If you’ve ever been injured you may have been advised by your physician or therapist that your condition was in some part due to some physical imbalance or attribute. How important are some of these physical characteristics in regards to the actual injury? Most are completely irrelevant though so many want to make some correlation between their presence and the complaint. Yet although there is no science to back up the treatment or advice, many still buy into certain ideas behind injury correction and prevention based off assumptions.
Heavy patients are often told that their weight either caused an injury or is contributing to their inability to heal. This is very common for those with low back, hip, and knee problems. Additionally, these overweight patients are told they need more shock absorption in their footwear.
For those who have a foot or ankle injury, the physician will often make a strong correlation between the height, or lack thereof, of the arch and its relationship to the injury.
And for anyone who has ever been to a chiropractor, physical therapist, or other body specialist, they most likely were told that the length of their legs had something to do with their pain or injury.
Developing a treatment and rehabilitation program around such issues often works out very unfavorably for the patient. Let’s learn why!
Arch Height: Overrated.
The height or length of the foot arch is rarely an issue when it comes to how well the foot functions and its susceptibility to injury. The base of support of the foot is much more important than whether the main arch of the foot, (the longitudinal arch), is high or low. The support system is naturally built into the foot, with the heel at one end of the arch at the forefoot and toes at the other end. An injured athlete many have lost the natural strength of their foot and perhaps some, or all, of the arch. So they are prescribed support devices such as arch supports and orthotics which unfortunately do nothing to actually strengthen the arch but rather “support” the middle of the arch resulting in further weakening of the arch and other areas of the foot.
There are two types of flat feet, rigid flat feet (RFF) and flexible flat feet (FFF). An individual with RFF has no arch at any time – weight or non-weight bearing. RFF is usually caused by some underlying pathology, which I will not discuss here as it’s not applicable to the content. (If you have RFF then you should be investigating the pathological problem.) An individual with an arch non-weight bearing which fatigues or collapses when they stand or the foot is stressed is said to have FFF. FFF is most often due to ligament laxity (the ligaments connecting the bones together have weakened) or due to muscle or tendon weakness. The tibialis posterior muscle has a major impact on the medial longitudinal arch as it provides much of its support. Therefore, a problem with this muscle can result in FFF as well as other problems associated with tibialis posterior dysfunction – shin splints, plantar fasciitis, and injuries associated with overpronation.
FFF, or some loss of the arch of the foot, is common in athletes who have foot and lower leg injuries. However, if the complete or partial loss of the arch has been present for some time, the athlete may not be able to redevelop this arch. But that doesn’t mean that the injury can’t be fully healed. Regardless of the regaining of the arch, full function can be achieved.
In 2009, Pediatrics published a study of 218 kids aged 11 to 15 and found “no disadvantages in sport performance originating from flat feet”. The kids who had flat feet accomplished all 17 motor skills as well as the group with “normal” feet. Another study of 246 US Army recruits found that trainees with low or flat arches actually had a lower risk of injury than those trainees with high arches during their 12-week infantry training. So again, you can’t make a correlation between arch height and function or even injury rates.
To strengthen your feet and lower legs to not just help prevent an injury but also naturally support your arches, follow the guidelines I describe in the article “Lose Your Shoes” and also check out the Sock Doc video on “Foot Strength & Rehab”.
Body Weight: Weigh More, Think Less.
Physicians and therapists love to tell their patients that either the reason they became injured or are not healing properly is because of their body weight. That means you’re fat and there’s supposedly “too much stress on your joints.” This is also common when a heavy person is advised on footwear; they’re told they need a heavily cushioned shoe to absorb their mighty impact. Both weight related issues actually have no weight. That pun is weak.
Most people who are fat often tend to be carrying around a lot of inflammation as they are body fat. So there is a correlation between the two. An over fat person is most likely to become injured and more likely to have trouble healing. And someone who is over fat most likely will have poor joint function too, from both this inflammation and from lack of proper muscle function. So yes, losing weight (fat) will help, but not because there is less stress on the joint. Simply consider someone who is as heavy but very muscular – isn’t there as much weight stress on their joints? Whether it’s fat above your torso or muscle above that same area, they’re both going to contribute to the same weight “stress” to your injured knee or foot. And let’s not forget the relationship between body fat, estrogen, and ligament health – it’s a big deal when it comes to healing joints.
