This week I had the opportunity to watch a live dissection of a lower limb and foot. Anatomy is such a fascinating subject, especially when it’s taught and demonstrated from a functional perspective, rather than just a textbook, meat on a slab approach.
That was definitely the case here. The cadaver had never been frozen or embalmed, so the tissue was as close as possible to its natural, moveable state. It was quite different to my experience of studying anatomy at university.
I’m sure 24 years of clinical practice and hands on experience of anatomy in motion also provides a totally different context… at university it was largely an exercise in memorising strange Latin words!
This was instead a unique opportunity to add visual understanding and clarity to what I feel under my hands every day. It also taught me a whole new mechanism that explains some of the results I’ve been seeing in clinic… one that I previously never even knew existed.
I’ll bet you’ve never heard of it either… but you’ve seen it play out in your patients.
Recognising it will give you a fresh understanding of some clinical conditions you see every day… and why they can be so frustratingly persistent. It’ll also give you a preview of some of the techniques I’ll cover in the clinical workshop I’m planning.
One of the unique things about this dissection, apart from the state of the cadaver itself, was the perspective of the dissector. He was deeply versed in the Anatomy Trains model of the human body and an expert in myofascial dynamics.
Rather than looking at isolated individual structures, his focus was on their interactions and how they produce the intricate dance of human movement.
One of the first things he pointed out was the complex shape of the femoral condyles, including the medial one being longer than the lateral one. This mirrors the shape of the tibial plateau and creates and controls 3D movement.
In static anatomy thinking, we tend to consider the knee as simply a hinge with a little rotation. But it’s so much more than that. It’s the interaction between the tibial plateau and the condyles that initiates and relays the subtle vectors of movement that allow all the complex movements of the foot.
(Again, this is the difference between considering the body as a collection of parts rather than a deeply integrated whole.)
This includes all 26 bones of the foot working together to produce gait, stability, leverage and balance… to be honest, when you visually appreciate the complexity of it, it’s a miracle we can stand or walk at all, let alone run!
He clearly demonstrated the multiple pulley systems that maximise leverage and force transmission, allowing us to absorb impact forces when our foot strikes the ground and then return them as propulsive forces when we toe off.
These are 2 completely opposite functions… safely absorbing force on the one hand…
Then becoming a rigid lever to transmit force on the other. Our feet smoothly transition back and forth between these opposing functions with every single step…
At least they should if everything is working correctly!
(Spoiler alert… unless you’re wearing Better Balance Orthotics… it usually isn’t!)
What really struck me was how long the tendons are, and the fact than none of the lower leg muscles have their bellies in the foot. Some of the tendons were as long as his entire forearm!
There are 3 key tendons that wrap around the medial malleolus to create the pulley that maintains the medial arch of our foot. Those are:
- Tibialis posterior
- Flexor hallucis longus (FHL)
- Flexor digitorum longus (FDL)
Affectionately known as Tom, Dick and Harry…
(That one took me back to my university anatomy days… I hadn’t heard that in decades!)
The tendons that form the pulley around the lateral malleolus are:
- Peroneus longus
- Peroneus brevis
- Peroneus tertius
These 2 pulley systems are considered the major creators of our medial and lateral arches.
The most important muscles are the tibialis posterior (medially) and the peroneus longus (laterally.) These two muscles ultimately insert into the exact centre of the plantar foot and form a sling that maintains our arches.
Something I knew, but hadn’t really reflected on in the last few years, is that all of these muscle bellies are in the lower leg… not in the foot.
What that means is that none of these muscles are directly stimulated by Better Balance Orthotics.
Yet wearing Better Balance Orthotics consistently improves the arches in the feet.
Not just functionally.
Visibly.
I had totally flat feet for the first 30 years of my life.
Now I have clear, functional arches. I’ve shared in the past how my wife first noticed the shape of my footprint had changed as we were walking on the beach.
And I’m not an isolated case.
We see this outcome regularly with patients.
I tell them the orthotics stimulate the muscles, nerves and fascia in their feet.
As far as I understand it, they don’t work by stimulating tendons.
Yet none of these muscles supposedly responsible for creating our arches have any muscle fibres in our feet… only tendons.
So how are the orthotics rebuilding peoples’ arches?
(It’s not impossible that BBO may stimulate tendons- they do contain proprioceptors called Golgi Tendon Organs (GTOs.) But these largely monitor stretch. The dynamic, “bouncy” nature of the orthotics may provide some stretching, and therefore stimulation to the GTOs, but I’m yet to see research suggesting that.)
I believe there are 2 explanations.
The first is that the intrinsic muscles of the feet contribute more to the function of our arches than was previously thought. The research is increasingly supporting this.
Some recent papers have even shown that some people diagnosed with plantar fasciitis actually have no inflammation of the plantar fascia whatsoever.
Instead, it’s the intrinsic muscles that are involved.
These are located in the feet and are directly stimulated by Better Balance Orthotics.
I think this is one of the key mechanisms that creates many of their benefits.
One area this was particularly obvious during the dissection was when he dissected out the abductor hallucis muscle. It’s a relatively big, thick muscle and its belly corresponds exactly to the medial arch pocket in our orthotics.
It’s a perfect match.
No wonder that they’re so effective for correcting bunions!
Every step is firing this muscle and pulling that big toe back into alignment.
This is one of the things I love about them… and why they’re so congruent with our chiropractic paradigm…
They don’t work by pushing the foot into a different shape.
