PT on the Net Research

Barefoot Programming for LPH Stability

From walking to climbing stairs, lumbopelvic hip (LPH) stability is a necessary component to every closed chain functional movement.   Unfortunately injury, inactivity and a repetitive movement patterns can begin to disrupt this inherent stability of our core.   In fact, most lower extremity injuries can be related back to a delay or inhibition of the LPH stabilizers. 

This article is going to review how we can better help our clients restore LPH stability by resetting these muscle activation patterns – from the ground up.   We are going take a closer look at the interconnection between the feet and core, and how this interconnection relates to closed chain functional movements.   Finally we are going to introduce some great barefoot exercises which can easily be integrated into all client programming.

Learning Objectives: 

  1. Review the impact of delayed lumbopelvic hip (LPH) stability as it relates to joint centration.
  2. Introduce the concept of foot to core sequencing for reflexive LPH stability 
  3. Describe tips to properly activate the foot and deep hip stabilizers 
  4. Introduce exercises which can be integrated for proper LPH muscle activation patterning

The Lumbopelvic Hip Complex

Often referred to as the core or the lumbopelvic cylinder, the LPH complex includes the hip joint, pelvis, spine and ribcage.   Over 29 pairs of muscles help support the LPH complex allowing proximal stability for distal mobility.   

If we take a closer look at the hip joint we have the femoral head sitting in the acetabulum or joint surface of the pelvis bone.   Surrounding the acetabulum is a cartilaginous ring called the labrum.  The labrum is designed to increase the stability of the femoral head by deepening the hip socket.

Further stability of the femoral head in the hip joint is done by a group of muscles often referred to as the deep six or deep lateral rotators.   These small muscles act much like that of the shoulder rotator cuff, which means they create a suctioning type action to the femoral head within the hip socket.

Cadaver studies have shown that these deep lateral rotators are myofascially connected to the pelvic floor, or the bottom of our lumbopelvic cylinder.  The pelvic floor is myofascially connected to the diaphragm, or top of the lumbopelvic cyclinder.   And myofasically connecting to the diaphragm is the psoas major muscle which run across the front of the hip joint, preventing an anterior shift of the femoral head. 

Delayed LPH Stability and Joint Centration

This concept of hip stability is critical for optimal glute function.   If there is any delay in hip stability before glute activation or if any muscle imbalances are present, then an anterior shift of the femoral head can occur.‚Äč

Keeping the head of the femoral head centered and stable within the hip socket is referred to as joint centration.   Poor joint centration or an anterior shift in the femoral head can begin to stress the hip labrum, eventually resulting in a hip labrum tear.  

Our goal with our clients is to assure proper hip joint centration by training proper muscle activation patterns starting with the deep lateral rotators.  

So how do we ensure the deep lateral rotators are activating first during closed chain movements? 

By training our feet!

Foot to Core Sequencing

The LPH stability we need for functional and efficient movement is associated with a muscle activation cascade that begins with the foot.   First introduced by Dr Vladamir Janda, the foot activation that initiates the aforementioned muscle activation cascade is referred to as short foot.

Short foot is an exercise that targets the intrinsic muscles of our foot, namely the abductor hallucis.   When teaching short foot, I encourage you to teach one foot at a time.  The reason I always teach one foot at a time is that most people are disconnected from their feet, which makes it difficult for people to identify with what foot activation or engagement should feel like. 

Step 1 – Find the foot tripod

Start by cueing your client standing with a majority of their weight onto one foot.   Next find the foot tripod, which is under the 1st metatarsal head, the 5th metatarsal head and the heel. 

Step 2 – Spread the digits

Cue your client to lift the digits, spread them out and then place them back onto the ground.  They should now feel an even body weight distribution from their 1st digit to their 5th and down to the heel. 

Step 3 – Activate short foot

Focusing just on the tip of the great toe, cue your client to press the tip of the big toe down into the ground.  Digits 2 – 5 should also press down into the ground but the focus is primarily on the first digit.    You can cue that it should feel like they are rooting down into the ground.

Short Foot to Deep Hip Activation

Now to begin to feel the association between short foot and the deep hip stabilizers, cue your client to pay attention to their hip, glutes and pelvic floor.   As they engage and release short foot they should begin to feel tension or activation within the deep hip or the pelvic floor. 

Another way to teach clients how to appreciate foot to core activation is through what’s called body tension.

Step 1 – Engage the pelvic floor or do an abdominal brace

Have your client stand with their feet shoulder width apart and feet relaxed.  No short foot should be engaged at this time.   Cue them to find a deep abdominal or pelvic floor engagement.  A way that attendees can know if they are doing this properly is by palpating their erector spinae. 

Place the hands on the lumbar erectors with the abdominals relaxed.  Keeping the hands on the erector spinae msucles, cue the attendees to engage their core or pelvic floor and relax.  If they are doing a proper core engagement they should feel their erector spinae engage underneath their fingertips.  During the abdominal brace cue your client to be aware of the amount of body tension they are able to generate. 

Step 2- Engage short foot

Next cue your client to relax their abdominals or core and focus just on their feet.  Cue them to find the tripod on both feet and spread their digits.  Focusing on both feet at the same time, cue short foot.  

Step 3 – Activate from the ground up body tension

Now to tie them together, cue your client to engage short foot as they are activating their pelvic floor or abdominal brace.   They should note the increased body tension they are able to generate the second time around. 

Short Foot to Glute Activation

Now it’s time to put it all together and demonstrate how we actually get higher glute recruitment when they are activating on a stable LPH complex.   

Step 1 – Perform a single leg squat

Cue your clients to do a couple single leg squats or kickstand squats while relaxing their feet.  Note the amount of glute activation and stability felt during the squat.

Step 2 – Integrate short foot

Now cue your client to find the bottom of a single leg squat.  It is here that you want them to activate short foot.   Drive the big toe down into the ground.   There should be a sudden activation of the deep hip stabilizers upon activation of short foot.   While holding short foot, exhale and press out of the squat.   Note the increased glute activation during this squat. 

Step 3 – Integrate foot to core sequencing into client programming

Below are some of my favorite exercises for integrating short foot into LPH stability programming.   Remember the timing of short foot should always be on the bottom phase of the squat or exercise.

Tips for Success

  1. Activate pelvic floor and deep rotators prior to short foot
  2. Mobilize femoral head with a  monster band prior to short foot
  3. If balance is issue can hold onto chair or wall