How about more cushin’ (in your shoe) when you’re pushin’ (the miles)?
The answer to this is not only definitely no, but actually less cushion. Yes, the Sock Doc may have a habit of saying the opposite of the conventional “wisdom” but there is always a valid explanation why; at least I think so.
Peak forces while running actually occur in midstance, not when the heel hits the ground, where the shoe cushion is often most added. Joint torque and stress is highest when the foot is fully planted, with or without shoes. Cushioned shoes cause joints to work harder in midstance and this cushion response is out of sync with the natural increase and decrease of bodyweight through the gait cycle. It just doesn’t work.
So ideally the heavier the runner, the better gait there needs to be to decrease their chance of injury. Often thick, high-heeled, and cushioned shoes disrupt gait. In addition to a good gait, there needs to be less impact through the joints which will only occur if there is not a lot of cushion between the foot and the ground. So if you weigh too much you might want to think too little.
Leg Length: Short Side or Long?
Leg length is commonly evaluated by doctors and therapists who focus on structure. Chiropractors will often report to their patient that one leg may be longer than the other and it is a cause of some of their hip, lower back, or other area of pain. Physical therapists often will tell their patients that one side of their pelvis/hip is rotated anterior (forward) and this rotation is the root of their problem. The rotated pelvis will cause the leg to appear short and often the finding of a short leg has to do with a musculoskeletal imbalance of the pelvis.
Many of these therapists spend much, if not their entire treatment trying to equal out the leg length discrepancy, whether it’s a few millimeters or even several centimeters. They feel this is an abnormality that must be corrected as people should be symmetrical human beings.
Now of course you don’t want your pelvis shifted to the point where you’re off by a great amount, and thus your leg appears “shortened” by a centimeter or two. But achieving perfect balance of the legs alone often does not correlate with an improvement in symptoms, or rate of injury.
These leg length (and pelvis) imbalances are due to muscle imbalances, and the muscle imbalances are due to anything and everything that can negatively affect the nervous system. I’m talking about the physical, chemical/nutritional, and emotional stress that is discussed throughout the SockDoc site in relationship to poor health and injury. This is the cause of the problem, resulting in the symptom – in this case the sign, the perceived short leg of the injured athlete. It’s a correlation.
There is no need for us to be perfectly symmetrical to function optimally and be one-hundred-percent pain free. But again, I don’t want you to think a great asymmetry is necessarily okay; far from it. But there is too much focus put in the leg length discrepancy as well as the high or anterior rotated pelvis. Plus, it’s a very objective finding and can vary based simply upon how the patient is lying on the table or even differences in anatomical landmarks from left to right. Of course if their shoes are left on then that’s a factor too.
One last point on the leg length assessment is the infamous “heel lift”. Many docs and therapists use this to equal-out the leg or pelvis imbalance. Heel lifts make me cringe as much as orthotics. Now if someone truly has an anatomical leg length discrepancy due to an osseous (bone) disease during their growth years or they suffered some accident resulting in the actual loss of bone length, I can understand the use of a lift – sometimes. It depends on the situation. But most people are prescribed a heel lift for the above mentioned musculoskeletal imbalances and of course the heel lift is like putting a muzzle on a barking dog while you’re jumping on its tail.
Some therapists will put the lift under the “short” leg to make up the difference. Problem here is that the short leg is the side of the high pelvis, if you can picture that. If the lift is put under the longer leg, that would be the side of the lower pelvis, effectively raising the pelvis on that side to more even, but also providing a longer contact with the ground. Either way, they still do not correct the problem and often cause more imbalances and compensations.
So the lessons of this article are simple:
- Keep your body within a healthy weight to reduce inflammation on your joints and improve healing.
- Consider less shoe especially if you’re packing on the pounds.
- Don’t worry about the height of your arch but take note if it’s failing or falling.
- Don’t fret over a short leg or long leg being the cause of your injury but rather why you may have an imbalance somewhere in your body.