The Foot Bones Connected To The Hip Bone
On this week’s episode of The Dance Docs I am joined by Jay Dicharry PT out of Oregon. While Jay may be known in the running community for his book Running Rewired, he has spent plenty of time working with dancers, and has an in-depth knowledge of lower extremity kinematics. He helps to paint an understanding of how the foot and hip function together and can independently work as drivers of the lower limb, we dive into the spiraling needed for the lower extremity and why the correction of lifting your arches could be locking up a dancer's ability to move freely. I loved my conversation with Jay and I hope that you do too!
About Jay Dicharry PT
PT based out of Oregon
He has wanted to figure out how to build things better
Has spent time running the gait analysis lab and now in Oregon
They have taken normative ROM and strength data from PT evaluations and have been able to overlay it onto biomechanical data
Beginning with the foot as a clinician what are you looking for
First have to ask what do you/the body need to do
The whole foot needs to move
The foot is not just a brick that points and flexes, it actually spirals
It needs to be mobile enough to spiral the way you need it to and stable enough to control that spiral
If there are mobility or stability problems at the foot it can cause problems upstream and also work the other way.
Can your foot move enough and can you control it
Why the correction lifting your arches may not be the best correction
Dancers tend to lift the arches by pressing down into the big toe, shifting the weight to the outside of the foot and locking it into a supinated position to maintain look of a lifted arch in ballet
What we are really looking for the dancers to do it twist the forefoot on the hindfoot
When we ask people to move within the foot they create that motion by:
rolling the ankle in or out
you have locked some joints in the foot up
you have lost contact with the ball of the foot with the ground (specifically the first metatarsal)
in doing so you have caused problem upstream by locking the hip into ER,
now you have become stuck a wobbly system
You are in a reactive system instead of a proactive system
Almost impossible to rotate the torso in the opposite direction
Goal is to train the mobility within the foot
Inversion and eversion of hindfoot when maintaining the forefoot on the ground
This one compensation can cause problems within the whole system
Why are deep external rotators so important for foot and ankle control
When you create ER just from the glut max, you can lock the system from the top down
Hip can no longer extend fully
Hamstrings are overly lengthened and not strengthened through the range so they are no longer assisting in stabilizing the pelvis
Where would you start with a dancer who is locking up their foot by supinating and locking their pelvis with glut max activation
Begin in the foot- separating motion out between the forefoot and hindfoot
Thera-band with foot around arch pulling it diagonally up and outwards
Band is assisting in rolling the foot/arch up
Goal is to maintain the big toe down as your twist through the foot
Can place a second piece of theraband or a post-it note/quarter under the big toe
Once they are able to maintain the position with the theraband- take the theraband away and see if they can continue to maintain good mechanics of forefoot on hindfoot.
Once they can demonstrate good mechanics, begin lifting the heel 1 inch and see if you can maintain the twist/mechanics
Want to then echo the forefoot twist into the entire lower chain
Use a foam roller between shins, standing parallel
Squeeze the foam roller a little bit
Maintaining the ball of the foot on the ground roll the arches out and roll the arches in
With train you to twist the foot out and in
The feet are the drivers of this motion and it is reflected up into the hips
Going to do it again but you will use the hips to drive the motion
Feet will passively twist in and out
Great exercises to understand how the foot or hips can drive the motion for the entire LE
Muscles in the feet are much smaller and help with a lot of proprioceptive input for the system
The deep external rotators at the hip are like the rotator cuff on the leg
Hip is a ball and socket joint like the shoulder
Still need to have precise rotational hip control from these muscles
If you use glut max and lock out hip muscles you lose a lot of hip control and loose the ability to steer from the hips
Peroneus Longus
Theraband exercise described above is great for activating peroneus longus
Can work as a sling to help support and lift the cuboid
Many of us forget that the peroneus longus actually attaches onto the first metatarsal helping with plantarflexion of the first ray
If you wing your foot the peroneals work to evert the foot in an open chain position
In closed chain the peroneus longus twists the forefoot pushing the ball of the foot into the ground
Will help you ground the foot into the floor
If you lock the foot into a supinated position as described above with supination you actually inhibit the peroneus longus from working by putting it in a stretched/lengthened position
Want to make sure to drive it down and activate the muscle so that you can maintain the appropriate twist through the foot
Can also be very important for big toe pain in plantarflexing the first metatarsal and allowing for proper roll and glide mechanics
Even in pointe shoes you have to control the twisting of the foot
You need to show up ready to create the twist needed for proper control
Does a pointe shoe put different demands on the foot?
