Abdominal Strain? Look at Foot and Ankle Function - Part 2

Part 1 of this series discussed the chain reaction the foot has upon the core function and how any limitation of the foot or ankle can increase the risk of sub-optimal performance of the abdominal complex or lead to injury. Part 2 will review the abdominal function during the gait cycle.

Abdominal Chain Reaction

When viewing the abdominal group, one can see the arrangement of the fibers in all three planes. By viewing the above photo sequence of the gait cycle and the role the abdominals play, let’s explore the action of the abdominals in walking and concentrate on the left foot swinging forward. The foot lands on the lateral aspect of the calcaneus as gravity and ground reaction forces cause the heel to turn laterally, or more accurately, eversion. Along with gravity, ground and reaction forces the eccentric control of the anterior tibialis, peroneals and the extensors of the toes lower the foot to the ground. As the calcaneus everts, the subtalar joint abducts, the ankle dorsiflexes and tibia internally rotates, thereby creating a tri-planar motion at the ankle. The anatomical structure of the ankle complex makes the ankle, which dorsiflexes and plantar flexes in the sagittal plane, a perfect complement to the subtalar joint, which functions in the frontal and transverse planes. The posterior calf group, especially the posterior tibialis, lengthens to decelerate and control these actions. As the calcaneus everts during pronation of closed chain activities, the midtarsal joints invert, abduct and dorsiflex in relation to the subtalar joint and rear foot to allow proper absorption of forces through the foot. When the tibia moves over the foot, the soleus decelerates tibial motion in the sagittal plane, and the gastrocnemius helps control tibial rotation in the transverse plane. The chain reactions that follow are knee flexion and abduction, hip flexion and internal rotation, which absorb the forces of the body and gravity. The eccentric tri-plane actions of the calf, quadriceps and hip musculature must load to control these forces before any effective actions can transpire.

When the left heel strikes the ground, the right foot is in calcaneal inversion, relative plantar flexion and relative external rotation of the leg. This causes the right pelvis to tilt anteriorly (sagittal plane action), which lengthens the abdominals to the front and downward. Simultaneously, the left arm swings back, which causes the left shoulder to move posteriorly as the thoracic spine rotates to the left (transverse plane action). This causes the abdominals to lengthen up and backward. This reaction is dependent upon the foot and ankle to function properly and allow full pre-load to the lower extremity and hip. Additionally, this position eccentrically loads the hip flexors, adductor complex and rectus femoris as these muscle groups, along with the abdominals, decelerate (eccentrically loaded) hip extension and anterior pelvic tilt. Tightness of any of these muscles can alter the pelvic alignment and lead to suboptimal abdominal function. Additionally, if these actions become limited, the abdominals can be affected and not fully load and often can result in shortening of the abdominals and the muscles of the pelvic complex in all three planes of motion. Lack of motion in any of the events above can cause sub-optimal loading of the abdominals and reduction in the transfer of forces from the ground upward.

Integrated Flexibility: Rationale for Enhancing Performance

Traditional training and flexibility programs seem to have forgotten the importance of stretching the feet. There is significance to allowing the feet to have full freedom of motion, especially when we consider there are 26 bones, plus two sesmoid bones, 33 joints and 24 muscles of the foot. Like any other muscle and joint, the structures of the foot are subjected to multi-directional forces that can create tension within the foot itself. Also, the feet must support all the weight above them, and yet people typically neglect their feet both in training and flexibility. As muscles of the feet tighten, they lose their ability to absorb forces from body weight, gravity and ground reaction forces. This can create trauma over time, tension and torque upon the joints and reduced propulsive forces of the musculature. To remedy this development, fitness professionals need to suggest to their clients to stretch the feet in a tri-plane manner by extending the toes to lengthen both the deep and superficial muscles. When doing so, it is prudent to very gently rub the plantar surface of the feet from the toes toward the calcaneus. (Please refer to Plantar Flexor Extension photo.) Also, try gently rotating the mid-foot and fore-foot to stretch the foot through the transverse plane as this is a critical aspect of foot function. Lastly, gently spread the toes and metatarsal bones apart and gently effleurage between these structures. By doing these simple techniques, you will “free” the foot with reduced tension and achieve greater motion through the foot. Often people who have undergone this experience feel more foot action and “lighter” on their feet with more “springiness” being reported. When this is attained, a chain reaction is enhanced between the foot, ankle and hip to allow better function. (Please refer to photos below.)

