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Bunions and Big Toe Pain: Here’s What to Do…

March 15, 2021 · by Garrett McLaughlin

| Article written on March 15th, 2021 at 08:57am | Follow Garrett on Facebook and Instagram |

As we cover the topic of bunions and foot health, I can honestly say I am guilty of not prioritizing this area enough early in my career. We commonly emphasize the glutes, quads, and core that it’s easy to overlook this pivotal area.

The foot consists of numerous bones, ligaments, muscles, and tendons which ultimately create our foundation and connection with the ground. Whether it’s due to genetics, gender, occupation, anatomy, or footwear, there can be structural changes over time which negatively affect the alignment and function of the foot. One in particular is the development of bunions or hallux valgus.

Bunions can be classified as normal (less than 15-degrees) , mild (less than 20-degrees), moderate (20-40 degrees), or severe (greater then 40-degrees) depending on the degree of angulation at the great toe. Ultimately, as the great toe begins to angle towards the lesser toes and a bony prominence forms at the metatarsal head, this is a bunion (see image below).

Recently, I came across an article called, “Foot Mobilization and Exercise Program Combined with Toe Separator Improves Outcomes in Women with Moderate Hallux Valgus at 1-Year Follow-Up” by Abdalbary et al (2018). This is what we’ll reference in this article which will hopefully allow you to address your bunions and great toe pain to restore overall foot health and function.

Bunions are worth addressing since they are accompanied with functional disability, foot pain, impaired balance, and high fall risk in older adults. I regularly evaluate the foot and toes when working with runners and athletes because it has a big impact on stabilization and propulsion during gait and running.

Although surgery may be the most common approach to remedy this structural abnormality, it can be costly and create complications since it disrupts the normal mechanics of the great toe metatarsophalangeal (MTP) joint. From a conservative standpoint, treatment is aimed at mobilizing the necessary joints and stretching to decrease the angle of the great toe and restoring alignment with it’s respective metatarsal bone, increasing strength of the surrounding musculature which holds the toe in a more aligned position, and retraining normal function of the foot in various movement patterns.

The study mentioned above had 56 women (28 in the treatment group and 28 in the control group) who were diagnosed with symptomatic moderate hallux valgus. All of the patients in the treatment group wore toe spreaders for a minimum of 8-hours per day and completed the recommended physical therapy program consisting of three sessions per week for 12-weeks.

The physical therapy program consisted of…

Joint mobilizations: Targeting the metatarsophalangeal joints, 1st metatarsophalangeal Lisfranc, transverse tarsal, subtalar, and ankle joints
Stretching: Non-weight bearing achilles tendon stretch
Strengthening: Great toe flexion, abduction, and towel curls

As seen in the table below, there were significant improvements in many areas relating to pain, disability, and function of the great toe/foot immediately following the 12-weeks of physical therapy sessions which was also seen at the 1-year follow-up. That means a conservative approach, compared to no intervention at all, can be cost-effective and worthwhile in addressing big toe pain and bunions.

If you have a bunion or big toe pain and want to play your part in addressing this once and for all, below is a handful of exercises that are similar to what were prescribed in the study without the use of a trained physical therapist. Of course, I always recommend seeking the advice of a trained healthcare professional when dealing with pain. But these exercises could be your first step to seeing improvements when performed properly over a similar time period.

Passive Great Toe Abduction

Passive Great Toe Extension

Achilles Tendon/Calf Stretching

1st Metatarsophalangeal Isometric Flexion

1st Metatarsophalangeal Isometric Abduction

Towel Curls

With the improvements seen immediately post-treatment and at the 1-year follow-up, it provides hope that bunions and great toe pain can be improved with conservative treatment. Since surgery is a common strategy to address bunions in order to reduce pain and improve function, I highly recommend speaking with a trained healthcare provider sooner rather than later to determine what you can do to improve your situation. If you have any questions, please click here to contact me directly.

By: Garrett McLaughlin, MS, ATC, CSCS, ART

Core Training That Matters – How to Train the Foot, Core, and Breathing to Impact Running Performance (FREE Webinar Replay)

March 4, 2021 · by Garrett McLaughlin

When it comes to strength and movement training, too often do we target areas in isolation assuming that stronger individual pieces will translate to better overall performance. This is especially I see when working with runners.

What most runners need to realize is that the body functions as an interconnected unit to stabilize, transmit energy, absorb force, and create efficient movement. You still need to target the individual pieces while also putting them together in a bigger movement pattern. This is especially true when it comes to the foot, core, and breathing.

Recently, I held a FREE 60-minute webinar on the topic of ‘Core Training That Matters – How to Train the Foot, Core, and Breathing to Impact Running Performance.’ Please watch this webinar replay and understand how you can look outside of the traditional “core” to other areas which improve stabilization and alignment of the system. I am confident it will change your thought process on how the smaller pieces should work together in order to maximize performance and reduce your likelihood of injury.

In this FREE webinar replay, what you’ll learn is…

Understanding the demands of running
- The foot
- The core & breathing
Isolated drills to address the foot and breathing
How to tie these individual areas into bigger movement patterns to impact your running
Q&A

I hope you enjoy this webinar! Comment below or contact me directly if you have any questions or comments regarding this content. And, if you want to implement the best strategies to improve your running, click here to learn more about the Healthy Running Program.

