ExRx.net

Hey guys -

My feet tend to point outwards, and I'm assuming it's because of external rotation of the femur (I could be wrong). If I am right, what could be causing this problem? Tight IT band, weak glute minimus? Abit confused here!!

It is probably just genetic. Mine are like that too. I have always been that way as far as I can remember.

Do they point to the side excessively? I little rotation is fine and can be normal but a lot isn't a great thing to have.

It can be external rotation of the femur and / or external rotation of the foot only. It's normally a little of both. Does your knee caps point outwards?

KPj

Yep, my knee caps do point outwards. Could that be a sign of a tight TFL? And it's mostly external rotation of the femur, very little external rotation of the foot.

Yes, and tight external rotators of the hip, namely TFL and Piriformis. Actually, the TFL especially creates a pulling effect on the ITband, causing tightness. The ITband is just a belt of connective tissue, it's really just a victim of poor muscle function of the hip. Glute Medius is the most common culprit and can be strengthened via single leg movements. You'll get more 'bang for your buck' doing single leg movements with the 'off leg' unsupported, such as single leg squats or single leg DL's.

KPj

p.s just a 'fyi' - I would surprised to find anyone that didn't have a tight ITband. You should also look into soft tissue work, which is especially effective on the ITband (can provide immediate relief).

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So external rotation of the femur automatically means that the ITBand/TFL is tight, correct? What causes those muscles to become tight anyways?

I highly doubt it's tightness in the external rotators of the hip. I was thinking of strengthening the internal rotators, and stretching the ITBand/hip flexors.

What are some internal rotation exercises I can do?

Well, sort of. Nothings really exact with these things. A lot of strange things can happen if a muscle or muscles are weak somewhere - there's no 'designated path' that everyones body will take if certain muscles are weak. But there are common ones. Tight TFL's are very common. Therefore, tight ITbands are common - there's not many people who don't wince in pain when they put their ITband on a foam roller for the first time.

The ITBand isn't actually a muscle. It's a belt of connective tiisue which connects the glute max and TFL to the shin, and starts from the hip and runs laterally down the thigh. When it's tight, it's because of muscles pulling on it. The TFL is a big cuplrit - the TFL is a hip flexor, internal rotator and abductor (moving away from the body).




I wish it was as simple as having tight external rotators or internal rotators. Take glute medius, for example, the anterior fibres of the muscle internally rotate the hip, however, the posterior fibres externally rotate the hip.

I'm not saying it's deffinitly one way or the other - but the muscles mentioned (TFL, piriformis) are pretty good places to start. Which gives you one external rotator and one internal rotator.

It's much more straight forward to think of these things in terms of movements and not muscles. Afterall, whatever is going on with whatever muscles are just symptoms. The cause is lackof function (i.e. movement) some where. Find the dysfunction and work on it, and 'stretch what's tight.




I would be very suprised if you needed any internal rotation exercises. Most commonly, you need to train abduction more than anything else. Infact if you work on training abduction and stretching what's tight then everything else will probably fall into place.



Here's 2 articles that cover everything from activation movements, to strength exercises and static stretching - as well as some great info on the muscles of the hip and their function.

http://www.t-nation.com/free_online_art ... n_gear&cr=

http://www.t-nation.com/free_online_art ... ear_ii&cr=

Do you do single leg work? Observing what happens to your form during single leg moevments can tell you a lot - watch our knees, when it get's challenging, what happens? It's very common for your knee to be pulled towards the middle of your body (adduction and internal rotation) and this can be corrected by strengthening the glutes and consciously making sur eit doesn't happen - keeping the knees in front of the hips which requires you to 'push out to the sides' slightly which essenially works on abduction and external rotation.

KPj

KPj--I've noticed something which probably isn't a great break-through or new insight for others, but it was for me.

I was walking yesterday, and was thinking about the anterior tilt of my pelvis (which has improved, but is still there) and I was consciously tilting it anteriorly and then back to an exaggerated degree, and noticed that my femurs externally rotate with more anterior tilt, and rotate back toward neutral when I hold the pelvis back. Conversely, when I concentrate on walking with my feet more straight ahead, it's much easier to keep the pelvis in good position.

Now I'm wondering which is the chicken and which is the egg. Will trying to improve my foot position when I walk help my pelvic tilt, or will I need fix the pelvic position to improve my femur rotation and gait?

You've opened a can of worms here! Anyway, i'm just going to go wild with this one.

