I have an older adult client who just can't seem to get up on his toes (plantar flexion while walking). He has had some serious lower back problems in the past, which for some reason has made him walk around on his heels for quite some time. I have been training him for a while now and his mobility has improved greatly. Any ideas?
Thank you for your question and client concern. Although I do not know your client’s full history or current functional threshold, I would make an educated guess that his pelvic position is a “probable suspect.” Usually, a person’s body weight will not shift to the heels unless the body is contoured to some degree. Your strategy is to attempt to figure out WHY his weight is on his heels. Does he have a pelvis that is positioned more posteriorly? Check to see if his low back is flat along with a flat butt syndrome. If this is the case, there is a high probability that his deep hip structures are restricted (capsular tightness).
If so, the next analysis is to figure out the asymmetry that may exist. One must remember that the pelvis is an interdependent structure; therefore, one side will directly affect the opposite. One can assess this by standing with feet straight, flex one hip to 120 degrees or greater, then externally rotate the same side hip and place the foot of the flexed, externally rotated hip on an object such as a True Stretch or a high table. Observe range of motion throughout the entire body. How did he move into position with this task? Did his spine flex prematurely? Did the pelvis contort? Did his down side knee flex? Did the foot on the floor attempt to externally rotate? Compare sides. If one side is very different than the other, you know he has a pelvic malalignment, which will shift his body’s center and cause a less than efficient weight distribution.
Clinically speaking, I have not come across an individual who has experienced back pain that doesn’t have some form of asymmetry in the hip complex and/or foot/ankle complex. The key to assessing movement is first understanding movement is a sequence of segments for an intended task. First, understand the task and then assess the sequencing to search for the regions that exhibit the lack of motion-stability. Optimal movement is the unique synergy between motion and stability. Please refer to Gary Gray’s Functional Video Digest for information regarding optimal function and practical tools to assist you with your clients. I hope this leads you to understanding the cause.