Toe Abduction Flexibility	Plantar Flexor Extension
Metatarsal Flexibility	Forefoot Abduction Flexibility

Connect the Chain

It has been my experience that integrated training and flexibility has enhanced the chain reaction and force production of the abdominals by ensuring the client/athlete has adequate range of motion through the foot and ankle complex and the hip flexors. The rationale for this is when the ankle is in the dorsiflexed position, the calf group becomes lengthened (refer to photo sequence above). The chain reaction moving proximal is for the knee to extend, which then will extend the hip. Tightness of either the calf group or hip flexors will impact the other and result in a shorter stride length. If this transpires, the hip will not move optimally into an anterior tilted position and therefore not fully lengthen or load the abdominals in the sagittal plane. When the stride length is shorter and the abdominals are not fully loaded in the sagittal plane, this will impact the abdominals and torso by not fully loading in the frontal and transverse planes as well. Therefore, the abdominals are not in an optimal position to tri-plane load and forcefully tri-plane unload.

With this concept in mind, it becomes necessary to stretch the calf group with the same side hip flexor. If only one of them is stretched without the other, this can have a negative effect as the short and tight muscle will impact the other by not fully moving through its range of motion. Therefore, to essentially create the chain, both areas need to be integrated when performing a flexibility program.

Moving further up the chain, the shoulder girdle can be affected by the action of the abdominals and vice versa. The pectoralis major fascia conjoins with the external oblique fascia and both are affected by the mobility of the other tissue. As the shoulder joint moves into flexion, this creates a lengthening of the abdominals in the sagittal plane. Likewise, function has taught us that hip extension will enhance shoulder flexion of the same side. Conceptually, as the hip flexors (psoas, iliacus, adductors, rectus femoris) lengthen, the fascia of those structures pulls on the fascia of the adjacent abdominals. As the abdominal complex lengthens and impacts the external oblique, the torque of the obliques will pull upon the fascia of the pectorals and ultimately affect the action of the shoulder joint. For that reason, I always integrate this anterior chain when performing an integrated flexibility program. By having good range of motion through the anterior chain or flexibility highway, motions of extension are enhanced. Improving motion on the lateral flexibility highway improves frontal plane motions of the hips and torso.

Anterior X Factor Stretch	Lateral Flexibility Highway Stretch

Functional Integrated Abdominal Training

Effective training of the abdominals does not necessarily require a “separate” exercise alone. Effective abdominal training should incorporate many of the larger movement patterns, often positioning the performer in stances of gaits that mimic the desired action and should involve a degree of rotation. Additionally, the movement should include a pre-loading or lengthening phase followed by an unloading or shortening phase, should be tri-planar in nature and ground reactive. This “pre-load/unload” cycle will create an efficient and forceful reaction that can enhance performance, no matter what the activity may be.

I believe the following exercises to be effective for the development of the abdominals and will enhance function in all three planes of motion. It is not coincidental to obtain benefits to the gluteal complex, legs, back and scapular musculature while performing these exercises.

The following are a list of exercises that can be found on the video Functional Integrated Abdominal Training.

Basic Functional Obliques and Gait Exercises

Start with front foot half length ahead of the other.	Rotate hips and shoulder of the lead leg back against wall.	Return to start. Repeat at pace of one per second.

• Targeted Muscles: Rectus Abdominis, Internal Oblique, External Oblique, Transverse Abdominis
• Objective: Functionally develop the abdominals in three planes of motion from the gait weight bearing position.
• Level: Developmental
• Rationale: During the gait cycle, as the foot comes in contact with the ground and the corresponding leg becomes weight bearing, the same side pelvis goes into an anterior rotation. This lengthens the rectus abdominis and the obliques on that side. As weight transfers over the leg, the pelvis shifts to the weight bearing side, causing a frontal plane eccentric load to the abdominals. Concomitantly, the same side shoulder extends causing thoracic rotation and a lengthening of the abdominals in the transverse plane.
• Technique: The rotational component of this exercise is important for proper training. If the client has limited range of motion in the pelvis or thoracic spine, the full effect of this exercise will not be obtained. Additionally, the rotation will be compensated by the lumbar spine instead of the pelvis and thoracic spine, thereby increasing risk of injury to the lumbar region. Have the client stretch the pelvis and thoracic spine in the three planes of motion prior to beginning any program.
  1. Stand with the back to the wall. The distance from the wall will depend upon the strength and range of excursion of the thoracic spine and pelvis the individual possesses.
  2. Feet are shoulder width apart.
  3. Place one foot approximately a half of the foot’s length forward to the other foot.
  4. Flex the opposite shoulder, simulating the gait motion of the shoulder in relation to the opposite leg during gait (as shown in above photos).
  5. The same side shoulder of the weight bearing leg will extend similarly as in gait.
  6. Rotate the pelvis and thoracic spine so the shoulder on the lead leg side will posteriorly rotate and touch the wall. This lengthens the abdominals in the transverse plane.
  7. Immediately after touching the wall, return to the starting position.
  8. Repeat at a pace of one per second for 30 seconds, building toward 60 second bouts.

