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-   -   Possible cause for foot turned outwards (Steven Low please read). (http://board.crossfit.com/showthread.php?t=61642)

Arturo Garcia 09-20-2010 09:36 AM

Possible cause for foot turned outwards (Steven Low please read).
 
Hi.

I've had my right foot turned outwards for a long time now. A couple of years ago I tried implementing sprints into my programming and I'd get this horrible pain in my right hammie that'd last for a very long time, which I guess were minor tears or something. Ever since I've read all I could find on this, and have always found advice on stretching the hip musculature, strengthening the glutes (all of them), etc.

But just today I think I've found out what is wrong with me. I had heard before that Louie Simmons (I think) has said that foot turned outwards meant weak hamstrings. Now I know that my right hammie is weak and just today I was thinking of how to strengthen it, because bilateral exercises will continue to keep my left side much stronger.

But what I discovered today is that there can be an imbalance WITHIN the hamstring muscles. I was looking at an anatomy picture and I see that the outer hamstrings (viewed from the back) are also external rotators of the hip! While the inner hamstrings are internal rotators. Now, I usually get more sore on this right hamstring from my workouts than in my left, but guess what, the soreness is in the inner hamstrings, the ones that should be rotating my hip inwards. I think they are much weaker than the other hammies. I had noticed in the past that when I do a single leg hip extension on the GHD machine, that foot turns outwards. When I did an exercise called the "single leg hip thrust" where I only use my heel and not the whole foot, it also feels stronger when it turns out. Obviously the body wants to turn my right foot out in every move that requires hamstring usage and I think this will never fix my imbalances. I am also doing GHD raises lately (SUCK at these!!!) and I feel it turning out too, and I feel the left leg doing more work... I truly need more unilateral work and less bilateral!

Also... I am doing these two unilateral drills every week, on sepparate days: the bulgarian split squat with added ROM (foot on 6" box), and walking lunges. Both holding dumbells. Now on these two, as the feet is flat on the floor I don't think I can turn it out... therefore after these two "leg days" I have this soreness in the inner right hammie... which indeed feel like more than just DOMS, like I'm slightly tearing it every time (it does heal within a few days so can't be major).

I've wanted to solve this issue for a LONG time now. I've wanted to sprint for a very long time, but I don't do it because it's almost guaranteed that I'll injure myself in that right hammie again.

I guess my question is... (hopefully Steven read all this crap! :D) can this be a cause for some people's "duck foot"? I don't think Steven mentions this in his article on Lower Body Dysfunctions (I could be wrong though), so maybe it's not a very common cause, but right now everything looks to me like that's exactly my problem, weakness of the semimembranosus and semitendinosus (correct spelling) compared to the bicep femoris (outer hamstring).

How can I go on about this? Should I quit doing the GHRaises or other very big effort lifts where the right foot will inevitable turn out?

Arturo Garcia 09-20-2010 12:36 PM

Re: Possible cause for foot turned outwards (Steven Low please read).
 
I gotta add this: I used to think that a weak glute was the cause of this. And it might have been, in part. Some unilateral exercises were much easier with my left leg so my first rational thought was: the glute is too weak, so the hamstring is taking all the load on this right side... and in other exercises I even felt the right lower back a little strained. I was sure that my right glute was just weak so the hamstring and low back were working extra.

But after a looooot of glute drills that even today I still include at least one or two in my warm up, I think the glute issue is solved! Both glutes now get equally sore, where I used to get a sore left glute and sore (and even a little tore) right hamstring. So I think the glute fires nicely now, they might not be 100% symmetrical but I think it's not an issue anymore.

Good lord... so much glute drills.. am I now gonna have to be including "hamstring drills" for ever too ??? Man, why can't I just do whatever I want... :D

Now that I think of it.. during a glute drill called "the bird dog", of which there is also an advanced version called "advanced bird dog" where you flex the other knee to where it touches your chest, and you lift your back leg, straight, off the floor... I distinctly remember having a very hard time keeping that back foot pointing down (although I tried!), it rotated outwards on that one, and it gave me quite a sore hamstring on the right side! Again, back then I attributed this to "right glute is weak, so hammie is working too much".. but it may just be an issue of "inner part of right hamstring is just really weak and never worked out, so it'll get sore when you actually use it".

This has turned into just useless rambling, but hopefully Steven or someone will have some thoughts. My first thoughts are that I definitely need to include some low-load drills where I focus on form (feet pointing straight) and strengthen that inner right hamstring of mine.

Man... I wish I never got fat and out of shape during my younger years, it's haunting me now to solve all these issues.

Brian Strump 09-20-2010 01:52 PM

Re: Possible cause for foot turned outwards (Steven Low please read).
 
There is more than one reason for an externally rotated foot. The hamstrings are only part of the puzzle. Dysfunction of the glutes, TFL, among a few others can also be the culprit.

Steven Low 09-20-2010 02:34 PM

Re: Possible cause for foot turned outwards (Steven Low please read).
 
It's a potential reason. It's more likely to see a rotated tibia (compared at the knee) and then that will mess with foot mechanics. (I did include this one in the article).

If you're rotated at the hip, it's usually a flexibility issue than a hamstring issue. (Also included this one).

It is possible to unbalance the hamstrings but thats pretty rare... its more likely to unbalance the quads (hence patellofemoral syndrome)

If you think you finaly got it then throw int he corrections and try to fix it.

Arturo Garcia 09-21-2010 08:28 AM

Re: Possible cause for foot turned outwards (Steven Low please read).
 
Well I do have a smaller Vastus Medialis quad muscle on this weaker right leg, so it might be a quad issue too.

Yes I rotate at the hip, it's much more loose at the hip, this right leg. When I lay in bed it rotates out. A massage therapist told me it was much easier for her to rotate that leg in comparisson to my left one.

