Lilian Jarvis
Family Practice
December 1994


Last month’s column pointed out the necessity of correct leg and foot alignment to prevent stress on ankles and knees. With jogging and sports, which increase vertical impact to these joints, proper alignment is even more important if strain or injury is to be avoided.

I mentioned that pronation is likely to occur when the pelvis tips forward,  but a further explanation of why, in my view, pronation is so common can be useful to both doctors and patients in working to correct the problem. It is not one that normally afflicts animals, but happens with humans because of our upright posture.

When we stand with feet together, the femurs slant inward from the hip joints to the knees, unlike animals whose legs go straight down from their body. The natural tendency, therefore, is for our knees to continue the slant and to press inward when they bend. The pressure transfers to the inside of the feet and causes the pronation.

The femurs are vertical, however, when our feet are separated and directly below the hip joints. The knees can then be bent with thighs, lower legs and feet in alignment. As muscles become rebalanced, body weight and impact will be taken through the bone structure, and wear and tear on tendons and ligaments will be greatly reduced.

Increased resilience in the knees and ankles is another important consideration in preventing sports strains and injury. A certain “springiness” should exist to absorb the shock of landing and to provide rebound.

With respect to this, I cannot agree with the standard practice of rolling from heels to toes when jogging. While this is normal for walking, the faster movement of the feet in jogging keeps the ankles flexed and the anterior muscles of the tibia contracted. As these muscles become increasingly tighter, stress fracture of the tibia can be a resulting possibility. Coming down on the heels also makes for a “hard” landing, stopping the joints short and preventing a rebound that would reduce the force of impact.

A lighter and more resilient run will be had by landing on the ball of the foot with the heel touching momentarily thereafter. The heel then immediately lifts and the ball of the foot pushes off. This spring-like action of the foot and ankle allows the knees to slightly compress and release as well, and the combined action of the joints thrusts the body upward between steps. If the body is well supported – abdominals drawn in and the rib-cage lifted – the impact is further lessened. Together, joint resilience and supported body weight produce a “soft” landing which, along with proper alignment, will do much to prevent strains and joint damage.

The accompanying exercise rebalances muscles, increases resilience in the ankles and knees, stretches the Achilles tendons and contracts the Abductor hallucis muscles, lifting the arches. While these are important considerations for joggers or anyone involved in active sports, skiers may find today’s exercise and the one given last month of particular benefit.

To increase resilience in ankles and knees:
Stand facing a wall a good three feet away, feet under the hips with the second toe in line with the centre of the ankle and the ankles straight. Lean forward and place both hands against the wall.
Bend the knees, lifting the left heel slightly so the right shin presses forward over the toes. Keep the hips forward and the pressure on the ball of the foot with the toes flat.
Straighten the knees slightly and repeat the bend, lifting the right heel and pressing the left shin forward. Alternate slowly, pressing from one foot to the other and shifting the weight slightly, if necessary, to keep the knee over the foot. The hips, however, should move as little as possible to the side.
This exercise may jam the bones in the front of the ankle and produce some discomfort. The bending should therefore be done slowly so pressure into the joints is applied gradually. Over time, the discomfort should lessen or even disappear.

This will be my last column on what has been, predominantly, “bodywork.” What I have attempted to point out throughout is the need for as much attention to be given to the mechanical workings of the body and its structural requirements as has been placed on its cardiovascular needs.

There is a saying that we take better care of our cars than we do of our bodies. What we have neglected to do is consider what that care is. A car is not kept in good condition simply by driving it. It needs regular tune-ups and repair so each of its components works well and all mesh smoothly together. This is what makes the car fit to drive, ensuring both safety and performance that is trouble-free.

The same applies to the human body. Using the body in activities does not correct or improve those conditions that prevent its full and safe usage: tension, tight muscles, stiff joints, misalignment and lack of weight support. This is what “fit”ness is about: making the body fit to use. Cardiovascular activities can then be undertaken with more safety, pleasure and benefit to the body in its entirety.