summarize: If the road to stability begins with the breath, it travels through the feet—the
most fundamental point of contact between our bodies and the world. Our
feet are literally the foundation for any movement we might make. Whether
we’re lifting something heavy, walking or running (or rucking), climbing
stairs, or standing waiting for a bus, we’re always channeling force through
our feet. Unfortunately, too many of us have lost basic strength and awareness
of our feet, thanks to too much time spent in shoes, especially big shoes with
thick soles.
Going back to my race car analogy, our feet are like the tires, the only
point of contact between the car and the road. The force of the engine, the
stability and stiffness of the chassis, the skill of the driver—all of it is useless
if the tires are not firmly gripping the track surface. I would argue that our
feet are even more important to us than tires are to a car, as they also play a
crucial role in dampening force before it reaches the knees, the hips, and the
back (at least a car has suspension rods for that). Failing to pay attention to
your feet, as most of us do, is like buying a McLaren Senna (my dream car)
and then going to Walmart and getting the cheapest tires you can find. That’s
what spending years in mushy shoes does to us.
Take another look at my “before” squat. Yes, my hips are obviously
askew, but look more closely at my feet. Are they flat on the floor? No, they
are not. As you can clearly see, they are rolled out on their outside edges
—“supinated,” in physiologist-speak. They should be flat, grounded, stable,
and strong, to support my weight. But instead they are rolled over and
wobbly. No wonder my squat looks so bad.
To help reacquaint us with our feet, Beth Lewis likes to put me, and our
patients, through a routine she calls “toe yoga.” Toe yoga (which I hate, by the
way) is a series of exercises intended to improve the dexterity and intrinsic
strength of our toes, as well as our ability to control them with our mind. Toe
strength may not be something you think about when you go to the gym, but
it should be: Our toes are crucial to walking, running, lifting, and, most
importantly, decelerating or lowering. The big toe especially is necessary for
the push-off in every stride. Lack of big-toe extension can cause gait
dysfunction and can even be a limiting factor in getting up off the floor
unassisted as we age. If toe strength is compromised, everything up the chain
is more vulnerable—ankle, knee, hip, spine.
Toe yoga is a lot harder than it sounds, which is why I’ve posted a video
demonstration of this and other exercises at www.peterattiamd.com/outlive/
videos. First, Beth tells her students to think of their feet as having four
corners, each of which needs to be rooted firmly on the ground at all times,
like the legs of a chair. As you stand there, try to feel each “corner” of each
foot pressing into the ground: the base of your big toe, the base of your pinky
toe, the inside and outside of your heel. This is easy, and revelatory; when
was the last time you felt that grounded?
Try to lift all ten toes off the ground and spread them as wide as you can.
Now try to put just your big toe back on the floor, while keeping your other
toes lifted. Trickier than you’d think, right? Now do the opposite: keep four
toes on the floor and lift only your big toe. Then lift all five toes, and try to
drop them one by one, starting with your big toe. (You get the idea.)[*3]
If you can do this at all, it likely takes a concerted mental effort, your
brain telling that big toe to drop or rise—which is exactly the point. One of
the goals of stability training is to regain mental control, conscious or not,
over key muscles and body parts. Because our feet spend so much time
crammed into shoes that may or may not fit properly, and likely have a lot of
padding in their soles, many of us have lost touch with our feet, or have
worked them into unhelpful contortions over time.
In my “before” squatting photo, as noted above, both of my feet are rolled
out to the outside, or supinated, a common phenotype. Another common foot
strategy is to “pronate” or fold the feet inward—a term you’re probably
familiar with if you’ve ever bought running shoes. Beth compares pronation
to driving a car with too little air in the tires, meaning you kind of slosh
through your movements, unable to transfer force efficiently to the ground.
Supination, on the other hand, is like having overinflated tires, so you skid
and bounce around. Your feet are unable to absorb shock, and all that
bouncing and jarring gets transferred straight to the ankles, hips, knees, and
lower back. Both syndromes, pronation and supination, also expose us to risk
of plantar fasciitis and knee injury, among other issues. We must be able to
move in and out of both supination and pronation to locomote efficiently.