I used to play tennis as a child, and I've played a bit as an adult, recently getting back into it. Just recreationally once or twice a week. I took a class with one of the coaches I've known for many years, and since he was throwing so many balls and so fast (something that wont happen when playing with a partner), I actually felt my LEFT leg fatigue, my stronger leg. I mentioned this and he said he'd check me out, and he said he sees me doing all my moves with my left leg. I think he means that wether I'm taking steps to my right side, or my left side, my left leg is always doing the movement while my right leg is always the "trailing" leg. I'm right handed, by the way.

I guess all I wanted to say with all my rant in the original post, is that I wish someone had stated clearly that the FEET must be straight when performing all this glute drills! So maybe while I did so many glute drills in the past year, I would've solved the hamstring imbalance and killed two birds in one stone. But since I kept doing single leg hip extensions with a turned out foot, and Birddog's with a turned out foot, the advanced birddog with a turned out foot, and who knows if I even turned it out during my single leg glute bridges since I only use the heel of the foot and don't plant it flat on the ground.

I feel this is why everytime I do use medial hamstrings (lunges, bulgarian split squats, where my foot is fixed on the floor so I don't rotate it out), I get very sore on that medial hamstring the next few days. Always, even if I do this week after week, it always gets sore. Why? I feel it's because I don't use that muscle in my everyday life.

The temporary fix I'm gonna attempt, is to do some low-load drills like I did the glutes, while really focusing on keeping that foot straight or even a little inward. In fact some of the drills I used to do for the glute left me with a sore medial hamstring for this very reason since they use it a lot (advanced birddog and single leg hip extensions are two that killed that right hamstring of mine). I used to think it was because of a weak glute (therefore overloaded hamstring), but I think I found the true reason now.

Another thing that makes me think I'm in the right path is that whenever I used to stretch my right hamstring, the foot would turn outwards... meaning my medial hamstring is not only weak, but stretched. I always felt I had more flexible hamstrings in this weaker right leg. But the truth is, if I hold my foot straight or even a bit inwards, it feels worse and I can't reach as far. This leads me to believe that my outer hamstring (bicep femoris) is not only much stronger than the medial hamstrings, but tighter. So I'll stretch it everyday too.

Oh well... we'll see in a few weeks. If I improve noticeable I'll report it. I did find one person in an article who mentioned the difference between foot possitions and which hamstring muscle is working more. WFS: http://www.thefitnessblueprint.com/m...age=hamstrings

Mike Mallory 09-21-2010 10:24 AM

Re: Possible cause for foot turned outwards (Steven Low please read).
 
Some of the thinking is correct, but hamstrings don't just imbalance themselves for no reason....it's always some other mechanism that they're responding to, unless you had some sort of traumatic injury to that spot.

If you've got big muscle-size-imbalances, then that points towards neurology and big compensation mechanisms.

I've seen the one-leg duck footed things a few times, most of 'em being the hamstring compensation for a lack of stability through the midsection. That's still a shot in the dark though if someone doesn't do an analysis of your body and see what actually going on.

Simply strengthening or stretching the muscle usually just undoing the body's compensatory mechanism, which can lead to more of a mess!

Have someone check out your pelvic biomechanics.

Steven Low 09-21-2010 12:40 PM

Re: Possible cause for foot turned outwards (Steven Low please read).
 
^^^ +1 that

Arturo Garcia 09-21-2010 01:22 PM

Re: Possible cause for foot turned outwards (Steven Low please read).
 
Thanks for your input Mike and Steve.

Just to clarify, I don't have "big" muscle-size differences, but there is a tiny difference. This could also be cause of doing bilateral things like squats and deads... I guess if one leg is a little bigger it will stay a little bigger as long as one keeps doing bilateral work, right?

What surprised me was my tennis experience. Recently I played for almost 2 hours and no leg fatigued, but with the coach and all the balls coming at me at both sides randomly, my left leg got tired, the "strong" leg, and not the weak leg. It seems I naturally move using it much more. I definitely need to stick to unilateral movements.

Two years ago they were SO bad, that I just couldn't do them right. Bulgarian split squats, lunges.... I had absolutely no stability whatsoever. I could hardly do single leg romanian deadlifts... unweighed! This all applies to the right leg though, with the left I could do everything, and add weight and it wouldn't be a challenge.

According to some tests, I did have a weak core. Maybe I still do, but I'm using an Ab-wheel and seeing progress. I used to stuff like hanging leg raises but I realized I had very weak abs when my hip was extended (read: body straight). Abs would give in first in ring push-ups, for example, and I can't even do that many push-ups. Pathetic ab strength. I got the ab-wheel and did 5 reps from the knees on the first time. Since the max load is when I'm stretched I feel this is better than timed planks, which were all I had found for the abs in the "body straight" possition. I did 17 reps last week and today I have to do them again, I'm using it on tuesdays, maybe I have progressed a bit, who knows. But your "weak midsection" definitely applied, or applies, to me.

I did go to a phisio therapist once. He had me do x-rays of my pelvis in what he called a "frog" possition and he said I was fine. He measured both legs and said they were equal length as well. He recommended glute strengthening stuff because he said I had weak legs in all the tests he made (to flex the knee, to extend the knee, etc.). But he didn't notice anything abnormal.

But everything is weaker on this right leg, from glutes, to hamstrings, to quads, to foot muscles. But they're all getting better, I even have better balance on that right foot now, I can do lunges and bulgarians and not fail due to balance. I still don't have it as good as in the left leg, but it's improving. Maybe after I loosen the lateral hamstring a bit and strengthen the medial hamstring a bit, it will be even better? these are my hopes. I'm not going to structure a whole routine based on this, just gonna do some low-load drills while focusing on that part of the hamstring and see what it does to me in a period of about a month or two. No big deal. I did this with the glutes and it "woke up" my right glute nicely, although it did take a lot of work!

