Alignment is a tricky word in the rehab world. It is one of the many pendulums that swing to and fro', with some folks saying alignment, body mechanics, or posture doesn't matter and other folks saying it DOES. I'm in the "it does" camp. One of the biggest reasons people debate that posture doesn't matter is because it is very hard to study in order to produce good research about it. To me, that just reinforces the fact that we are complex, interesting, and complicated movement systems. I am thankful for that, actually!
Anyhow, one self test that is easy to administer is the single leg mini squat. We use one leg at a time a lot throughout the day, including walking, running, stepping over something, and negotiating stairs. The single leg mini squat gives us a clue as to how well are you able to control your foot, ankle, hip, and beyond. We aren't going to go into "the beyond" with this post and instead will focus on the waist down. But trust me when I say, anything could contribute to this movement from the waist up. For goodness sake, let's keep it simple!
Here's the test:
Stand in front of a mirror
Place your heads on the top of your pelvis (the boney rims on the right and left side)
Stand on one leg and bend your knee, performing a mini squat to about 45 degrees of knee flexion.
Take note of a few things: Do your hands stay level? Does your knee cap face forward towards your 2nd-ish toe, does it point inward towards your big toe, or outward towards your pinky toe?
If you like to walk or run a lot, this is a good test to perform with multiple repetitions to see if after a while, you start to do something funky that might not show up right away.
Here's a great tip: Sometimes it's hard to observe yourself in the moment. There's something about being IN the body that you're trying to watch that makes it hard to watch. I'm sure there's a word for that. Some good options are to ask a pal to watch you or record yourself doing it a few times and play it back, using slow motion if you want to really get picky!
So what should this test look like? In the efficient state (and only focusing on the lower half of your body for now), your hands on your pelvis should stay level. Your knee cap is pointing towards your 2nd-ish toe. The distance between one ankle bone and the floor is similar to the other ankle bone. People that have difficulty with this test often have low back, pelvis, hip, knee, or ankle pain. Whatever shall you do if your test looks funky?!
Dropped pelvis, knee pointing towards big toe :( Level pelvis, knee pointing towards 2nd-ish toe :)
There are many reasons why your single leg mini squat may be a little off the rails. Sometimes, there are more than one reason happening in unison! This is because in the research, we know that with weakness in one area often comes weakness somewhere else in the chain. Focusing on the waist down, here are some possible culprits, how you would know, and what to do about it:
Hip musculature is weak.
How to tell: If you actively engage your glutes to point your knee cap towards your 2nd toe, is it easier to maintain that position throughout the movement?
How to work on it: Glute work is where it's at. Some great ones are clams, leg raises while on your side with your heel against a wall, bridges, and leg raises lying face down. Standing on one leg while trying to keep your pelvis level is also helpful.
Hip range of motion is limited.
How to tell: Lying on your belly with your knee bent 90 degrees, can you touch your ankle to your other leg (the straight one) without your pelvis lifting off the floor? You should be able to reach the opposite leg or at least come close without your pelvis lifting up.
How to work on it: Lying on your back with your knee bent and foot flat, place a ball no larger than a tennis ball behind your hip. Slowly let your knee move outward, allowing the ball to sink deeper into your hip. Return to the starting position. Repeat this until you are able to move further with ease. Always end with a strengthening exercise! A clam is a good one for this motion.
Foot and/or ankle is weak.
How to tell: If you place a small rolled up hand towel under your arch, does that help your alignment during the single leg mini squat?
How to work on it: Over-the-counter arch supports from a running store can be great "stepping stones" to use while you work on strengthening your foot. The short foot exercise is great, which is where you practice lifting the arch of your foot without crunching your toes. Standing on one leg while barefoot can also make your foot muscles work hard. You can also practice the single leg mini-squat while maintaining an arch in your foot as long as you don't lose that good contact of the ground through your big toe.
Ankle range of motion is limited.
How to tell: If you are in a 1/2 kneel position with one knee down and the leg of interest's foot is forward. As you shift your body weight forwards, can you travel the forward knee just as far beyond your toes as the other side? If it is limited, that knee will not be able to move as far beyond the toes as the other side and this often corresponds with a calf tightness sensation or a jamming sensation in the front of your ankle.
How to work on it: A deep massage with a ball that is smaller than a tennis ball is very helpful. Stretching the calf while the knee is bent is great, as long as you pay attention to the patella pointing towards the 2nd toe. Always end with strength by performing this stretch while standing on one leg, which is basically a single leg mini squat isometric hold.
**See below
Is it a forever rule that our knees should never point anywhere else besides our second toe? Of course not. If you've ever done any martial art, you'll quickly learn they love to point their knees all over the place. The difference is, they "own" these positions with a lot of strengthening through prolonged holds in these unique positions as well as practicing transitioning in and out of them. Strengthening with the legs in various positions can also be helpful in preventing non-contact injuries, especially for athletes who have to have many movement options and strategies in their toolbox if they want to perform well. Getting back to the basics, making sure you have good control in an activity that you perform every day is a good place to start.
**If you have any questions about the exercises mentioned above, head on over to my online movement community where there are plenty of exercise videos to get you going as well as a chat room where all questions and comments are welcome: https://patreon.com/inspirept
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