The pain was like a sharp spike driving directly into my hip. The longer I lay on it, the more the intensity mounted, until there was simply no way I could continue lying on that side.
So I’d flip over onto my other side…
Only to have the whole cycle repeat within 10 minutes.
Lying on my back was out of the question. The burning pain in my lumbosacral area was far worse than my hips. And it came on instantly… I didn’t even get 10 minutes peace in that position.
This was how I slept… or at least tried to, for a year or two after having my abdominal hernia surgery.
I wouldn’t say life was miserable…
That would be going too far.
But everything is definitely more difficult when your sleep is constantly interrupted by relentless pain every night.
One question kept going round and round in my head…
How could my body have got to this point?
I was in my early 40s…not exactly a young man anymore, but I felt and moved more like a man in his 80s.
As a chiropractor, I was getting regularly adjusted, by highly skilled colleagues.
I wasn’t sedentary. Whilst not a star athlete, I’d been reasonably fit my whole life. I played soccer throughout my childhood, then moved on to rock climbing and snowboarding throughout my 20s and 30s. I also hit the gym regularly.
I paid close attention to my diet and took a bunch of high-quality supplements.
How did it go so wrong?
And how could I stay in integrity and congruently continue to care for my patients when my own body was experiencing debilitating daily pain?
My x-rays clearly revealed what the problem was…
But not why it was there.
It doesn’t take a chiropractor to see that my L5/S1 disc was in bad shape. In fact, it was so badly reduced that the radiologist commented that it “may be congenital.”
Only I knew it wasn’t…
Because my previous spinal x-rays, taken when I was a chiropractic student at university, showed a perfectly normal L5 disc.
My hips weren’t in great shape either… bilateral osteoarthritis, reduced joint space, subchondral sclerosis, and suggestion of a type of deformity that tends to cause labral tears and cartilage damage.
Again, none of those issues were apparent on my previous x-rays.
I didn’t understand it then…
But I do now.
The answer lies in the fourth and final Key function of the human foot- The ability to create a Single Leg Stance (SLS.)
This is critical to maintaining an upright posture and bipedal gait… something that only humans are capable of.
On an evolutionary level, it was made possible not only by the development of our complex foot structure, but also by the shifting of our pelvis.
As we left the trees and adapted to life on the grasslands, our ilia rotated laterally. This shifted the function of our glutes from pure extension, to both extension and external hip rotation. This gave us control of abduction… an essential prerequisite for creating single-leg stability.
In simple terms, SLS is the ability to maintain stability and balance when one foot is off the ground. It sounds straight forward…
After all, we all do it several thousand times a day…
But biomechanically and neurologically, it’s one of the most demanding tasks the human body performs.
When we walk, SLS (also known as the swing phase of gait) accounts for about 60% of the gait cycle. It requires us to maintain our moving centre of gravity over a very small base of support (the foot on the ground.)
This demands precise coordination of the intrinsic and extrinsic muscles of our feet, legs, hips and spine, as well multiple aspects of our nervous system.
It all begins with the ability to:
- Effectively sense the ground
- Manage ground impact forces
- And unlock and lock the foot through pronation and supination.
Each of these key functions have been covered extensively in my last 3 emails (if you missed them please reach out and we’ll resend them to you. We’re currently working on an archive so you can access all previous emails… more on that later.)
What ties it all together are the myofascial meridians, described as Anatomy Trains in Thomas Myers excellent book of the same name.
These take all the individual joints, muscles, tissues and neurology and organise them into functional units. I’ve come to think of them as the pathways that force naturally follows as it flows through the body.
When it comes to creating a balanced SLS, the two key pathways are the Deep Frontal Line and the Lateral Line.
The Deep Frontal Line, as the name suggests, runs up the front of the body and connects our intrinsic foot muscles to our core. This provides a level of local stabilisation that is critical for SLS.
If we don’t effectively stabilise the foot there is no way we can stabilise the pelvis (and the rest of the body) above it. Therefore, this stabilisation is the first thing that must happen during the swing phase of gait.
The Lateral Line runs up the side of the body and includes our gluteal muscles. This is what provides the global stabilisation of the pelvis, keeping it level during gait rather than allowing the side where the leg is swinging to drop.