Don't scare me telling me I'm gonna mess me up! :p:)

Steven Low 09-22-2010 01:42 PM

Re: Possible cause for foot turned outwards (Steven Low please read).
 
Yeah, just make sure you do everything right.... feet forward... I should probably put that in the shoes and sitting article heh

Paul Shortt 09-23-2010 06:12 AM

Re: Possible cause for foot turned outwards (Steven Low please read).
 
Quote:

Originally Posted by Mike Mallory (Post 845912)

I've seen the one-leg duck footed things a few times, most of 'em being the hamstring compensation for a lack of stability through the midsection. That's still a shot in the dark though if someone doesn't do an analysis of your body and see what actually going on.

This..

Arturo Garcia 09-23-2010 01:28 PM

Re: Possible cause for foot turned outwards (Steven Low please read).
 
Thank you all with this wonderful suggestion about seeing a specialist. Believe me, the reason I haven't seen one is not due to money, not due to time, not due to lazyness. I just don't know any.

Back in 2007/2008 when I first started having AC joint problems, the first 5 or 6 doctors I went to were absolutely sure my problem was on the gleno-humeral joint. Doctors in here suck. I don't even know if a "sports doctor" exists, otherwise I'd go to him everytime, even though I'm not an athlete (but I'm also not a 70 year old arthritis patient). So, finding a good doctor is actually hard for me.

If it were for me, by now, I would have gone to a chiropractor, a rolfer, and who knows what else. Believe me. But as far as I know, there is none. There are, I think, some "fake" chiros but I cannot trust them, they're usually foreigners who come and practise here maybe because they're banned from practised in their home country, who knows.

It sucks to try and fix oneself, I know. Thanks for the tips.

Mike Mallory 09-23-2010 06:38 PM

Re: Possible cause for foot turned outwards (Steven Low please read).
 
I don't think anyone's just trying to sluff it off onto 'see a practitioner', but you simply can't test yourself on everything, or correct your own neck, or examine your own SI joint.

It's not to say you can't go through your whole body with a lacrosse ball and start finding out where trouble zones are either. With all the things your thinking about, and the awareness you have of your body, you probably just need to find some pesky little thing that your overlooking.

Why not travel to someone in the US? We got people who travel to see us, and I travel too.......And for you, Miami's a cheap plane ticket away, and I know people who could look into it there......just sayin-

Arturo Garcia 09-27-2010 07:56 AM

Re: Possible cause for foot turned outwards (Steven Low please read).
 
Mike,

Even thought it sounds crazy, I'm considering doing just that. There are some good offers to Miami sometimes, with which I can fly there and back for about US$300 if I get lucky (I just checked). I'd have to add hotel costs and taxi costs so it's still a lot. And how much would the person charge me? From what I've read these people aren't cheap. Plus, my biggest concern, is having to require some follow-up. Is this guy (or gal) gonna be able to find out what's wrong in just one day? ... I was under the impression that whatever physical issue I have would have needed some work and follow-up. This issue has been bothering me for so long, that I would actually be willing to pay for the flight IF (big IF) I knew that I would get at least a partial solution from my one visit (and then I'd do stuff on my own of course, I don't expect to magically get fixed in a day). But if I need to go back every week or even month... that's a little too much for my pocket, know what I mean? And I think usually people do need to go back for many vists. :(

But even for some improvement I'd be willing to pay, because I'm sick of this condition.

Mike, I've been trying to get some more info out of you but you're not easy :) ... those people with one leg duck-footed, what exactly was wrong in their abdominal wall and how did you find out? I'm genuinely curious.

Arturo Garcia 10-01-2010 02:55 PM

Re: Possible cause for foot turned outwards (Steven Low please read).
 
I found a Dr. today, he seems to know his stuff, at least he convinced me which is hard to do. He's a chiropractor amongst other things, but a doctor too.

He thinks my hamstring issue is being caused something in my lower back, or my upper back which he saw was disproportioned as well (right side stronger, the ooposite of the legs). He noticed, when I laid facing up, one of my pelvic bones was higher than the other. I wonder if this explains why squatting hurt right under the left hip bone (the left leg is the stronger one). Maybe or maybe not. He says he thinks in just a few sessions I'll see big improvements, we start tomorrow... I'll keep my hopes up. Something better work coz he aint cheap either.

He did notice a lot of stuff very quickly so that's why I think he knows what he's doing. He didn't "adjust" my hip bones because he says my low back is a little inflamed (or something), which makes sense since I worked out my legs 2 days ago and I felt my lower back very pumped when doing single leg hip extensions. Oh well.... just letting ya know.

Steven Low 10-01-2010 04:22 PM

Re: Possible cause for foot turned outwards (Steven Low please read).
 
Quote:

He noticed, when I laid facing up, one of my pelvic bones was higher than the other.
Sounds like slipped SI joint....

Easily can cause the problems you've been having. If you had been to a decent PT/chiro before they SHOULD have been able to spot that.

Sucks living out where there aren't any decent ones though if you're actually in the Dominican

Arturo Garcia 10-02-2010 08:18 AM

Re: Possible cause for foot turned outwards (Steven Low please read).
 
Steven, yes I live here. And yes, I had tried this before with no luck. I spent all day yesterday searching for chiros and only found this one! Just one! He said that he's a doctor and that's why he's the only one listed anywhere, because there are other chiros who aren't Doctors, just chiros, so they don't appear listed and work a little more "underground". I had heard of a few of these chiros, 2 or 3 of them, all foreigners, and I've heard stories of they coming here because they were forbid from practising in their home country (usually USA) and they having hurt a couple of patients... so I was kindof scared to try them.

This guy seems legit so far, in a few hours I'll go for the first session.

If it is indeed a slipped SI joint... it can't get fixed by just putting it back, right? Something must've caused it to slip. I fear it could get slipped again unless we find the true cause. But I might just be talking crap as I know so little about this.... I'll ask him more questions today.

