by Mitch Hauschildt, MA, ATC, CSCS
A little over 2 years ago I published a post entitled, “Rotation = Less Foot Pain” where I wrote about the direct connection between our inability to control rotation and it’s impact on the lower leg and foot. After treating dozens of athletes with foot pain, plantar fasciitis, posterior tibialis pain, and tibial stress fractures very effectively by working almost exclusively on their rotary stability, I am more convinced than ever that this connection is much more than a coincidence. The connection between lower leg pain and our overall lack of ability to control rotation is undeniable to me.
I also recently read an Instagram post written by someone who gets a ton of traffic online because of the their ability to vomit out volumes of content each day (which tells me that they likely don’t actually treat patients) and their recommendation for treating medial shin pain was to start by taking 3-4 weeks off and then introduce basic flexibility and strengthening exercises. In other words, basically the same thing that pretty much any primary care physician or old school PT would have recommended 20 years ago.
I think we as clinicians can do and must do much better than that. We should demand more from ourselves and each other. There are much better options out there and we should be promoting them to our circles. Like or not, people look to social media for their medical care these days.
One thing that I know for sure is that we (when I say we, I mean PTs, ATCs, DCs, Personal Trainers, Strength Coaches, PTAs, COTAs, LMTs, and anyone else who teaches movement) suck at training people in the transverse plane. We just do. We like to put people in the sagittal and frontal plane and we forget about the all so important spiral line. This limits our ability to move cleanly and predisposes us to pain and injury. Even walking has a rotational stability component to it.
Something has to change.
Without going too high on a soapbox, I’ll take it back to the foot and lower leg. Training rotation has quickly become my go to for a lot of injuries, but specifically for foot and lower leg pain.
Like most clinicians, I see my fair share of foot and lower leg pain. At the collegiate level, plantar fasciitis, posterior Tib pain, and Tibial stress fractures occur much more than I would like. We have seen a reduction over the last 8-10 years in these injury rates due to a better understanding of the causes, superior training techniques, improved nutrition and better patient education on when to seek help. But despite these efforts, due to the rigorous demands placed on college athletes, these ailments continue to plague some of our athletes.
One thing that I know about foot and lower leg pain is that they are rarely caused by the foot or lower leg. It seems that with only a few rare exceptions, the problem is somewhere else up the kinetic chain. Our job as clinicians is find the dysfunction and fix it.
Over the past couple of years, I have been toying with the idea of treating the foot and lower leg via Thomas Myers’ Spiral Line. When you look at the Myers Spiral model, you find that it creates a stirrup on the bottom of the foot, moving from medial to lateral. Myers’ approach also states that we can affect the fascial line anywhere along its path. If both of those items are true, then training in rotation will facilitate the more anterior portion of the line, while releasing the more posterior aspect of the line will, in theory, inhibit that part of the line. Thus, we can use the stirrup effect of the spiral line to assist the body in creating foot structure and unloading the medial aspect of the lower leg. I have seen over and over how treating the foot and lower leg via the spiral line is extremely beneficial.
Treatment has initially involved taping their spiral lines to both confirm my theory (by upregulating the nervous system in that area) and to provide an open window for corrective exercise to make faster and larger improvements. All patients have reported immediate and significant improvements in their symptoms.
Now that we know we are headed in the right direction, the corrective exercise portion of their therapy is pretty straightforward. It begins with anti-rotation exercises. One important item to keep in mind is that a person must first know how to resist poor rotation before they can create high quality, authentic rotational movements.
Movements such as the Pallof Press, Rotational Bridge variations, and a plethora of carrying and crawling patterns make up the bulk of their therapy in the first few treatments. As they demonstrate postural control in an anti-rotation environment, dynamic rotational movements are incorporated. At this point, they typically rely less and less on tape outside of their training sessions, so the amount and frequency of using tape are reduced and eventually eliminated.
Our training programs tend to focus on movements in the frontal and sagittal planes, thus making even mild improvements with rotation can make large improvements in the kinetic chain.
Overall, I constantly marvel at the human body and its complexity. Understanding the concept of regional interdependence is not always easy or convenient. But, if we are truly going to solve what ails our patients, we must play the detective to identify and correct their true dysfunction.