A lot of the overuse injuries (itis’s) that athletes are suffering from today are coming from what we refer to as the performance paradox. The performance paradox can be explained by athletes who are bigger, faster, stronger, and more powerful today than ever before. In an attempt to get bigger, faster, stronger, and more powerful, many athletes ignore training for movement control. Movement control is the foundation that protects muscles, bones, ligaments, and cartilage from overuse injuries. Movement control comes from having the right flexibility, stability, and strength in the muscles around the foot/ankle, knee, hip, stomach/back, shoulders, and neck. An athlete can prevent ~ 75% of all overuse injuries by implementing an intentional movement control program.
As for the PF, common causes include lack of ankle dorsiflexion (if you cant bend your ankle in the sagittal plane) then your foot compensates by moving in the frontal and transverse plane – flattens/turns out). This increases the load on the soft tissue complex. Furthermore, the talonavicular joint and calcaneocuboid joint become restricted, adding further stress to the soft tissue.
Research by Khamis, demonstrated that a 2 degree increase in pronation of the foot (flattening of the feet) increases the anterior pelvic tilt by 50-75%…..simply put, if your foot flattens out, then your knee caves to the inside, decreasing muscle activity of your gluteal muscles by > 36%+. When your foot flattens and your knee caves in, the athlete develops adaptive “tightness” of the adductor muscles (groin muscles), TFL/ITB (front/outside of hip/thigh), and short head of the biceps femoris (behind the outside of the knee). Tightness of the adductors and TFL create further adduction (knee caving to the inside) and tightness of the short head of the biceps femoris causes the tibia to externally rotate (turn to the outside). It also restricts the proximal tibiofibular joint (joint on the outside of your knee). Restriction of the proximal tibiofibular joint decreases ankle dorsiflexion (ability to pull your foot straight back), causing further pronation of the foot (and adaptive tightness of the peroneus longus and adductor hallicus……muscles that attach to your big toe). This compensation restricts 1st MTP joint motion (big toe), which causes the foot to pronate even more.
So, weakness in the lateral gluteals and tightness in the inner thigh can force the foot to pronate which increases stress on the PF. Also, tightness in the gastrocnemius, soleus, and peroneals can restrict ankle dorsiflexion and force the foot to evert/externally rotate (Prontate), thus increasing stress to the PF. These imbalances are easy to identify and correct:
- Do a movement assessment by performing overhead squats and single leg squats to determine movement efficiency (does the foot turn out? does the foot flatten out? does the knee cave to the inside of the big toe? does the trunk flex to far forward?)…..all of these movement compensations can cause stress to the PF
- Do a range of motion assessment…..assess 1st MTP range of motion, ankle dorsiflexion, hamstring length with knee at 90/90, hip abduction, hip internal rotation, and hip extension……restriction in ROM of any of this joints can lead to increased stress to the PF
- Follow a targeted manual therapy, corrective exercise and functional training program to restore normal ROM, muscle activation, and movement control
- If working with a PT, ATC, or Chiro, follow a targeted integrated manual therapy plan that focuses on inhibiting overactive muscles (myopractic), lengthening short/tight muscles, mobilizing restricted joints, activating underactive muscles, and then perform multi-planar functional movements without compensation
- If you are working solo, you would follow the same strategy but you would use a foam roll to inhibit overactive muscles, static stretching to stretch tight muscles, isolated strengthening to strengthen underactive muscles, and then following a progressive functional movement program to strengthen the inside calve, outside hip, and stomach/low back
- Ancillary assistance to decrease load/stress to PF: you can utilize orthotics, braces, ice, and more supportive shoes while you are addressing the cause of the overuse injury