Steven Low 10-02-2010 08:54 AM

Re: Possible cause for foot turned outwards (Steven Low please read).
 
Usually an SI joint slips from impact or compensation imbalance (such as if you sprained your ankle and are putting more weight ont he other side chronically).

Ifit's been there a while it may take a while to reset back to the proper place.

Basically, if it's stuck you're giong to have to help it stay put after it would get put back in place by doing proper flexibility work to loosen the tight muscles that were keeping it there, and strengthening to help strengthen the loose muscles.

Both PTs and chiros should be able to do this type of thing but yeah.... Adjusting SI joint isnt like a major injury thing. Any chiro or PT worth their salt should be able to do it

Arturo Garcia 10-04-2010 09:27 AM

Re: Possible cause for foot turned outwards (Steven Low please read).
 
Steven,

I've been to two sessions now. Saturday, and today, monday morning.

On both days he applied heat and ultrasound first to my lower back as he feels the problem lies there, also the mid back kindof. And then the front/inner right thigh. In this last bodypart also massage with some cream that feels cold. Last he's had me do some strengthening exercise only on that right leg. Today he said it already looks to be filling up a little bit, kindof in the inner thigh, whch looked a little "empty" compared to my left leg. I thought he was BS'ing me because how could we be seeing improvements in just 2 days?

Anyways I go back tomorrow morning again.

Funnily enough, he has not adjusted the hip just yet. I asked about it but he said not yet.

Yesterday (sunday) my LEFT lower back felt very odd all day. Not in pain, but just odd... I mentioned this and he said it's part of the process, probably because of our session saturday. I find it weird because I had never felt that before.

Today I feel my right hip odd, like the front part. Again, not in pain but just odd. Different. I'll take this as a sign of progress...

Sucks that he's forbidden me from doing anything, at all. I'll take a rest week, might do me some good.

Edit: you mentioning putting weight on one side chronically. Everytime I step onto a Wii Fit board, my balance is always on the same spot. I only step on one every few months, but it's always the same. My center of balance is to the left (stronger leg) and to the rear. When I do any unliateral drills on it I get scores like 30 with the left leg and 8 with the right, and so on. Heh heh.

Steven Low 10-04-2010 11:38 AM

Re: Possible cause for foot turned outwards (Steven Low please read).
 
Shifting is a good sign if your pelvis is off.

The process is good... youve had it for a long time so its going to take a while

Arturo Garcia 10-07-2010 09:05 AM

Re: Possible cause for foot turned outwards (Steven Low please read).
 
I have gone all week, including today, thursday, to the therapy. This is really expensive, on monday I'll talk him into making a deal or I wont be able to keep going much further... will have to spend my life savings at this rate, if I have to go daily for something like two months, no way.

Still ultra sound and heat on low back, mid back, and thigh. He told me he has seen the muscle is forming in my right leg. Which muscle, I asked? He says he sees emptyness kindof in the inner thigh. This was yesterday, today I went with a drawing of the Gracilis muscle and asked if it was it. WFS: http://exrx.net/Muscles/Gracilis.html

He says it is. It makes sense, seeing the functions of this muscle. Adduction, transverse adduction, knee extension, and although not mentioned in the above link, it helps in internal rotation as well (remember this leg is externally rotated).

This reminded me of a time where I had to make a 4 hour drive and I decided to keep my right leg straight, instead of letting it rest on it's outer side where it touches the car (around the gearbox). I remember I had incredible DOMS for about 4 days, I believe in this Gracilis muscle to be honest. Makese sense, considering what kind of work I had it do for several hours, although very light. This was about 2 years ago. I was already aware of my "problem" back then. Edit: the soreness back then might have been on the Adductor muscle, I guess I'll never know now. WFS: http://exrx.net/Muscles/Adductors.html

He's had me done prone leg extensions while he places a DB in the back of my ankle, and supine leg raises with a dumbell on the front of the ankle. So far that's it. I honestly have my doubts, he says we'll do more stuff but it needs to be slow. At this price I don't want it to be slow.

He said tomorrow he'll adjust my hip, I'm anxious to see how that feels. Tomorrow I'll go to the beach for 2 nights until sunday afternoon... so I wont be posting again until monday, probably after I see him again on monday. I'll wait until then to discuss these prices with him, lol.

When I had AC joint surgery I remember the rehab place I went to also had the same equipment and it cosed 40% of what this guy is charging. I don't know if they know enough, though, but if he's not willing to make some kind of deal I'll go to them and check it out.

Oh, I forgot to mention that I swam a bit two days ago... and yesterday I rode my mountain bike for the first time in several months. Both things he told me I could do. I actually hit the bike pretty hard on a hill, big pump at the end. But no soreness today (cool!) and he says the lower back is improving every day, despite doing those activities.

Arturo Garcia 10-11-2010 08:42 AM

Re: Possible cause for foot turned outwards (Steven Low please read).
 
I'm incredibly depressed right now.

Friday morning I went to my 6th session with this guy. After this, I had to drive 3.5 hours to a beach resort in the east part of the country, for a weekend there with my family. First time taking the kids to one of those. Probably last, until they're older.

The drive can be described with this one word: PAINFUL. At about 40-45 minutes the pain begins, it feels at the origins of the right hamstring, right where it connects with the glute, kindof the inner side of the hamstring (or medial, as I think they're divided into medial and lateral hamstrings... can't remember their true names.. actually, I can, but can't remember which is which). By 1.5 hours it's hard to keep going... I can barely reach 2 hours and needed to stop for 10-15 minutes so I could walk around and "shake it off". Driving is resumed with no pain, but again after a while, nearly the same amount of time as the first time (40 minutes?) it starts hurting, and gradually increases to unbearable by the time I reach my destination. Good thing I don't have to drive long distances in my everyday life. The return trip on sunday was exactly the same. Pain begins at maybe 50 minutes, then it becomes very painful gradually, and after 1.5 hours of straight driving it's horrible. A stop in the middle of the drive reliefs me and I can drive pain free for another 30-40 minutes.. then it sets in again and builds up from there.