Now when I squat, or do any standing lift, my first step is to ground my feet,
to be aware of all four “corners,” and distribute weight equally. (Also
important: I prefer to lift barefoot or in minimal shoes, with little to no
cushioning in the soles because it allows me feel the full surface of my feet at
all times.)
Feet are also crucial to balance, another important element of stability.
One key test in our movement assessment is to have our patients stand with
one foot in front of the other and try to balance. Now close your eyes and see
how long you can hold the position. Ten seconds is a respectable time; in fact,
the ability to balance on one leg at ages fifty and older has been correlated
with future longevity, just like grip strength. (Pro tip: balancing becomes a lot
easier if you first focus on grounding your feet, as described above.)
—
The structure we most want to protect—and a major focus of stability
training in general—is the spine. We spend so much of our time in car seats,
in desk chairs, at computers, and peering at our various devices that modern
life sometimes seems like an all-out assault on the integrity of our spine.
The spine has three parts: lumbar (lower back), thoracic (midback), and
cervical (neck) spine. Radiologists see so much degeneration in the cervical
spine, brought on by years of hunching forward to look at phones, that they
have a name for it: “tech neck.”
This is why it’s important to (a) put down the phone, and (b) try to
develop some proprioceptive awareness around your spine, so that you really
understand what extension (bending back) and flexion (bending forward) feel
like, at the level of each single vertebra. The easiest way to start this process
is to get on your hands and knees and go through an extremely slowed-down,
controlled Cat/Cow sequence, similar to the basic yoga poses of the same
names.
[*4]
The difference is that you have to really, really slow down, moving so
slowly and deliberately from one end of your spine to the other that you can
feel each individual vertebra changing position, all the way from your tailbone
up to your neck, until your spine is bent like a sway-backed cow. Then
reverse the movement, tilting your pelvis forward and bending your spine one
vertebra at a time until your back is arched again, like a really scared cat.
(Note: Inhale on Cow, exhale on Cat.)
The point of this exercise is not how much extension or flexion you can
reach in extreme Cat or Cow but rather how much segmental control you can
achieve, going from one extreme to the other. You should learn to feel the
position of each vertebra, which in turn helps you better distribute load and
force throughout the spine. Now when I deadlift, this segmental control
allows me to maintain a more neutral arc from my thoracic to lumbar spine,
spreading the load evenly; before, my spine would have a sharp lordotic bend,
meaning I was taking too much force on its hinge points. That’s what stability
is about: safe and powerful transmission of force through muscles and bones,
and not joints or spinal hinge points.
Next we come to the shoulders, which are both complex and
evolutionarily interesting. The scapulae (shoulder blades) sit on top of the ribs
and have a great ability to move around. The shoulder joint is controlled by a
complex set of muscles that attach in various positions to the scapula and the
upper portion of the humerus, the long bone in the upper arm (which is why
we medical types call it the glenohumeral joint). If you compare this balland-socket joint to the far more stable and solid one in your hip, it becomes
clear that evolution made a huge trade-off when our ancestors began to stand
up: we gave up a lot of stability in that shoulder joint in exchange for a much
greater range of motion and, in practical terms, the all-important ability to
throw a spear. But because there are so many different muscular attachments
in the shoulder (no fewer than seventeen), it is much more vulnerable than the
hip as I learned in my boxing and swimming careers.
Beth taught me a simple exercise to help understand the importance of
scapular positioning and control, a movement known as Scapular CARs, for
controlled articular rotations: Stand with your feet shoulder-width apart and
place a medium to light resistance band under your feet, one handle in each
hand (a very light dumbbell also works). Keeping your arms at your sides,
raise your shoulder blades, and then squeeze them back and together; this is
retraction, which is where we want them to be when under load. Then drop
them down your back. Finally, bring them forward to the starting point. We
start out moving in squares like this, but the goal is to learn enough control
that we can move our scapulae in smooth circles. A large part of what we’re
working on in stability training is this kind of neuromuscular control,
reestablishing the connection between our brain and key muscle groups and
joints.