Anterior Lunge with Drop Step

Step 1	Step 2 - Anterior Lunge	Step 3 - Return to start position.

Step 4 - Return from anterior lunge.	Step 5 - Drop step w/rotation (front view).	Step 5 - Drop step w/rotation (side view).

• Targeted Muscles: Calf group, quadriceps, gluteal complex, erector spinae, spinal rotatores, obliques, parascapular musculature, posterior deltoid
• Objective: Strengthen lower extremities while performing a dynamic movement pattern and enhance the relationship of improved range of motion of the hip to the opposite shoulder girdle and shoulder strength development through the transverse plane.
• Level: Intermediate to advanced depending upon strength, agility of the person and the use of external weights or resistance
• Rationale: In the transverse plane optimal shoulder joint and shoulder girdle function is dependent upon enhanced range of motion of the opposite hip and thoracic spine.
• Technique: Efficient movement is dependent upon the strength of the lower extremity, hip, motion of the subtalar joint, the range of motion of the internal hip rotators and the opposite shoulder in the transverse plane.
  1. Stand with the feet approximately shoulder width apart, knees slightly flexed and abdominals in the drawn-in position (see Step 1 above).
  2. Do an anterior lunge until the client feels the tension in the gluteals and lower extremities. If desired, a spinal flexion moment can be integrated into the movement pattern (see Step 2).
  3. Immediately return to the start position (see Step 3).
  4. With the right leg, perform a posterolateral lunge to the 4 o’clock position. Keep the left foot pointed to the anterior or 12 o’clock position as best as possible. This will enhance the range of motion of the left adductor group to allow greater left hip external rotation. Simultaneously, perform a right shoulder external rotation with abduction. To reduce injury risk to the lumbar spine, it is essential to rotate the pelvis to the lateral or 3 o’clock position.
  5. Repeat on the opposite side.
  6. Perform two sets of eight repetitions, building to two to three sets of 15 repetitions, depending on the needs and objectives of the client.

Transverse Plane Lunge w/Transverse Plane Reach

Step 1	Step 2	Optional opposite shoulder external rotation.

• Targeted Muscles: Deltoids, obliques, gluteus medius and minimus, peroneals
• Objective: Enhance the relationship of hip range of motion and shoulder function through the transverse plane, while at the same time improve strength of structures through rotation from a weight bearing position.
• Level: Advanced
• Rationale: A strong relationship exists between adequate range of motion in the hips and proper function of the shoulders. This exercise is designed to enhance strength of the shoulders through the transverse plane, strengthen the conduit between the shoulders and hip through the abdominals and obliques. Additionally, the stabilizing action of the peroneals and hip abductors during rotation occurs when performing rotational movements.
• Technique: When performing this movement pattern, it is critical the exerciser select correct weight and proper form be maintained. A breakdown in form often occurs when weights are too heavy.
  1. Stand with feet approximately shoulder width apart and dumbbells held just proximal to shoulder level.
  2. Starting with the right hand, rotate the hips to the left while pressing the dumbbell to the 11 o’clock position (reference 12 o’clock is directly overhead) (see Step 2 above). Keep the left hand near the left shoulder joint; do not drop it out of the position. It is very important the hips rotate nearly 90 degrees when moving through the rotational phase of the movement, otherwise, the risk of back or hip pain increases. For this movement to be successful, there must be adequate range of motion in the hip flexors, obliques, thoracic spine and left external hip rotators.
  3. Return to the start position.
  4. Repeat to the opposite side.
  5. Perform five to eight repetitions, building to two sets of 15 repetitions before increasing weight.

To add a scapular reaction moment of the opposite shoulder girdle, as the movement pattern is being performed, add adduction with external rotation of the opposite shoulder not doing the pressing movement. This will assist in the development of movements requiring the reaction of one side scapular abduction while the opposite shoulder girdle adducts.