Just what in the holy hell is wrong with me?

If I stretch my hamstrings doing the "good morning stretch", this right hamstring hurts, the more I push the hips back the more it hurts.

The doctor was surprised today, he wasn't expecting that. I'm going to give this guy just this week... if no improvement or no hopes of improvement is seen I'm gonna have to stop going because he's so expensive. Right now I'm regretting not going to the USA. This is what happens when you don't have a wide variety of specialists around and have to just go to whoever you can find.

Today was more of the same: ultrasound and heat. But he did something different... he had me do the prone leg raises with the dumbell in the back of my ankle for what felt like a gazillion reps, I guess he just wanted to tire out the muscle. He did almost the same with the supine leg raises with the DB on the front of my shin, close to the ankle. By touching my hamstrings he says he feels my right one is really "contracted" or whatever. I have not worked out in about 10 days by now. In the beach I did nothing that could even begin to stress my leg muscles, unless you call saturday's 20 minute beach walk a "workout" (which did produce some soreness in unusual places in the lower leg)...

Everyday I regret more not taking Mike Mallory's advice of flying to Miami and seeing someone there. Of course, it's not like every physical therapist in there is a Magician, right? Maybe I could've ended up seeing one that didn't help either, who knows. Like I said I'm gonna continue to go for a couple more days, maybe this week... if nothing improves by friday I'm gonna have to stop, it's costing too much and I aint seeing any benefit yet.

Steven Low 10-11-2010 09:08 AM

Re: Possible cause for foot turned outwards (Steven Low please read).
 
Well, the problem is that you've had it for years... so it's probably going to take months to get it back aligned.

But yeah if money is an issue then... that's problematic.

Don't really know what to tell you.

Ask him for a home exercise program because you dont have anymore money to spare

Arturo Garcia 10-11-2010 09:57 AM

Re: Possible cause for foot turned outwards (Steven Low please read).
 
It's about US$67 per day. That's US$335 per WEEK if I go mon-fri ... but I guess in the US it'd be even more expensive.

Mike Mallory 10-11-2010 11:24 AM

Re: Possible cause for foot turned outwards (Steven Low please read).
 
I would cut it off now and save your money........paying out of pocket for ultrasound and heat is a waste of time.

Arturo Garcia 10-13-2010 01:17 PM

Re: Possible cause for foot turned outwards (Steven Low please read).
 
Yesterday I dusted off my old Egoscue DVD for begginers and I did the session. I bought this in early 2008 and did it daily for about 2 weeks before quitting, was too anxious to do CrossFit back then. I remember seeing improvements in those two weeks, quitting was probably a very, VERY dumb idea.

The whole selection of exercises are not meant to be a workout for mass or anything, just posture and all that good stuff. I'm gonna try it out for a few weeks, this time trying not to quit. I also noticed there is an Advanced version, a second DVD that I never even bothered to watch! Duh. So maybe after a few weeks on this begginer version (of which some drills kicked my butt yesterday), I can do a few weeks of that other one, and see if anything improves.

One thing that I had noticed in the past, and noticed today, has always bothered me: One of the exercise is side leg raises, laying on one's side, with the forearm on the floor... you know, for gluteus medius. The thing is, today I am sore in my right "lower back". But it's not the lower back. About a year ago when I was doing tons of glute drills, I noticed that if I did these leg raises to failure I'd get a pump in this same place, and not the glute med. Well, I think I identified the problem back then, and on my right side I seem to use my Quadratus Loborum to help with the side leg raises. So today when I woke up with a sore right QL, I remembered that I used to get a sort of pump in there on the right side, instead of the right glute med. I have to focus very hard on not using it in order to target my glute med on that right side. Today I'll try it and focus and see if I get the burning in the glute med and not the QL.

I have no idea what this could mean. Just QL compensating for weak G.med?

Steven Low 10-13-2010 03:15 PM

Re: Possible cause for foot turned outwards (Steven Low please read).
 
Could be.... could also be you're rotated.

Do you still have the leg length difference?

If so you may want to try the self SI joint stuff wfs
http://www.eatmoveimprove.com/2010/0...ur-lower-back/

Or have the chiro pop it and then just not go back to him after that, and hope it holds while you do the other mobility stuff

Arturo Garcia 10-14-2010 08:44 AM

Re: Possible cause for foot turned outwards (Steven Low please read).
 
Steven,

I think I might be onto something. Before telling you, let me say he did that adjustment shown in the 54 second video from your article, where he pushed my shoulder back and my hip forward, kinda. There was a pop but not too loud.

Two days ago, in fact the very same day he did that manupulation, I decided to dust off my Egoscue DVD and did it. Yesterday I woke up with a sore QL in the right side. A quick Google search brought up this article: WFS: http://www.floota.com/QuadratusLumborumStretch1.html

This part got my attention big time:
Quote:

Because most people sit for 90% of the day, their quadratus lumborum muscles are short, tight, and overused. If you have back pain that is only on one side of your lower back, thereís a good chance itís the quadratus lumborum on that side. If (1) you have a quadratus lumborum muscle thatís causing you pain only on one side and (2) no obvious injury initiated the pain (e.g., a fall), your pain could be coming from your everyday sitting habits. For example, if, for some reason, you like to cross your legs when you sit, and you frequently only cross them one way (e.g., always right over left), this means there are unequal forces on your back. To keep you sitting up, one of your quadratus lumborum muscles is then engaged. Some people have a tendency, when they cross their legs while sitting, to shift their weight onto the butt cheek of the uncrossed leg. For example, crossing your left leg over your right means you lean slightly to the right, with, say, 70% of your weight on your right sit-bone, 30% on your left. This isnít a problem, unless you do it for 12-14 hours a day, every day (like most of us do when weíre sitting). If this is habitual, that means one of your quadratus lumborum muscles is doing most of the work all day while you sit.
This article spoke to me. For over 10 years I ALWAYS sat with my right leg crossed over my left, the outside of my right ankle over the top of my left thigh. My right glute is therefore way more flexible and this probably contributed to the outward rotation of that right leg. I cannot even comfortable place my left leg like the right, in fact it slips down if I don't try to hold it there on purpose. I am 100% sure that I always crossed my right over the left, never alternated, and I did this through hischool and while at the university and up until maybe 2-3 years ago when I started having problems with this and I suspected crossing the legs wasn't making it any better.