Center of pressure
In a normal standing position there is a wide distribution of forces
When you are on a pointe shoe platform the distribution of forces is much smaller
This is more demanding on the foot in a demi point and full pointe position
Any little bit of imbalance will be magnified up the chain
You still need to be able to steer the forefoot hindfoot motion in a full pointe position and
Shoes allow you to do some interesting things but they do not offset the control that you need.
How would you work to maintain the twist through the foot in a full pointe or demi pointe position?
Have you earned the right
May need to take them back down to ground zero and build them back up
Incremental process maintaining forefoot on the floor
Gastroc/soleus are great for plantar flexing the foot, but they do not control the twist
There is some help from peroneus longus and tibialis posterior to control rearfoot on forefoot mobility
You need to train forefoot muscles to build the strong forefoot twist
Clinicians need to work on their cues and images to guide the motion in the foot
Work on getting the dancers to feel the motion
MOBO board
Squishy pads are not the best for improving body position and proprioception because they take away sensory feedback, which is what you need to build proprioception
BOSU or wobble board tend to lead to compensation patterns, it’s not specific training
MOBO was designed to restrict someone into using the proper mechanics through the first ray
Also works around the proper axis for pronation and supination
Cues and trains the muscles of the forefoot to work and drive the arch into a better position
Also trains the entire chain from the foot up to the hip
Can use as a rocker or in a static position to just work on stable mechanics
Ankle Sprains
Leads to compensated timing and strength patterns in the peroneal muscles
Using the mobo board with fins on the outside will help to retrain these patterns
This goes for a minor bobble to a torn ankle ligament
Repetitive ankle sprains leads to compensated patterns when the foot is on the floor and during swing phase of gait (can be similar to what may happen when someone is jumping post ankle sprain)
The more time you actively retain muscle firing patterns through up-regulating sensors that were undamaged
Can do this through high reps of closed chain exercises into open chain
Closed chain exercises for ankle strengthening
Have to do closed chain strengthening
If you are only doing open chain theraband exercises you are not training your dancer for return to sport
Theraband may be appropriate for someone who is just out of a boot, but not for full return to sport rehab (day 1- week 2)
Don’t just treat the foot we treat the whole person
Your foot and ankle guides rotation at hip pelvis and spine
If you are not doing things in closed chain positions then you are not integrating foot control with the rest of the system
Isolated training will not translate into sport
Are dancers overusing the Glut max and locking up the hip
Trandelenburg gait pattern- dropping of one side of the pelvis in single leg stance
Many times what we are seeing in a 2D picture of the person
We are losing the third dimension- actually a rotational problem
Spend a lot of time working with athletes on transverse plane control and rotational awareness
Want to be able to find full IR/ER control of the hip joint
Especially important for dancers because you are working in extreme end ranges of motion, and you need to own it or else you are riding the “tightrope of death” to fall over or to compensate and cheat things up and down stream
We need to train a movement and not just a muscle
Sometimes we need to back the support off and work in double leg stance and then move into single leg stance
Full external and external rotation- using roller dolly ot slider
Move into single leg stance
Then onto flat ground
And then combine everything onto mobo board
Let’s find full mobility when we are challenging the stability
Not on day one but what you will need for full return to sport
Important when working with dancers to make sure that when initially training ER and foot motion you do not want to let the dancers grip foot into the floor and use learned compensation patterns
Use your hands to help reboot the computer system and then reinforce the pattern
Hands allow your body to move and you have to take active control of that
Great research on focused practice- turn the music off and make the space quiet so that you can upregulate the neuroplasticity process
When you can apply mental focus you get better results
How do you dose foundational foot control exercises?
Really based around the person and their lifestyle
Looking to create neural changes
Would like things done more frequently per week in small doses
This works well with foundational exercises because many people may get frustrated after a few reps
After a few days you will begin to feel like small wins
Some of these exercises you can do throughout the day when doing things like standing in line
Want to know how to easily correct the position
Comes from repetition
Also think about these movement patterns during the first exercise or two in class, try not to think about it all the time so that it doesn't take over your entire class
Find exercises that are appropriately challenging
Challenging enough to cause change but not so hard that they feel defeated
Sometimes you need the basics
Meet the athlete where they are
We succeed by winning
Want them to come back and demonstrate exercises with good form so that you can progress them
Jay’s best advice- HAVE FUN!!
Give feedback to your clinicians, we are on the same team and want you to succeed
Find Jay
Instagram @ Mobo.Board