Head & Shoulders, knees & toes, knees & toes… by Lisa Snow

lisa-snow-2When we’re young, most of us have an amazing amount of ankle mobility—think of a diver flying off a springboard, a ballerina poised gracefully on her toes, or a kid chasing a ball in the park.  As we get older (and more frequently parked at our desks), we tend to move our ankles less.  We walk more than we run, rarely jump, and often only walk or run forward.  Kids, on the other hand, go forward, backward, side to side, “cut” and change directions, etc.  But if we’re not playing sports, does this lack of ankle flexibility matter much?

As we age—and our ankles get stiffer—our knees, hips, and low back tend to pick up the slack, doing the work that the ankle should take care of.  In the very long term, this can result in joint pain, worsening balance, and back problems.  In the short term, most people don’t have pain and therefore aren’t aware of what’s happening.  But it can translate into unnoticed negative behavior shifts, like taking the elevator or escalator more, or taking a bus or cab for short distances you would’ve walked in the past.

Start by taking a look at how you walk.  Or better yet, have a friend with a camera or videocamera on their phone check it out for you.  To be clear, I’m not recommending people try to self-diagnose or do their own gate analysis.  (That’s what PTs are for!)  But seeing your feet and ankles from someone else’s (or the camera’s) point of view can be very enlightening.

Are your toes pointed straight ahead, or are one or both feet turned out?  

If your toes—comfortably—point straight ahead, congrats!  If not, see what happens when you try to walk with your feet straight.  If you can do it but it just feels odd or difficult, you may improve your gait tremendously just by having more awareness.  If walking with your feet straight ahead actually hurts or makes you feel like you’re losing your balance, it’s time to check in with a podiatrist and a physical therapist.  Remember, the tightness may not be coming from your feet/ankles, but may be a result of stiffness much further up, in your hips, knees, SI joint, etc.

Do you have any pain or discomfort in your ankles, knees, or hips while you walk?

Is it on both sides?  Just one side?  One hip and the opposite ankle?  Write all this down, so you can discuss it with your doctor or PT.  Walking should feel good.  Anything that doesn’t is worth talking about.

DorsiflexionNow see what happens when you’re sitting down.  Sit on the very edge of your chair, with your legs outstretched.  Try pointing and flexing the toes on both feet at the same time with your heels on the ground.

(Pointing your toes like a dancer or gymnast is what doctors and PTs call “plantarflexion.”  Flexing the toes back up toward you is what medical people call “dorsiflexion.”  Many small muscles contribute to both these actions, but pointing or plantarflexing is mainly done by the calf muscle, aka the gastrocnemius.  Flexing or dorsiflexing is primarily done by the muscle beside your shinbone, the tibialis anterior.

Then try pointing the toes on the left foot, while flexing the toes on the right foot.  Switch sides several times, almost like you’re walking while still staying seated.  Here’s the interesting part: while you’re moving your ankles, watch your knees.

When you sit on the edge of your chair and flex your ankles/toes, if your knees stay straight, give yourself a high five!  Your ankles are doing the work they’re supposed to be doing.  If your knees bend when you’re only trying to move the ankle, your knees have taken over.  Don’t be mad at your knees: they’re just trying to help.  If the ankle starts to flex but can’t go very far due to tightness or injury, the knees will try to finish the job of bringing your toes all the way up.

Try practicing this exercise every day for a couple of weeks to see if your ankle mobility improves.  If you’ve worked on it consistently and still can’t get your knees to stop pitching in, see if your doctor is open to giving you a referral to physical therapy.  Don’t be surprised if your doctor thinks this is overkill!  They’re used to patients waiting until they’re in pain to get help.  But getting your ankle mobility back to normal before you have severe pain or an actual injury can help prevent many joint problems down the road.  If going to PT is truly not an option, consider getting some help from a personal trainer or yoga teacher to restore your ankles to the strong, flexible, comfortable way they used to move.

Missed last month’s column? Read it now:

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Protecting the Spine While Stretching Your Hamstrings – Part 2
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