Like I said, yesterday I woke up with a sore right QL... from what? Doing a few side laying leg raises? C'mon !! It's still sore today, by the way.

Now here's the thing... the main function of it is to laterally flex the trunk. Looking where it's attached, I am wondering if a tight right QL has contributed to what the chiro saw when I layed supine, that my right hip bone was a little higher than the left. (By the way Steven, the legs themselves are equal length).

Also, about 3 days ago a lady that works with the chiro, while applying heat to my lower back, said to him that she felt she could dig deeper in my right side by putting preassure with her hand. The Doc told her it was nothing but I was laying prone, so I didn't see their faces. I mentioned this today, and he said he noticed this but told her to shut up (with a sign) so I wouldn't worry, he said he didn't want to tell me just yet, but he was always aware that the problem was in the lumbar area. I don't know if to believe him but he sounded honest. And he did state repeateadly that the problem was there.

I just don't know if it makes sense. If my right QL muscle is very tight or overused or whatever, is it normel that someone would feel an "emptyness" in that right side, poking from around the lower back area?

If I stretch this right QL right now it hurts a bit, the good kind of pain, though, that you get when stretching a sore muscle. I think I will have to stretch this QL muscle everyday for a few weeks, and see what happens. I am wondering if a tight and overused right QL is the root of all my problems.

When I do stuff like single leg hip extensions, or single leg hip thrusts... I'd get a HUGE pump in what I always thought was my right lower back.... but I suspect now it's always been the darned QL !!! I kept overusing it, no wonder the chiro said it was pretty swollen when I first got there. Which is odd to me: how could it be swollen but at the same time you can dig deeper with the fingers around that area? Maybe when it gets swollen and tightened it just shrinks and gets harder, or something similar?

I would really like to hear Steven and Mike on this theory. I know Internet diagnosis is not the best, but yesterday I found a post of mine from February 20th 2008 talking about this same subject!!! That depressed me. 32 months ago!! Wtf? I really need to solve this. I remember back then I did the Egoscue DVD for 2 weeks and saw improvements, but I dropped it forever. I've done it 2 days now, and will do it for several weeks, while at the same time stretching the QL everyday with the stretch from the article I linked above. I might just go to the chiro every couple of weeks in case I need manipulation, or I could do it on my own.

By the way Steven, I once did a similar manipulation to the guy in the video, I lowered to the bottom of an air squat, placed a long wooden block between my knees (maybe a foot long) and tried to crush it with them, and I did feel a loud pop. I might actually try it today and see what happens, since the guy in the video just says to put both fists between the knees. I wonder if doing it laying down is better than standing up and the bottom of a squat.

Sorry for the long post, but I'm kinda excited, I think I might be getting somewhere. Too bad the article itself says that stretching the QL daily might still take weeks to make a difference, ouch. So it's Egoscue + QL stretching daily for me... I gotta put in at least a day of strength training in there, at least upper body or something while I fix this! :)

Mike Mallory 10-14-2010 09:34 AM

Re: Possible cause for foot turned outwards (Steven Low please read).
 
That popping is to be expected......That's your pubic symphisis, which 'pops' back into place when its pulled apart by the adductors. It's representative of an SI joint misalignment.

This is to be expected when you have muscle discrepancies in each leg......And besides that its just so amazingly common in everyone.

I would get your lacrosse ball and dig away at your QLO's......When you don't have anyone to treat joitn misalignments, you can still do all that you can to normalize the tissue around the problem. A lot of times that can solve the problem enough to where you don't have to worry about it......It becomes a subtlety.

remember what I was talking about a few messages back? When the abdominal wall doesn't function correctly, it leaves the SI joint unstable......then the SI joint slips out of place, or the muscles around it tighten up in funky ways to protect the joint-->weird hamstring stuff

Keep diggin' dude! ;)

Steven Low 10-14-2010 10:15 AM

Re: Possible cause for foot turned outwards (Steven Low please read).
 
Sounds alright.

The pop with SI joint or pubic symphysis is likely good as well.

While soft tissue work won't correct the actual imbalance it shoudl be able to loosen up the tissue there to allow us to see what you need to do from there if it keeps slipping out one way or the other

Arturo Garcia 10-14-2010 01:27 PM

Re: Possible cause for foot turned outwards (Steven Low please read).
 
Thanks for the replies guys. I just ordered a heating pad as suggested by that article, so I can apply heat by myself, hopefully I'll have it sometime next week.

One thing is bugging me though... seeing the location of the QL in a transverse cut (second pic here, WFS: http://www.exrx.net/Muscles/QuadratusLumborum.html), I realize, again, that in my right (weaker) side, that's exactly where the hand can dig deeper, where the QL is... kindof to the side of the erector spinae muscles. So if this right QL is too tight or shortened or whatever, is it normal that it wouldn't be filling that gap like that?

Next week, or tomorrow, I'll go see another physical therapist and see what he says. In the mean time I'll just keep stretching it.

Arturo Garcia 10-15-2010 08:41 AM

Re: Possible cause for foot turned outwards (Steven Low please read).
 