Frontal Plane Lunge w/Frontal Plane Reach

Figure 8s w/Medicine Ball

Step 1	Step 2
Step 3	Step 4

• Targeted Muscles: Abdominals, Hips, Spinal Rotators
• Objective: Functionally develop the abdominals, hips and spinal rotators in a weight bearing, integrated mode in three planes of motion.
• Level: Advanced
• Rationale: During the gait cycle, as the foot is comes in contact with the ground and the corresponding leg becomes weight bearing, the same side pelvis goes into anterior rotation. This lengthens the rectus abdominis and the obliques on that side. As weight transfers over the leg, the pelvis shifts to the weight bearing side causing a frontal plane eccentric load to the abdominals. Concomitantly, the same side shoulder extends causing thoracic rotation and a lengthening of the abdominals in the transverse plane.
  This exercise causes the body to decelerate and reactively accelerate motion against a resistance in all three planes. This movement pattern will train all muscles groups from the plantar surface of the foot to the cervical spine.
• Technique: The rotational component of this exercise is important for proper training. If the client has limited range of motion in the pelvis or thoracic spine, the full effect of this exercise will not be obtained. Additionally, the rotation will be compensated by the lumbar spine instead of the pelvis and thoracic spine, thereby increasing risk of injury to the lumbar region. Have the client stretch the foot, subtalar joint, hamstrings, pelvis and thoracic spine in the three planes of motion prior to beginning any program.
  1. Select a medicine ball or weight no greater than five percent of the individual’s body weight.
  2. Hold the ball in front of the body at waist level.
  3. Stand tall with the navel drawn toward the spine. Maintain the “stand tall” position throughout the movement pattern.
  4. The motion of the arms will create a figure 8 pattern. It is important to reach at each point of the cycle.*
  5. Starting with the left leg, proceed forward and simultaneously raise the medball on the oblique angle through the transverse plane to slightly above shoulder height of the left shoulder. Be sure the shoulder and pelvis rotates to the same side of the medball (see Step 1 above).
  6. As the client walks through the motion, the medball swings down through the oblique angle through the transverse plane to the lateral aspect of the opposite hip level (see Step 2).
  7. As the weight of the body transfers over the lead foot, the medball is brought slightly above shoulder height of the same side shoulder (see Step 3). During this transition, it is important to rotate the hips and thoracic spine through this phase of the movement. If not, the lumbar spine will be required to perform considerable rotation, which is not conducive to lumbar spine function.
  8. As the client walks through the motion, the medball swings down through the oblique angle through the transverse plane to the lateral aspect of the opposite hip level (see Step 4).
  9. Start with five repetitions per side and build to 12 per side, three sets.

*Note: The motion of the arms is a result of the rotation of the pelvis and torso. You can think of it as the arms are attached to the torso and are going for the ride. The arms do not pull the medball through the movement pattern.

Reverse Wood Chops w/Medicine Ball

Step 1	Step 2

• Targeted Muscles: Quadriceps, Hamstrings, Gluteal complex, Spinal Rotators, Spinal Erectors, Entire Abdominal Complex
• Objective: Functionally develop the abdominals, hips and spinal rotators in a weight bearing, integrated mode. Additionally, this exercise will train the musculature through the transverse plane, thereby requiring a strong decelerating action to control the motion.
• Level: Advanced
• Rationale: >Movement patterns through the sagittal and frontal plane not only must overcome the external resistance that is being moved but gravity as well. Additionally, both the resistance and gravity decelerate the action. In the transverse plane, the action occurs perpendicular to gravity and must be controlled and decelerated by muscular action without the direct influence of gravity. This exercise develops eccentric loading and control of muscles during rotation.
• Technique: The rotational component of this exercise is important for proper training. If the client has limited range of motion in the pelvis or thoracic spine, the full effect of this exercise will not be obtained. Additionally, the rotation will be compensated by the lumbar spine instead of the pelvis and thoracic spine, thereby increasing risk of injury to the lumbar region. Have the client stretch the foot, subtalar joint, hamstrings, pelvis and thoracic spine in the three planes of motion prior to beginning any program.
  1. Select a medicine ball or weight no greater than five percent of the individual’s body weight.
  2. Hold the ball in front of the body at waist level.
  3. Stand tall with the navel drawn toward the spine. Maintain the drawn in navel position throughout the movement pattern.
  4. Starting with motion to the right, turn the pelvis toward the right knee, by lowering the hip and rotating the medball to the lateral side of the right leg. Be sure to maintain the neutral spine position. It is important to rotate the pelvis toward the right knee and not keep it facing forward (see Step 1 above).
  5. Forcefully push off the right foot and rotate the pelvis to the opposite side as the client extends upward from the squat position. Do not pull the medball; rather, allow the arms to be “carried” by the torso rotation and bringing the medball to the lateral aspect of the opposite shoulder. It is very important for the pelvis to face toward the left. (Think of the navel facing to the left when completing the rotational movement pattern). See Step 2.
  6. Repeat the movement pattern starting with eight repetitions and build to two to three sets of 15 repetitions before increasing resistance.

Please keep in mind that not all movement patterns are suggested for all populations. It is the responsibility of the practicing fitness professional to develop a health history and movement profile of their clients to determine which exercise is appropriate and when to apply the technique in the comprehensive program design.

With these concepts carefully planned and incorporated into a well thought out program design, you will be able to assist your clients toward enhanced mobility and function in all activities of daily living ranging from moderate to high intensity actions with a reduced risk of injury.