They work by Stimulating muscles and allowing the body to correct itself naturally.
The second explanation for their effectiveness also aligns beautifully with chiropractic.
It’s simply this…
Better Balance Orthotics don’t work through support… they work through Stimulation of the nervous system.
Every time they stimulate those intrinsic muscles in the feet, they fire off the muscle spindle cells (proprioceptors), directly increasing feedback to the brain.
I believe this is their most powerful mechanism of action. (There are also others, which we won’t dive into today, like their influence on fascia.)
This is how they improve the function of the extrinsic muscles in our legs that maintain our arches, even though they never touch those muscle bellies directly.They fire a signal to the brain, which then responds by resetting tone throughout the leg (and entire body.)
Research by Heidi Haavik and her team in New Zealand has demonstrated that this is primarily how a spinal adjustment works. It’s not just about the local mechanical tissue effects (although those do exist.)
It’s about sending a signal to the brain, which then resets tone, muscle length and movement availability in that area.
Our nervous system is a Sensory-First System.
When you improve the quality of the Inputs (for example, with an adjustment or with Better Balance Orthotics…)
It responds with improved quality of motor Outputs.
This also fits with a whole new clinical mechanism I learned during the dissection that I had never considered before…
Yet it’s incredibly common, and likely playing out with many of my patients…
And I’d bet with many of yours too.
I even recognised it in my own body.
As I mentioned, the dissector took a very holistic view of the body. Rather than focusing on individual joints or muscles, he demonstrated how they function together to transmit force and create movement potential throughout the body.
He showed how the tibia and fibula rotate laterally because of the shape of the tibial plateau and the different lengths of the femoral condyles. This sets up and allows movement of the talus, which then translates into movement potential for all 26 bones of the foot.
The talus has no muscles attached to it… its movement is completely controlled by its bony relationships.
Because the talus is wider anteriorly than posteriorly, when you squeeze the tibia and fibula together, it creates a mechanical “brake” on the talus that reduces it’s movement… and thereby reduces the movement of all the joints in the foot that come after it.
The example he gave was…
“Most people have sprained or twisted their knee at some point. If the collateral ligaments are thickened or scarred up from an injury, the rotation that takes place at the tibial plateau is reduced. So then the brake, the tibia and fibula, will act differently on the talus, and all the joints in the foot are going to accommodate and move slower. This is what creates “old person shuffle.”
This occurs when the nervous system detects any instability in the mechanical chain due to injury. It responds by tightening the muscles in the leg to prevent further injury.
Over time this tightens the interosseous membrane between the tibia and fibula, pulling them closer together and applying the “brake” to reduce instability.
Although I’d never heard of this mechanism before, I can personally attest to its effects.
When I was 17, I went skiing for the first (and only) time…
And seriously damaged the medial collateral ligament in my left knee.
After months of physio and walking on crutches, it seemed to settle down and I never gave it another though (except for switching to snowboarding to prevent a repeat incident!)
Decades later, I was snowboarding down a steep, icy mountain and realised I was going dangerously fast… and accelerating. I was still in control… and I wanted it to stay that way, so I hit the brakes pretty hard.
I didn’t fall. I didn’t even wobble.
But I completely blew out both the medial and lateral collateral ligaments of my left ankle, resulting in the wasting the whole next day in emergency waiting for an x-ray (nothing broken) and a premature end to my snowboarding season.
I couldn’t figure out why it happened.
I didn’t do anything I hadn’t done thousands of times before.
My other ankle was fine.
But my left one was a wreck.
In the course of repairing and rehabbing myself, and working with some excellent practitioners, it became apparent that the underlying cause that set me up for that incident was my left knee injury many years before.
Even then I didn’t fully understand the mechanism… but now I do.
Here’s the thing though…
You don’t need to be a skier or snowboarder to experience this.
How many people have never sprained an ankle before?
How many have never stepped funny and twisted something in their foot?
I’d say virtually no one.
Most people have had so many of these minor incidents they don’t even remember most of them.
And every injury is increasing instability in that mechanical chain…
Tightening the muscles in response…
Cinching the tibia and fibula tighter together through the interosseous membrane…
And applying the brake to the talus, thereby reducing movement throughout the entire foot.
Creating “old person shuffle.”
Shortening their stride and reducing extension at their hip joint.
Which loads up their lower back…
Weakens their glutes…
And tightens their hamstrings.
How many of your patients complain of “tight hip flexors”?
Even if they stretch regularly?
They’re chronically shortened because they never fully extend their hip.
They can’t… it’s simply not biomechanically possible once the talus “brake” is applied.
This is such a common and debilitating pattern I plan to write a whole future issue on it.
I guarantee you see it in clinic every day.
Recognising and understanding the pattern is the first step.
Learning how to easily and quickly test for it and resolve it is the next one.
It’s a game changer for your patients and your practice.
It’s part of what I plan to teach at the workshop I’m thinking of running here in Sydney. I mentioned it last week. Thanks to the people who’ve already put their hand up.
If you’d like to learn how to undo these hidden patterns that are setting up so many of your patients’ problems…
And actively working against your adjustments…
Let me know and I’ll add you to the list to notify about the workshop.
If you can’t make it, getting Better Balance Orthotics on your patients’ feet is a great start.
For years that’s all I did, not understanding how much more could be done. In fact, it was the quest to understand the results I was seeing that led me to develop the techniques I want to teach you.
Until next week…
Have a great week.
Cheers,
