20 Abr It all starts with the feet
The foot is a complex area of our body, consisting of 22 bones, 33 joints, and an enormous number of muscles, tendons, and ligaments. (Mojica et al., 2017) Having suffered several knee injuries actions like walking, running, and jumping became difficult for me, and it took me awhile to learn and realize that the feet had something to do with it. The feet are the first to come into contact with any surface and are responsible for helping to absorb and produce force with each step. Many injuries come in part from having unstable and weak feet.
The stability of the foot depend a lot on the arches. The foot is made up of the medial, lateral and transverse arch. The medial arch in particular provides it with the ability to function as a flexible and rigid structure for proper locomotion. (Jung et al., 2016). In other words, if the arches fail, the force applied by a movement can affect the knees. This highlights the importance of training the foot. There are different exercises that can be programmed to strengthen the feet. From learning to have stability on one foot, having mobility of the toes, exercises where you have to hold an object with your feet, or squeeze the ground hard activating the three arches.
What you want to avoid is falling into a knee valgus. It is clear that a knee valgus does not mean that there will be an injury. (Dischiavi et al., 2019). Many times it has to do with a lack of motor control starting with problems from feet. Dischiavi’s article mentions that knee valgus becomes a problem when the foot and hip muscles fail, causing all the load to transfer to the knee. This is a complex issue, since most knee and meniscal injuries to the knee occur with a valgus.
This is what leads me to the next topic and that is that there is a difference between training one foot during weight lifting and another is applying it to locomotion. There is a lot of literature on running biomechanics and they highlight the efficiency of forefoot running (Khorz et al., 2017). It is very efficient since there are only two phases in every step, the landing and takeoff phase. Dropping the heel is slower and is known as being a risk in injury during moments of high speed and agility. Sporting actions were the heel will touch the ground are in a sudden deceleration or when making a vertical jump.
And this is where the importance of the pivot points comes in, they are located behind the 4th and 5th metatarsals. I know this is controversial, since there is a lot of talk about the big toe, and I agree that it is important. However, the big toe is the last to push, but when it comes to stability, landing and efficiency it is key to give more importance to pivot points.
A simple test I like to do is to put ourselves in an active position, which is on our forefeet. The key of the exercise is to find balance and stabilize, and one will notice that to do be able to do this, the weight will go towards the pivot points. There is no need to provoke excessive force, it is simply working efficiently with our anatomy.
When running, it must be the same, as highlighted in the photo of the knee valgus, the most predominant injuries in sport always have a common factor, and it is a foot that has completely collapsed causing other structures to be affected. Pivot points are landing and take-off point, and continuously at each step. This will reduce the risk of injury in running, jumping, throwing, and in sharp stops and direction changes.
Personally, I was able to start running and jumping when I learned to apply this concept. My knees are in a safe position since it is stable. I manage to efficiently strengthen the muscles and tissue necessary to do all kinds of actions. The foot is complex, however, it should not be difficult to train it, strengthen it and make it a safety weapon for the body.
This will lead to the theory of the “spinal engine”, which I will leave for another blog.
I want to give credit to GOATA, who were the ones who introduced me to this concept.
Dischiavi, S. L., Wright, A. A., Hegedus, E. J., & Bleakley, C. M. (2019). Rethinking dynamic knee valgus and its relation to knee injury: normal movement requiring control, not avoidance. journal of orthopaedic & sports physical therapy, 49(4), 216-218.
Knorz, S., Kluge, F., Gelse, K., Schulz-Drost, S., Hotfiel, T., Lochmann, M., … & Krinner, S. (2017). Three-dimensional biomechanical analysis of rearfoot and forefoot running. Orthopaedic journal of sports medicine, 5(7), 2325967117719065.
Mojica, M. N., & Early, J. S. (2017). Foot Biomechanics. Atlas of Orthoses and Assistive Devices E-Book, 216.
Jung, Y., Jung, M., Ryu, J., Yoon, S., Park, S. K., & Koo, S. (2016). Dynamically adjustable foot-ground contact model to estimate ground reaction force during walking and running. Gait & posture, 45, 62-68.