Well today I went to him again, probably for the last time, at least for a couple of weeks. He told me about giving me an 8 session package, but the total price is a reduction of about 20%. It's still way too expensive for what we're doing. For the past 3 days he did again: heat, ultrasound, electrical things (whatever they're called) and in the past two days no strength training. He does say I'm much better, he said it like 3 times today which was kindof funny, because yesterday I rolled my QL against the wall with a tennis ball (don't have a lacrosse ball) and today the soreness is almost completely gone. This week he saw the biggest improvement, but this week I've done the Egoscue routine 3 times and yesterday rolled the QL. Coincidence?

I asked about hips in place and he says they're still in place, he didn't manipulate me again but he said that's the one of the first things he looks at when I lay prone and they're level, the two little holes in my back. (which I didn't know I had, lol).

I am definitely not going back though, not even at a lower price. Her secretary gave me that "deal" at about 80% of the original price, but asked me how much I was willing to pay. I understand why he'd take anything because what he does costs nothing.

But I think I can improve myself. Like I said above I ordered the heating pad and as soon as I get it I'll apply heat everyday. Maybe in the meantime I'll apply a hot wet towel for a few minutes to the area. I wonder what the best time for the heat to be applied is? Maybe before doing the Egoscue routine, if I had to guess. I will also keep rolling with the tennis ball and maybe progress to a harder ball eventually but I only have a billiards ball (very hard), not a lacrosse one.

I might start going to a sports massage place that I've went before, at least once a week, since they're cheap (about US$22) and they also have the heat pads, the electrical thingies, and I think ultrasound too although they haven't used it on me (but they've used the other two things). They're good at finding a lot of "knots" in my muscles which hurt like hell. I should make a habit of going there at least weekly since it's not so expensive. If I go I'll ask them to specifically dig in the QL muscle.

I haven't lifted heavy in about 2 weeks. :yikes: But next week I plan to at least do one or two lifting sessions a week, even if only upper body for the first couple of weeks while I attempt to fix things with heat, egoscue and massage.

Oh and I forgot to mention yesterday I played tennis and still he saw me much better today, so tennis doesn't affect me I think, at least I can have some fun. It sucks that I also find strength workouts fun, 'cause I won't be having so much fun in the next few weeks! :(

Arturo Garcia 10-15-2010 12:05 PM

Re: Possible cause for foot turned outwards (Steven Low please read).
 
Very interesting: WFS: http://www.downeastschoolofmassage.net/forum/king03.htm

Arturo Garcia 10-15-2010 04:55 PM

Re: Possible cause for foot turned outwards (Steven Low please read).
 
OMG! I just had another thought!! My ribs are asymmetrical. Now, I know noone is perfectly symmetrical, but there is a very noticeable difference in mine. When I suck my stomach in, as if I were doing a vacuum exercise, anyone can clearly tell my right ribs, at the bottom, are more pulled towards the inside of my torso. I used to think "my left ribs stick out", but I am now wondering if the left ones are just fine, and the right ones are being pulled down/back by the tight QL!! After all, the QL is attached to the 12th rib. (Is this the last one? Looks like it from the pictures.)

Could the QL really be so tight and shortened as to have pulled my lower right ribs inward????? Or should I consider other muscles?

Steven Low 10-15-2010 07:29 PM

Re: Possible cause for foot turned outwards (Steven Low please read).
 
It's certainly possible.

Arturo Garcia 10-25-2010 01:11 PM

Re: Possible cause for foot turned outwards (Steven Low please read).
 
Man, I'm so dumb. I went to a physiotherapist I found last week. This guy seems to know more than the chiro for sure. He rx'd an MRI so I had one done on saturday. I'll have the results tomorrow afternoon or so. Anyways, he mentioned something very interesting: the multifidus muscle. I did not know of this muscle, but guess what? It's located right there, right where I feel the "emptyness" in my right side.

It turns out this muscle is also commonly atrophied and there's even a condition called multifidus dysfunction. WFS: http://www.totalcontrolprogram.com/copy/exercises2.html
(One of the many links I found).

The reason I said I was dumb, was because when I started doing the Egoscue exercises almost 2 weeks ago, after the first session I felt quite sore in that right lower back (I thought it was the Quadratus Lumborum). So I stopped doing the exercises that caused this, and replaced it with another drill that targets the Glute Med but wont overwork that section that I felt sore the day after beggining Egoscue. This is why I now think it was a very, very dumb move. If I was getting sore there, it's probably not because of what I originally thought (some muscle in the lower back compensating for a weak Glute Med.). It's probably just some muscle that is never worked and is atrophied, doing some work with that drill. My right GMed is as strong as the left, or very close, nowdays. Other drills tell me that.

Argh. So I could've been working the Multifidus for 13 days but I haven't... I want to hit myself in the head now. Now I feel that's the most important drill of the whole 40 minutes (or so) it takes me to complete this routine, and it's the only one I had decided to take out. Awesome. Just awesome.

I read some more articles and atrophied Multifidus appear to be seen in MRI's. Hopefully my MRI shows something so I can stop guessing. But now it really sounds like that is the whole issue. I've been palpating the lower back area lately and I can really feel a big difference from right to left side. As I begin to move my fingers to the spine towards the side, I find a "hole" on the right side, where as the left side is much fuller. Also the left side never gets sore from that Egoscue drill that seems to target this muscle so well. ARGH!#%^@&(%$ I wish I would've kept doing it. But I start today with it... maybe I can start filling that gap in there. I'm a little anxious about the MRI results too....

Edit: There is a whole book dedicated to this little muscle. WFS: http://backandneck.about.com/od/trea...fidusrevie.htm

Since that Egoscue drill hit it so hard and left me sore in it for a few days, I'm just gonna try doing it for the next two weeks and see if it it makes any difference. Well, I know muscles don't grow much in two weeks but if it's really that atrophied, even in that short amount of time it should make a difference.

Arturo Garcia 10-25-2010 01:48 PM

Re: Possible cause for foot turned outwards (Steven Low please read).
 
