat (that is, maintain the normal curve of the upper back). Don't lift off or push the rib cage into the mat. Pay particular attention to the placement of the rib cage when inhaling or while performing arm movements overhead.

[edit]Scapular movement

Stabilizing the scapulae (shoulder blades) on the back of the rib cage is as important as contracting the abdominals^[17] during the initiation of every exercise. This will help avoid strain through the neck and upper shoulders. To achieve proper placement, a sense of width should be maintained across the front and back of the shoulders, making sure to neither allow the shoulders to round forward too much nor squeeze together toward the spine. Shoulders should not be lifted too far, or over-depressed. Placement should be somewhere between these two positions.

[edit]Head and cervical spine placement

The cervical spine (neck) should hold its natural curve with the head balanced directly above the shoulders when sitting, lying and standing. In some cases, a small pillow should be used when lying on the back to put the head and neck in a comfortable position. Whenever lifting the head and upper body from the mat, lengthen the back of the neck and nod the head forward without jamming the chin into the chest. There should be enough room to fit one’s fist between the chin and chest. Once the head is in proper position and the shoulder blades are stabilized (Principle 4), the upper torso can be lifted by contracting the abdominals and sliding the rib cage toward the pelvis.

Envisioning what you are working on: the pelvic floor anatomy

"Hmm. And just exactly where is my sacrum...?"


I'm sure you must have asked this question to yourself a dozen times during our first few pilates sessions together. 


Here's a video that will help you envision what I'm talking about when we're training your core. (Sorry, men, this video is based on the female anatomy; but it should still be somewhat helpful - and very informative.)

Introducing the Signature Pilates Studio resource blog!

Hello! My name is Yvonne, and thank you for checking out my pilates studio blog. This will be a place for me to share helpful resources about Pilates & health...


Please check out my studio website: www.signaturepilatesstudio.com