Of all the different resources that I look at, the general recommendation is to work on things 'from the ground up'. However, when we're talking about your every day postural issues, and assuming that I was forced to give a straight answer, then I feel that focusing on the hips first would be best. The reason I think that is because I feel that the imbalances start at the hips. I think this because the problem, or root 'cause' is sitting down too much and, well - you sit on your hips. So I feel it sets you up for the imbalances or should i say, the compensation patterns to follow.

In saying that, I don't even agree with myself. Often, we take our postures from our parents. Like 2 friends I have, both brothers, both had torn ACL's, and interestingly, their dad had the same injury. They look similar, stand the same way, and walk the same way - obviously nothing new there since kids mimic their parents. However, they are all quite knock kneed which will obviously increase the 'Q angle' which puts their ACL more at risk - same reason woman are more at risk, really.

When you consider that, which I guess would fall under genetics - then who knows where you should start!

You also need to address the specific imbalances. Some people have internally rotated femurs and so they compensate by externally rotating the feet. When you think of that case, then it would be pointless to try and fix the lower leg imbalance without addressing the upper leg / hip. When thinking of it in this context, then looking at the other scenario - externally rotated femur and feet (which I had) - then it looks like the foot is just going with the flow of the hip, and so you should address the hip first.

Gait is an interesting subject. Something I've not read much on specifically, but recommendations I've seen when referring to post rehab of a knee injury is to work on getting back to normal gait (i'm sure you know that often people continue to limp even after symptoms have gone) and the recommendation has always been to 'squeeze the glutes as your heel strikes the ground' - which again would imply 'prioritise the hips'.

In everything thats randomly coming to my mind, hips seem to winning on points.

Then you have the practical application. With externally rotated feet, then typically you have tight calves and ankles, with weak dorsiflexors. If you do soft tissue work, it only takes a few minutes to work over the calfs and plantar fascia. Moblising the ankle and calf is about one minute, too. On top of that - train the dorsiflexors, which is a quick exercise that can be slipped in anywhere in a program, really.

With the hips - well, if you do soft tissue work, you can go round your hole lower body in about 10 minutes. Whether this is done pre warm up or outwith the session is negligible, I believe. Stretching or mibilising whats tight can be added to the warm up, or betweem exercises that it won't negatively effect, and training the posterior chain should be priority anyway...

So maybe it's irrelevant what came first and we should be focusing on everything?

Then I think of my own personal experience. I used what I call the 'blanket approach'. I was the postural equivelant of the fat kid in denial the day he realised he was actually very fat. Furiously determined to fix it, I threw everything I could think of at it. From changing the way I sleep to setting a timer every 30 mins in work to remind me to stand up and /or fidget (reach for the sky etc). From doing a soft tissue work on my 'plantar fascia' to training my 'anterior neck flexors' (chin tucks!). So i've always felt that there's probably a lot of things that I done that you probably don't need to correct someones posture. But the more real life experience I get, the more I think that the blanket approach is the only realistic way of doing it. Certainly if your posture is REALLY bad, anyway. Truthfully, i'm not sure it could really be done without a big focus on soft tissue work, AND activation, AND mobility AND stability AND strength. I do believe that all of this can be implemented into a 45-60 minute lifting session, though (well, assumung you foam roll on the side). After that, all you need is the lifestyle changes (like fixing gait).

So, my preferred answer now that i've thought out loud via my keyboard about it, would be, "both".

You also have the same question with regards to the upper and lower body. Excessive kyphosis is often compensation for excessive lordosis which is a result of imbalances in the hips (and so on!!). Are you fighting a losing battle trying to fix kyphosis if you're not addressing lordosis? I actually think that you probably are. Perhaps the 'ground up' recommendations I have seen really mean "start with the lower body".

When I was at Cressey seminar in England about 18 months ago, he asked who had abad shoulder to get looked at. About 60-70% of hands went up. He assessed the guy right there infront of everyone - first thing he did was look at his feet.


KPj

It's funny that when I was a little kid, my dad used to tell me that I was "sway-backed" and that my toes "splayed out" when I walked. He used to nag me about straightening my low back and trying to point my toes straight ahead. When I got bigger I decided that those things were "just me" and decided not to worry about them. Now I realize that they were important and that he was right. One more example of him turning out to be right. If I'd have obeyed better as a boy, I'd be better off now!

You could have a tight/overpowering biceps femoris. That muscle can cause external rotation of the the leg. Also, like others said it could very well the piriformis,gluteus maximus. I would try stretching out those muscles.