PT on the Net Research

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.

Calf and Hip Flexor Stretch

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.

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).

Transverse Plane Lunge w/Transverse Plane Reach

Step 1 Step 2 Optional opposite shoulder
external rotation.

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

*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

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.