OUR BODIES NATURALLY WEAR DOWN WITH AGE, and there are many factors, from genetics to lifestyle, that affect the rate of this process. Father Time can be one of our body’s worst enemies, but we know that staying strong and maintaining balance and fitness, and optimal foot function, can decelerate this process, thus allowing us to live a more active life.

With that being said, one of the primary objectives of the treatment plan for our patients should include improving activity levels. Sitting truly is the new smoking. Combatting the negative effects of prolonged sitting is only achieved through a paradigm shift of improving activity.

Every day, athletes of all skill levels walk in the doors of our chiropractic clinics. My philosophy is that we should look at each patient for their athletic potential and thus treat every patient as if they are a world-class athlete.

With that being said, I will use the word “athlete” as a substitute for patient from here on. As stated above, one of the primary treatment goals is to help the athlete maintain or improve their active lifestyle. Our bodies are mobile machines and thus, not only do they like to move, but require movement. Active rehab is the avenue for addressing functional movement deficits and is a vital component to the management of injuries involving the elite athlete as well as the “weekend warrior.”

Unfortunately, injuries are commonplace in the active individual. In order to effectively manage the active athlete, the clinician should not only focus on the area of issue, but also identify technical issues that are potential contributors to their active complaints or future musculoskeletal injuries. The end result of most musculoskeletal injuries is stiffness. This restriction of movement compromises function, which leads to a loss of functional movement. It is here that we witness biomechanical failure and injury.

When addressing musculoskeletal injuries, the clinician should focus on three things:

• Injury prevention • Injury management • Maintenance

During each of these three phases, close attention should be paid to posture, alignment and mobility. This includes addressing technical issues that can be contributors to the athlete’s current condition or potential for future injuries. Addressing foot function and asymmetrical and unbalanced postures will greatly reduce musculoskeletal stress and strain.

When evaluating the injured athlete, always include a thorough assessment of the feet and work your way up the kinetic chain. The feet are not only our foundation, but the first line of defense when it comes to mechanical stress on the lower extremity and spine. Technical issues with the feet such as pronation can contribute to a myriad of musculoskeletal injuries. Two of the more common lower extremity musculoskeletal conditions are plantar fasciitis and IT band syndrome. Both conditions can be associated with excessive foot pronation. Therefore, to successfully manage these two conditions, the clinician must consider the feet as a contributor.

Foot pronation is easy to identify and addressing it via implementation of a custom foot orthotic will pay huge dividends. Supporting the natural architecture of the foot reduces the risk of many injuries related to the compensatory changes resulting from excessive foot pronation.

Lack of support to the plantar vault, as seen in pronation, causes excessive stretching of the plantar fascia when weight bearing, thus resulting in pain in the plantar surface of the foot and heel. Excessive pronation also causes stress on the hip and knee. Foot pronation affects the knee and hip by causing an accentuated genu valgus and pelvic un-leveling.

Based on its attachment sites and length, the IT band is intimately related to the knee and hip. Compromise in function through pronation results in unrestrained stress on the IT band, resulting in lateral knee pain and possibly hip pain.

Addressing technical issues within the feet, increasing flexibility and improving strength are the keys to prevention and recovery of these two injuries. During the gait cycle, the foot strikes the ground, and a cascade of events occur throughout the kinetic chain. The result is proper foot function and support, or failure at the ankle, knee and/or hip, depending on how the foot responds at impact.

In order to help the athlete reduce the risk of injuries to these areas, the practitioner must gain an understanding of simple lower extremity anatomy and biomechanics, and then incorporate specific evaluation and rehab protocols for the lower extremity.

A detailed evaluation of both feet is the first step in the prevention and rehab of lower extremity injuries, specifically plantar fasciitis and IT band syndrome. The foot is the keystone of the body’s foundation.

During the weight bearing inspection part of the evaluation, begin by evaluating the feet to determine the foot type. Pronation in varying degrees is a common finding among athletes. With pronation, the tibia rotates and the knee collapses medially causing a genu valgus deformity. Laser 3D technology is a state-of-the-art piece of equipment that evaluates the feet, providing a simple but detailed visual, allowing the athlete to see and understand the vital link between the foot and its impact on the kinetic chain. A custom foot orthotic can be a game changer when it comes to supporting the natural architecture of the foot, which in turn can prevent plantar fasciitis and IT band syndrome, as well as many other lower extremity and mechanical issues involving the spine.

