Heel Lifts with Strap is an exercise many of your clients will benefit from. It is one of the exercises in the Pain-Free Program that has helped people from all over the world feel and function better.
This is not a calf exercise!
Tags: ankle stability, corrective exercise, foot stability, Pain-Free Program, pelvic stability
Anthony, thanks for sharing this corrective exercise. I actually tried this corrective exercise #17, with my last client. You made me “look good.” My client is an accountant and sits all day in front of his computer, and his hip flexors, hamstrings, calfs, low back are always tight and uncomfortable. I had him try this, and not only did it make him aware of the need to perform this sort of program, but he left our session feeling positive and eager for more.
Thanks again,
Alex Signorello
Anthony
When you say the forefoot is supinated while the rear foot is supinated, which axes in the midtarsal joint is the forefoot supinated around?
Hey Shawn,
It rotates along the longitudinal axis. The forefoot is inverted (probably more accurate then “supinated” as I stated) relative to the rear foot, but supinated relative to where it is during midstance.
Based on the external ground reaction forces acting on the metarsal heads and the myfofascial contribution from the intrinsic muscles of the feet and the windlass effect transferred through the plantar fascia-the arch rises.
Anthony
Just so we are on the same page, you’re saying when the client in the video is raising her heel, the rearfoot is inverting and the forefoot is inverting while she keeps all five of her met heads on the floor? And she’s not using any of her plantarflexors because you said this is not a calf exercise?
Thanks!
Shawn
Shawn,
Yes, at the top of the movement, the rear foot, mid foot and forefoot are all rotating laterally along a longitudinal axis relative to normal weight bearing or mid stance in gait. Real and relative motion being accounted for between the different areas of the foot.
My point in saying it is not a calf exercise was not meant to imply that the plantar flexors are not being used. In fact, at the very top of the movement when the heels are maximally raised from the floor this can only be done with the plantar flexors as I’m sure you know.
The movement at first glance looks very much like what occurs on the seated calf raise machine. And Corrective Exercise 17 can be done incorrectly from a corrective exercise perspective by just raising the heels and not engaging the hip musculature.
Therefore, the functional purpose of the exercise is not about working the calves in the traditional sense, but they are involved.
Thanks for helping me clarify for others if I wasn’t clear in the video.
Anthony
Anthony,
Thanks for clarifying. Ok, the only way to keep all five met heads on the ground, as demonstrated by Wendy, while the rearfoot (calcaneus) is inverting at the subtalar joint, is for EVERSION to happen at the longitudinal axis of the midtarsal joint. This, along with plantarflexion of the 1st ray, plantarflexion at the oblique axis of the midtarsal joint, and dorsiflexion at the MTP joint, is what creates the “locking mechanism” and a rigid foot to propulse over.
Shawn
Shawn,
Are you saying EVERSION occuring is real or relative to the subtalar joint?
I agree with most of what you said that this is what happens during normal gait. Keep in mind that the locking and unlocking at the longitudinal axis of the midtarsal joint occurs as a response to the body’s center of mass moving from behind the calcaneus, over the midfoot and then eventually to the metatarsal heads.
Ideally in normal gait the talocrural joint is dorsiflexing before heel rise and the pending inversion that will take place at the calcaneus. This would also be coupled with knee and hip extension and the tibia and femur would be externally rotating.
No movement of the body’s COM, dorsi flexion or hip/knee extension is happening during this exercise. The tibia is just moving up and down vertically and the only ground reaction forces that come into play are at the met heads and toes at the top of the movement. And very little GRF’s at that.
The client is instructed not to push too much with the toes and instead initiate the motion with the hips. This is almost akin to open chain supination until the top of the movement.
So after all of this very good dialogue, we may be doing a little comparing of apples to oranges.
Great stuff though and I appreciate all your input. If you want to discuss more on the phone, let me know.
Thanks again.
Anthony
I hear what you’re saying, and as you know there’s alot more to the gait cycle, but my comments are specifically directed at the parameters you set up for this particular exersice. You said Wendy was keeping the balls of her feet on the floor as she raised her heel. Then you said her midtarsal joint was inverted, as was the rearfoot. The only way to keep the balls of her foot on the ground and lift her heel in the way you dictated in this exercise, is to evert at the longitudinal axis of the midtarsal joint. Another point, you said when the rearfoot supinates and the midtarsal supinates,you get that locking of the foot. That’s innacurate. It is the invertion of the rearfoot while at the same time evertion of the forefoot that causes the locking mechanism. Again, I’m only addressing this particular exercise and the rules and statements you made for it. Also, if there’s none to very little forces through the foot as you stated, how could this be a good exercise to “stabilize” and strengthen this if there are none to very little forces going through the foot?
Shawn
Hi Anthony!
Thank you for posting this exercise! This is no doubt a beginner’s question, but will you kindly explain why we want to strengthen the hip flexors here? I’ve always been taught the hip flexors are already chronically tight in most people from hours of sitting. I do understand that muscles can be both tight and weak. I am just wondering why strengthen first? Why not elongate first?
Thank you so much!
Tracy
Shawn, it comes down to real and relative motion. The midtarsal joint is everted as you say RELATIVE to the subtalar joint because the subtalar joint moved farthur and faster than the midtarsal joint. However, the net result from the anatomical is still supination or inversion.
What I described is not inaccurate. Multiple authors refer to this position as supination of the rear foot and mid foot or just as supination of the foot that is occuring.
I had a meeting with Dan Cipriania Phd., P.T. this morning on an unrelated matter and ran our conversation by him for his input. And he agreed that it is a matter of real and relative motion and that the midtarsal joint is in fact supinated at that point if the anatomical is our point of reference.
He also added that it is the closed packed position for the mid tarsal joints which adds to the foot stability (something I had not considered).
But I had considered the effects of the opposing pulls of the posterior tib and the peroneus longus. Their counter forces create a stirrup effect on the plantar surface of the foot adding to its stability.
I did not say there was “none to very little force”-I specifically said GRF (ground reaction force). Stability can be generated without GRF’s as in any tensegrity model. Stability that occurs via tension versus compression.
Hi Tracy,
Thank you for your question. Although there are lots of tight hip flexors in our society, they can also be weak. And we also must be able to differentiate between a client’s sense that they feel tight and what their assessment(s) tell us.
We can look at postural assessments of pelvic tilt, hip joint alignment relative to the plumb line, passive ROM, active ROM and functional movement patterns of hip extension to assess tightness and/or weakness.
Posturally, if the hip joint axis is forward of the plumb line when a client is standing that is a reflection of a posturally lengthened hip flexor muscle group and an indication of structural weakness. This can be seen in the Form 1 in the Pain-Free Program.
Thank you Anthony for your very specific attention to detail when explaining your exercises. As a seasoned trainer and corrective exercise specialist it is so helpful to hear more than the very basic info. We can never stop learning, can we?
And sorry you have to deal with “know-it-alls” like Shawn who are probably unknowingly searching for attention & self-elavation.
Keep the valuable info coming! And I love your book!
Thanks~Cindy
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