Ok I just keep thinking about this.

I remember once a workout that I slightly modified from mainpage: walking lunges with a 50# dumbell (just ONE dumbell) and I did hip extensions (mainsite called for swings). I could not finish this, in round 4 I had this HUGE cramp-type of feeling in my right "lower back". I know now it was not the lower back.

I get the same feeling after doing single leg hip extensions with the right leg. Or single leg hip thrusts with the right leg.

It's a pain in that "empty" area in my right lower back. I'm beggining to feel pretty certain that what's causing most of my problems are atrophied muscles in that area which I need to target specifically. I mean, even though stuff like walking lunges target all those core muscles, mines are obviously not getting worked enough for whatever reason.

Ok, I gotta stop myself from repeatedly posting here. But I get kinda excited when I feel I'm on the verge of solving (or improving) my never-ending problem.

Arturo Garcia 10-27-2010 07:34 AM

Re: Possible cause for foot turned outwards (Steven Low please read).
 
I was so excited, but the MRI showed nothing. Apparently everything is OK. This is good news, isn't it? But I was hoping it'd reveal something.

Yesterday I remembered something: about a year ago, I tried doing some DB windmills for shoulder stability. I would've tried the Turkish Get-ups but had a wrist injury that didn't let me push my hand off the floor, so I decided to try windmills since they are a little similar, at least shoulder-wise. I had worked up to 73# x5 reps and I think I quit because I developed a tremendous low back pain. Looking back, the pain was right there, where I am now theorizing I have atrophied muscles. Oddly enough, in the Quadratus Lumborum article I found, it says KB Windmills work it. It kindof makes sense... so maybe I can try Windmills with lighter weight, higher reps? I need to find ways to work that area specifically... it seems hard from what I've found so far.

Steven Low 10-28-2010 09:30 AM

Re: Possible cause for foot turned outwards (Steven Low please read).
 
May be a good idea to try them and vid yourself to see if you see any compensation pattern differences from side to side as well.

Arturo Garcia 11-02-2010 01:00 PM

Re: Possible cause for foot turned outwards (Steven Low please read).
 
Last friday I did Windmills, 25# dumbells, 3 sets of 10 each side. I'm gonna keep doing 3x10 3x/week adding weight little by little. Yesterday I used 30#. Will continue with 5# increments as long as I can get all reps. This has made what feels like my QL muscle quite sore, it feels kinda good. I have also started doing planks since I absolutely SUCK at them. Today I tried 3 sets with rest in between them and I got 0:53 in the third... wtf? I truly suck at something others find so easy. I guess my abs are weaker than I thought.

I'm still doing the Egoscue routine nearly everyday and I've been getting a sports massage 2x/week for the past... well, week. This week I'll do it again, it seems to have improved a tight knot I had in my left upper back, probably related to my ever-loose left shoulder. Yesterday I tried chin-ups and I felt my scapular retractors quite sore from last week. Very odd. Today it feels good though. But I'm guessing some stuff is working better around that area since the massages.

I was once told by a Z-health practitioner that my left lat is my right glute, and a whole theory of an "X" in the body and how "opposing joints" are related, etc. Maybe my weak rotator cuff and loose left shoulder has something to do with my problematic right hip? LOL, I'm so desperate I've gotten to the point where I believe anything I'm told! :D

Anyways, my current plan is to continue what I'm doing, and over the next few weeks I will have hopefully improved both my plank times and my Windmill poundage, which I hope strengthens the QL... and through all of this I'm doing no lower body training. Well, the Egoscue routine has some Bird Dogs and glute bridges.. and I'm playing tennis 1-2x/week, so I hope the lower body wont shrink in the mean time :rofl: After a few weeks of all this mobility, stretching and strengthening of the core muscles (QL and abs specifically), I will try a lower body session or two and see how my body reacts, but in the mean time still nothing. Dang I miss deadlifting. Just when I had gotten a PR at 300#x5 a couple of weeks ago. (I know, pathetic for a 180 pound guy, but still, PR's make me happy).

Arturo Garcia 11-17-2010 05:50 PM

Re: Possible cause for foot turned outwards (Steven Low please read).
 
Steven and Mike:

Could this be a nerve issue? I have been getting a sports massage 2x a week, and they have used the TENS unit on my left upper back and rolling some knots in there that I think are messing my shoulder somehow. Anyways, just for kicks I asked to have the TENS unit applied on my right hamstring since it has been painful for two weeks now, ever since one short sprint. (And I suspect it wasn't healing because I continued stretching it and working it out with windmills, but I stopped now so it heals). Something odd happened: at about two different moments, and for maybe 30 seconds or 1 minute, the TENS unit caused me a little bit of pain, like the pain from an electric shock. Just to make sure I had them apply the TENS next session and same thing happened. That makes me wonder: could this be a nerve issue???

I was just reading this from a Piriformis article: "If there is a positive test to the straight leg lift (causing sciatica like pain), externally rotate the leg to see if this lessens the pain. This could indicate compression of the sciatic nerve by the piriformis."

This happens to me. At first I tought it was because of tight medial hamstring that it hurt more. But the truth is, all this time I have been stretching the hammies and I think I shouldn't have - they are weak already, and this right one is even MORE flexible than the left. So inflexibility in the hamstring isn't likely the cause. Same with the glute... after years of sitting with my right leg crossed over my left, and my wallet in that back right pocket, the right glute is very flexible. I suspect the external rotators are indeed tight because I have less ROM internally rotating this right leg. But all stretches for the piriformis that I have found, seem to stretch the glute instead, and like I said, my right glute is very flexible already. This is confusing. Maybe I am not stretching the piriformis right??

I read that the sciatic nerve goes right under the piriformis, so maybe that is what I have... a compressed nerve by this tight muscle??? I will start rolling on it with a tennis ball and see if that helps. It hurts "good" when I do that.


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