So, what are some effective ways to evaluate the lower extremity? Begin by inspecting the feet. With the shoes off, identify the presence of a collapsed medial longitudinal arch. If present, direct your attention to the knees. Pronation will cause the tibia to rotate medially, resulting in a genu valgus condition.

An additional but valuable test is to have the athlete perform a single leg stance (SLS) exercise. With the athlete standing upright, have him/her balance on one leg and bend the weight bearing knee to 30 degrees. The practitioner should note the presence of any dynamic genu valgus when performing this exercise. If present, the dynamic genu valgus results from one or two issues: a technical issue with the foot such as pronation, and/or a lack of co-contraction between the quadricep and hamstring muscles. When present, these issues contribute to both plantar fasciitis and IT band syndrome. Both issues need to be addressed.

Foot pronation may require a custom orthotic to support the natural architecture of the foot. This will keep the lower extremity aligned properly and allow the foot to absorb and disperse energy at impact, reducing the transfer of impact up the kinetic chain. Specific strengthening, flexibility and proprioceptive exercises can be effective in managing and preventing these two conditions.

Targeted stretching and exercises can help ease and even prevent IT band syndrome and plantar fasciitis by improving flexibility and strengthening key muscles. The following are proprioceptive, strengthening and flexibility exercises that each athlete should routinely perform to reduce the risk of these two conditions, as well as other associated foot, ankle and knee injuries:

Single Leg Stance — Using a stability trainer, stand upright and balance on one leg for one minute. Perform three sets for one minute daily.

Single Leg Stance 30 Degree Squat — Using a stability trainer, stand upright, balance on one leg, and slowly bend the weight-bearing knee to 30 degrees, focusing on keeping the patella tracking in line with the second toe. Maintaining knee alignment is critical. If necessary, have the patient gently hold on to something while doing the exercise until they can accomplish the alignment without assistance. Perform three sets of 10 reps daily.

Ball Wall Squats — With or without hand weights, position an exercise ball behind the back and against a wall. With the feet shoulder-width apart, push into the ball and squat to 30 degrees. Perform three sets of 10 reps daily.

Hamstring Muscle Stretch — There are two effective stretching techniques for the hamstring muscle. A passive stretch is a slow progressive stretch. A PNF or contract/relax stretch is the procedure of choice for increasing both passive and active flexibility. This type of stretch involves elevating the target muscle to tension and then performing an isometric contraction of the hamstring using 20% of a maximum voluntary contraction. After holding this contraction/stretch for 10 seconds, elevate the target muscle to a new point of stretch and repeat the process, allowing pain to be your monitor. The hamstring muscle crosses the knee joint and is therefore intimately connected to the knee. Increasing hamstring muscle flexibility helps the athlete maintain a more upright posture and reduces compression forces on the knee. Ninety degrees of hamstring flexibility is a reasonable goal. Perform hamstring stretches daily. PNF stretching techniques can be performed once per week to help maintain the flexibility gains. Perform three reps on each side. To passively stretch the hamstring, sit on the floor with the back as flat against the wall as possible and then fully extend the knees. Sit in this position for 5-10 minutes daily.

Plantar Fascia Stretch — Place the foot on a massage roller while weight bearing and move the foot forward and backward. The athlete can adjust the pressure by applying more downward pressure.

IT Band Stretch with Foam Roller — Start on your right side resting atop a foam roller positioned at the bottom of your outer right thigh. Bend your left leg and set your left foot down in front of your right leg. Using your arm and left leg, roll your outer thigh up and down the foam roller from knee to hip. Roll for three minutes once a day. Do the same on the opposite side.

Identifying and addressing foot function issues along with integrating these active care techniques will help your athletes turn back the clock of Father Time and obtain longevity in living the active lifestyle their bodies desperately want and need.

KURT A. JUERGENS, DC, CCSP, is a graduate of Brigham Young University and Texas Chiropractic College. He is the owner of Juergens Chiropractic & Sports Rehab Center in Houston, Texas, where he continues to treat school and professional athletes in all fields from around the world. He has been a member of the sports medicine team for the United States Olympic Track and Field Trials, the NCAA Track & Field Championships, the ATP’s Tennis Masters Cup and the U.S. Clay Court Championships. As a member of Foot Levelers Speakers Bureau he travels the country speaking on chiropractic topics with a focus on sports medicine. See upcoming continuing education seminars at footlevelers.com/continuing-education-seminars.

Filed Under: 2022, Foot Orthotics, issue-06-2022, Resource Center Tagged With: foot function, iliotibial band syndrome, IT band, it band syndrome, plantar fasciitis

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