Mr. Halberd Hithy’s funky feet.
Mr. Hithy is about to enter my office on a Thursday. I know from our phone call two days before of his current state of being:
Occupation: IT – State of Idaho
Daily Activities: Running, Netflix, and Baking – he loves his danish pastries.
Primary Complaint: Pain at the bottom of his right foot. Feels mostly when he begins running.
Secondary Complaint: Right lateral knee pain. Feels most towards end of a run and afterwards for a short while.
Tertiary Complain: Stiff back in the morning. Loosens up after 10-15 minutes of moving around.
I immediately note that Mr. Hithy is on the taller side as expected for a competitive mid-distance runner – somewhere between 6’3″ and 6’5″. His true height is clouded due to his flexion dominated posture; something I expected to find in a man who spends his day over a computer screen.
Upon discussion I’m able to extract the following pieces of information:
– Main distance is a 10k but also enjoys running 5k’s and half marathons from time to time.
– His hydration is poor to moderate for a man who runs 40 miles a week
– Part of this is due to his substitution of water for various other beverages.
– Side sleeper
– Past history of shin splints bilaterally – although the right side was always worse. Hasn’t bothered in years.
– Stretches rarely to never
– Only runs – doesn’t do any other forms of fitness
– Left side low back is usually a little more cranky in the morning
– Due to his lifestyle we note that he spends the vast majority of his day flexed and hunched over. This is due to his work at a desk for 8-10 hours a day, watching shows on Netflix from his comfortable chair, being hunched over the kitchen counter baking (he is quite tall) and then sleeping on his side in the fetal position. Holding this flexed position for 16-20 hours a day has the potential to completely reshape his structure. These activities will need to be modified for any long term results to occur.
-Bilateral flattened arches – right side lower
– Common Cause: shortened gastroc, soleus, peroneus longus. Underactive/inhibited tibialis anterior
– Externally rotated feet
– Common Cause: shortened deep six hip rotators, biceps femoris. Underactive medial rotators – glute medius, glute minimus, TFL
– Mild genu valgus (knock kneed)
– Common Cause: shortened TFL/IT Band, Vastus lateralis. Under active gracilis, semiteninosis/semimembranosis
– Anterior pelvic tilt – right side worse
– Common Cause: shortened rectus femoris, TFL, Iliacus. Weak/inhibited glute max, hamstrings,
– Forward body lean
– Common Cause: Shortened Iliopsoas, rectus femoris, upper abdominals, scalenes, SCM. Weak/inhibited ESG, Glute max, hamstrings, rhomboids, middle/lower trap, lower abdominals.
– Forward rounded shoulders
-Common Cause: Shortened pec major, anterior deltoid, upper abdominals. Weak/inhibited serratus anterior, rhomboids, posterior delt, middle/lower trap
– Head forward posture
– Common Cause: Shortened SCM, Scalenes, sub occiptials. Weak/inhibitied longus colli/capitus
Palpation confirms anticipated findings. Due to moderate hydration tissue release was mediocre.
Foot pain likely coming from imbalance in the soft tissue sling of the medial arch along with overactive calves. In addition to the muscle imbalance his capability in single leg balancing exercises was quite poor. Corrective exercises for ankle reflex stability will be essential to full improvement.
Excessive tightness in the triceps surae is likely the main factor involved with the foot/ankle issues however it is likely being instigated from the anterior pelvic tilt and excessive forward lean that is putting the body at odds with gravity. This forward translation of weight places continuous increased stress on the gastroc/soleus complex leading to excessive hypertonicity. Again corrective exercise for core stability and hip extensors will be required to correct the structural imbalance.
The lateral knee pain is likely due to the mild genu valgus and a tight TFL/IT Band. Softening to the TFL followed by the IT Band (that order is important) will likely alleviate symptoms however the dysfunction is based around pelvic imbalance so we need to correct that for long term results.
Low grade chronic back pain likely from shortened Iliopsoas and weak core stabilization. It should clear itself with the work being down for the foot/ankle and knee.
I don’t want to overload the client with too much self care to begin so I’m going to start him with what I think will get us the most results the quickest. Given my findings this would be the beginning plan for Mr. Hithy.
Self MFR/Stretch: Iliopsoas, TFL, rectus femoris, triceps surae
Activate/Strengthen: Lower abdominals, Glute max/hamstrings, Tib Anterior.
Attempt to stretch 2-3 times a day gently. Strengthen 1-2 times daily with just enough resistance to create a mild degree of difficulty. If there is pain with any of the activities cease them immediately and contact me.
Start drinking more water and less other beverages.
Attempt to shift sleeping position away from curled up on his side. Ensure good ergonomics at his desk, perhaps a standing desk, or at the very least stand every 30-60 minutes and do a couple gentle stretches.
Follow up for massage 1x a week until symptoms have dissipated. I don’t anticipate this being more than 2-3 visits. Next visit begin working more expansively in an attempt to further resolve postural related issues and continue to realign the body.