I’ve seen it time and time again now. A client starts working with me and during their initial intake questionnaire they mention how walking for any distance (beyond going to the fridge from their couch) makes their knees and/or hips hurt. Then, during their first movement evaluation with me it becomes clear as to why they suffer when walking. I see even more clients that can walk OK, but when they run or jog BOOM, there is a serious problem in their ankles, knees, or hips.
Today I would like to go more in depth about walking mechanics and give you some simple things to keep in mind and look out for if you yourself have issues with locomotion. The best part is that I will keep this fairly simple and actionable because if you are like me you want the TL;DR more than anything. Heck, I’m even gonna include a video explanation!
Aint nobody got time to read some crazy long article with a bunch of anatomical jargon!
Who needs reading!?
Watch the video if you dont feel like reading. If you are on AOL dial up from 1995 and you can’t load my video, read on!
Alignment is KING!
When I screen someone for walking issues the #1 cause of problems I see is t̶h̶e̶i̶r̶ ̶l̶o̶v̶e̶ ̶o̶f̶ ̶c̶o̶u̶n̶t̶r̶y̶ ̶m̶u̶s̶i̶c̶ ̶ misalignment of the hip, knee, ankle, and foot.
In order to determine if your alignment is good or bad, have someone take a video of you walking from both the front (towards the camera) and the back (away from the paparazzi). Are your knees traveling over your toes or pointing our towards the sides? Are your legs in straight lines from the hips down, or do your feet point out or in?
For proper alignment you want to see a straight line from your hip, through your knee, down to the ankle and foot. Your knees should be traveling over your toes (somewhere in-between your big and little toes) and not moving away from or towards your mid line.
An easy way to determine this is to look at what direction your knees are facing when you are standing. Have someone take a picture of the back of your knees (exposed skin) and look at what direction the back of your knees are “facing”. Imagine you had to draw a line from the middle of the back of your knees through your leg and in front of you. Would that line be straight over your toes, or does that line go to the left or right of your toes? You want to get an idea of this in both standing and walking.
Your feet are super important!
If you have knee pain and you take nothing else away I want you to hear this. Problems with the knees are almost always driven by the feet or the hips. That’s because the line of knee travel as you walk is dictated by your hips and feet.
A common fault I see in people is that they walk on the outside of their feet. This creates a bit of external rotation in the ankles and knees and makes walking unpleasant. That’s because the knees are now pointing outward rather than forward. Remember how we just talked about how the knees pointing out or in too much was bad? Well that can be easily driven by walking on the outside of your feet. This means that when you are walking your big toe is usually pointed up, and not in contact with the ground.
So, a quick fix (or something to try) for that is to make sure your big toe is the last thing that leaves the ground when you are walking forward. You see, your big toe is the main driver of propulsion of your foot as you walk/run and it also helps keep the knee pointed in the right direction, which is straight ahead. You should not be “pushing yourself forward” with the outside of your foot. It just doesn’t work well! And before long your knee is going to be letting you know that its a problem.
Tripod Foot
One technique that is helpful in re-patterning how the lower extremity works is the concept of the tripod foot. This is as simple as working my Keurig in the morning!
All you have to do is make sure that you keep your weight evenly distributed through your entire foot while you are doing exercises like a squat or deadlift. So you want the weight of your foot evenly divided between your big toe, your little toe, and your heel. Technically you want it on the bones behind the big toe and little toe, but that’s just not as memorable to say.
As you are performing your exercise pay attention to where the weight is on your feet. Do your toes always lift off the ground? Do your heels come off the ground when squatting? These are both indicative of problems. Make sure to do this without shoes on, especially when you start learning the tripod foot because this is very difficult to learn in modern athletic shoes with all their support and padding.
Try out these suggestions and let me know how it goes! Sometimes it changes things radically immediately, and other times it takes some release work and practice to get everything to move in the right direction.