Dictionary.com defines standing as when a person is in an upright position on the feet. Notice that in this definition, the feet are directly referenced as the structures the body is standing on top of. We have come to understand that the 26 bones, 29 muscles (10 foot/ankle, 19 intrinsic) and 3 arches of each foot form the foundation of our body and are integral to its overall proper function.
As Chiropractors, we spend multiple hours of the day standing on our feet. Our patients are no different. Many of them have daily activities requiring short to long standing periods. Cooking and housework are just a couple of the tasks that incorporate standing for varying lengths of time.
Turning our eyes toward occupational or work-related standing, we can look to the United States Bureau of Labor Statistics. This entity indicates that standing is present when workers are not sitting or lying down.
- Walking. For example, tellers walk to escort customers to a safety deposit box.
- Climbing. For example, electricians climb ladders to reach wires placed in ceilings.
- Low postures such as stooping, crawling, kneeling, and crouching. For example, pest control workers crawl into and through an attic to apply pesticides.
- Standing during an entire work shift except during paid breaks.
On average, lawyers spent 19.5 percent of the workday standing, while animal caretakers stood for 94.5 percent of the workday. So this just gives you some perspective on how much standing as an activity is utilized.
The impact of standing on the whole body
Standing for prolonged amounts of time puts tremendous pressure on the feet. People generally mix in walking to vary body position. If they have to stand for very long, we observe people shift weight, put one foot on an elevated surface or stand on a mat to absorb the pressure from the ground. With regards to walking, each time we take a step there is an average of 5 G’s of force that hits our calcaneus bone. This force moves up the Kinetic Chain from the legs to the spine up to the TMJ in 10 ms. The force becomes .5 G’s once it gets to the jaw. Obviously the heavier the person or the flatter the arches, the more shock. Running also increases the shock as well.
If everyone had ideal feet and their arches were functioning well, then standing, walking, running, jumping, etc. would occur without any biomechanical consequences. However, in my practice I have observed that excessive pronation exists in 99% of patients – those who have healthy weight bearing or supinate are only about 1% of the population. So helping patients understand this is crucial to understanding the potential effects of weightbearing in general.
Your Feet and Arches Are Critical Support Structures
In your clinic, you have had the situation where a patient is sitting on your exam table as you explain the three arches of the foot to them. While pointing out their medial arch, they often say something like “I have arches, Doc, see?” Remember that when the patient’s foot hits the ground, everything changes. Once you have them stand up and point out how the medial arch collapses, they start to understand the message.
Standing and weight-bearing activities have powerful effects on the human body and most people in the world are walking around without any idea. Let me take you on the journey I take all of my patients on starting from the foundation and making our way up.
Use Visual Aids to Make Education Interactive and Interesting
To orient yourself, take a look at our classic “Crooked Person Diagram”.
I know most of you have seen this once or twice, but do you use this as a visual aid with your patients? I sit down with every new patient and explain this diagram. This is where I teach them how much stress is introduced into the body with weightbearing. As we start from the feet, the patient can follow right along with the picture.
Human beings are visual creatures and respond to and process visual data better than any other type. The human brain processes visual content 60,000 times faster than text so a picture is actually worth 60,000 words. 90% of information transmitted to the brain is visual so it’s critical in helping us observe, learn, process and make decisions that are often emotional. Furthermore, It’s been shown that people recall 65% of the visual content that they see up to three days later (vs. only about 10% of written content).
The Effects on the Lower Extremity:
Starting at age 6-7, the arches are fully formed so arch collapse can begin in its early stages with young children. This is where you see how much genetics from the parents has already begun to make the arches fall. I hate to see little kids with bunions and corns forming already, but these are important findings that you and the parents need to understand.
As the plantar fascia, the bone-to-bone ligaments, and the spring ligament continue to overstretch, arches will continue falling. In order, the lateral arch, the transverse (metatarsal) arch, and finally the medial arch flattens, dropping the foot to the floor. This is where patients can complain of plantar fasciitis, metatarsalgia, neuromas, heel spurs, hallux valgus, bunions, corns, and calluses.
Once the foot flattens enough, a medial force is placed on the tibia causing it to twist inwards. This rotational force moves up the shaft of the tibia towards the articulation with the femur and patella. The Achilles, calf, and shin muscles are affected by all of this, and shin splints, Achilles tendonitis, Osgood Schlatter, and calf issues can result.
From the tibia, the inwards rotational force on the patella creates medial and inferior stress. Patients indicate feeling inner knee stress as their pronation worsens. Patellar tracking issues, medial meniscus injuries, MCL, ACL, and patellar tendonitis are a few of the ailments that can arise from this region.
The medial rotational forces continue up through the shaft of the femur bones. The pelvis ends up tilting towards the side of the more pronated foot, it anteriorly rotates and forward translates the pelvis. This helps create the short leg on the prone leg length check, usually on the side of the worse pronated foot. In this region, patient complaints can include sciatica, hip pain, labral issues, ITB pain.
The Effects on the Rest of the Body
As the overpronation pattern continues into the spine, the lumbar spine can have lateral curvature towards the flatter foot side. This in turn makes the thoracic area have a compensatory curve to the opposite side to try and level out the shoulders. That does not work completely as the shoulders are unlevel. The muscles and soft tissue of the spine are affected leading to pain from the lower, mid/upper back, shoulder blades, ribs and the neck. This will cause physical stress on the shoulder girdle and contribute to various shoulder conditions (impingement, rotator cuff tendonitis/tears, biceps tendonitis, etc.). Don’t forget to check the rib joints in the front and back as those are often involved as well.
We end our journey by observing the stress in the neck and the TMJ that are related to the rotated and (to some degree) laterally curved spine. When TMJ pain, headaches, neck pain, dizziness, and vertigo come up as patient complaints, the feet can still be contributing factors. I try to remind you that the further away we get from the feet, the easier it is to forget about the feet. Don’t forget about them.
What Do We Do Next?
Between the “Crooked Person Diagram” and the explanation above, the patient has a clear idea of the biomechanical stresses that could be in their body. Now you go hunting and see what else in your Chiropractic exam you discover that correlates with the various body parts and structures we previously discussed. You will help your patients understand that whenever they are standing, they are likely overpronating.
Aside from your Chiropractic adjustments, stretching/strengthening exercises and home care are solid parts of your treatment plant. But don’t forget that supporting the 3 arches of the feet are the key to long lasting symptom relief and ultimately stability of the biomechanical stress patterns we see from toes to nose. The Foot Levelers Spinal Pelvic Stabilizers (SPS) have the patent on the 3 arch technology. Foot Levelers is the only company whose orthotics will accurately support all three arches of the feet and the body as a whole.
Standing and the activities related to it are frequent parts of just about everyone’s day. By understanding the weightbearing effects that standing has from the ground up, you can help not only identify the source of the patient’s discomfort but provide proven solutions to give them lasting relief.
Dr. Kevin M. Wong, DC is a graduate of the University of California, Davis, and a 1996 Summa Cum Laude graduate of Palmer College of Chiropractic West. He has been in practice for over 25 years and is the owner of Orinda Chiropractic & Laser Center in Orinda, CA.
As a member of Foot Levelers Speakers Bureau since 2004, Dr. Wong travels the country speaking on extremity and spinal adjusting. See upcoming events with Dr. Wong and other Foot Levelers speakers at footlevelers.com/seminars. Check out his monthly blogs with proven practice tips to help you achieve optimal patient outcomes.