This whole cascade of stabilisation begins in the feet first.
As Dr. Emily Splichal, functional podiatrist and human movement specialist puts it…
“Your glutes are only as strong as your core is stable, and your core is only as stable as your foot is strong. The faster your foot can contract, the faster the stabilisation.”
Studies such as this one: Brain Connectivity Associated with Muscle Synergies in Humans
show that this pattern is hardwired. When intrinsic muscles in our foot contract, muscles in the pelvic floor reflexively fire with them.
The bottom line:
Without strong, functional feet, you can’t have a strong, functional core.
So how does this relate to my story about the premature degeneration of my hips and spine?
Well, unfortunately I grew up without strong, functional feet.
They were actually quite flat.
Everyone in my family knew about it… but nobody ever thought there was anything that could be done about it.
In fact, nobody ever even seemed to think that anything needed to be done about it. My feet didn’t hurt… nowhere really did (at that age.)
I was terrible at running… but so what? Swimming was more my thing anyway.
What nobody even imagined was how those dysfunctional mechanics would come to affect me by the time I hit my 40s.
What I’ve learned these days is just how critical our gluteal function is to the biomechanical stability of our entire posterior chain.
When our glutes don’t fire properly, we end up with tight, overloaded hamstrings and lower back muscles, such as multifidus and sacrospinalis.
You see this in your clinic every day.
Not only that, we end up shortening our stride, as we can’t fully extend our hip due to our poor gluteal activation.
This in turn means we don’t toe off effectively…
Which not only makes us slow, inefficient runners, it also causes a specific pattern of degeneration of our metatarsophalangeal joint, known as a “dorsal bunion.”
I know these photos aren’t super clear, but notice the red bony bumps on my MTP joints, especially on the left.
This is where the body has laid down extra bone to buttress that joint. It’s easily palpable. It limits my extension at that joint and further reduces my stride length and effective forward propulsion.
The redness is always there to a greater or lesser extent. It represents ongoing inflammation, despite my foot care routine and natural anti-inflammatory supplements like turmeric.
It’s not painful…
But it is dysfunctional.
Is it any wonder I ended up with L5/S1 and bilateral hip degeneration!
If there’s one key clinical tip I can share (apart from “you’re crazy if you’re not regularly wearing Better Balance Orthotics”) it would be this…
Pay attention to your patients’ gluteal function.
Check the tone, strength and firing patterns. If all you did was improve that, I guarantee your results with lumbar, cervical, hip, knee and even shoulder problems would improve significantly.
One thing I only learned relatively recently is the strong link between glut max activation and knee function.
In anatomy class I was taught that the glut max is an extensor of the hip, due to its insertion on the femur. What was never explained to me was that it also inserts heavily into the fascial tissue that forms much of the support for the posterior knee.
Since learning this and applying it in practice I’ve seen many knees that were “Better but still niggly” or “Better but still feels a bit vulnerable” become bulletproof.
Of course, if we don’t sort out the foot mechanics and activation through ongoing stimulation…
And our patients continue to wear shoes and walk on flat, neurologically boring surfaces…
Then these issues simply recur. Or morph into another form as the stress moves to the next weakest link in the biomechanical chain.
That’s why I’m such a believer in the benefits of Better Balance Orthotics.
When you combine that level of daily stimulation with your expert care…
You are really setting your patients for the best, most lasting outcomes possible.
Thanks for joining me on this deep dive into foot function over the last few weeks. I know these have been long emails. Hopefully there’s been some food for thought and some tips you can apply to have an even greater positive impact on your patients’ lives.
Next week we’ll be launching some upgrades to these weekly emails… I’m excited to start taking this message to the world in a bigger way. Keep an eye on your inbox and please feel free to share with anyone who you know would benefit.
Cheers,
PS. In case you were wondering, these days I’m 99% pain-free in my hips and lower back. It was certainly a journey getting here (which is still ongoing), but it’s been rich in lessons and experiences along the way. I know I’m preaching to the choir, but don’t ever doubt the ability of the body to heal… it’s such a gift to be part of a profession that gets to see (and experience) miracles every day.