Core Training for Runners (FREE Webinar Replay)

February 21, 2021 · by Garrett McLaughlin

The core is an important but often poorly targeted area. It’s not that runners are neglecting the core altogether because most know it’s value… it’s just that so many are going about it the wrong way which creates limited results.

Over the years, I have seen so much emphasis on strengthening the muscles of the core with traditional exercises. This is needed to a degree, but running requires stabilization more than anything else. Therefore, a specific approach must be executed to actually build the core in a way which translates to better running performance and injury reduction.

Recently, I held a FREE 60-minute webinar on the topic of core training for runners. It’s my hope that you use this content to better understand the key components of core training to positively impact your running in the months and years to come. I am confident it will change your thought process on how a simple and progressive stabilization routine will allow you to run on all cylinders.

In this FREE webinar replay, what you’ll learn is…

What is the core? (5:05)
Functional requirements of running at the core (9:57)
Important training principles (14:23)
Types of core training (20:27)
The best core exercises for runners (27:14)
Q&A (54:24)

Pelvic Control: The Overlooked Link to Better Running Performance & Injury Reduction (FREE Webinar Replay)

January 29, 2021 · by Garrett McLaughlin

Pelvic control tends to be an overlooked area for many runners. What most fail to realize is that the body needs to withstand 2-4 times it’s bodyweight while landing on a single leg. Therefore, proper stabilization and alignment of the pelvis and lower limb needs to be a priority.

Over the years, I have seen so much emphasis on areas outside of pelvic control. Not only do I feel that pelvic control in particular is misunderstood, but it’s actually very overlooked. Fortunately, the research tells us it’s easy to assess and modify so a shift in perspective might allow us to improve running performance and reduce the likelihood of injury to a better degree.

Recently, I held a FREE 60-minute webinar on the topic of pelvic control. It’s my hope that you reflect on this content and weigh it’s relevance alongside your injury history, needs, and running goals. I am confident it will change your thought process on proper stabilization to be the best runner you can be.

In this FREE webinar replay, what you’ll learn is…

What is pelvic drop? (4:54)
Injury and running economy research (14:53)
Assessing areas that contribute to pelvic drop (21:18)
Tips & drills to improve pelvic drop (30:40)
Q&A (57:00)

Pelvic Control & How to Address Within Your Strength Training Program

November 23, 2020 · by Garrett McLaughlin

| Article written on November 23th, 2020 at 12:03pm | Follow Garrett on Facebook and Instagram |

There are a lot of different areas to analyze when it comes to running form. But one in particular which is important from a shock absorption and stability standpoint is called contralateral pelvic drop (see image below). This is easily overlooked for foot strike pattern, stride length, and vertical oscillation, but is vital to promote frontal plane efficiency as you run.

Plain and simple, contralateral pelvic drop occurs when the opposite side pelvis drops during the initial loading response and/or the stance phase of running. What’s important to realize is that the opposite side pelvis is supposed to drop while running. I’m in no way attempting to say that the pelvis needs to remain completely level. But through the research we know this should equate to around 3-degrees or so, and anything more is deemed excessive.

Therefore, it’s important not to automatically assume contralateral pelvic drop is bad just like we have done with pronation over the years. Both of these are normal shock absorption strategies for the lower body when landing and loading on a single leg. But to optimize function of the lower limb, both need to happen properly rather then excessively to create stable and efficient movement, as well as to mitigate potential injury risk.

Over the years I have been fortunate to work with runners in sports medicine clinics, gyms, private fitness studios, and sports performance facilities. What this has allowed is the ability to watch hundreds of people move on a daily basis. There is often a lack of knowledge and instruction when it comes to pelvic control that can limit performance and create compensations associated with pain at the lower back, hip, knee, and foot.

Recently I created a video discussing contralateral pelvic drop and how to address this within your strength training program. With the majority of my running clients, we execute programs that address strength training and running retraining simultaneously rather then placing priority on one versus the other.

Fortunately, there is growing research and understanding that strength training is necessary for runners. However, I find that this is taken too literally as the majority of runners are focusing on strength over shock absorption, stability, and lower limb alignment. Improving strength can certainly make you faster and more resilient to running-related injuries, but the tips I provide in this video will lead to more efficient and economical running.

Do you have any questions about this content or are curious how contralateral pelvic drop relates to you? Click here to contact Garrett and schedule your running analysis now.

By: Garrett McLaughlin, MS, ATC, CSCS, ART

Self-Limiting Exercise and It’s Impact on Movement Quality

November 9, 2020 · by Garrett McLaughlin

| Article written on November 9th, 2020 at 03:19pm | Follow Garrett on Facebook and Instagram |

In 2013, I was first introduced to the concept of “self-limiting exercise.” Truthfully, it allowed me to really shift my thought process when prescribing training and rehabilitation programs for clients. Over the years, I have grown to appreciate that more is not always better, but better is better. Self-limiting exercise certainly fits that mold.

If this term is unfamiliar to you, self-limiting simply means…

“Relating to something which limits itself.”

Now, if we reconfigure that definition to encompass more of a movement perspective, we clearly understand that self-limiting exercise is a type of training that requires additional emphasis on quality and proper form above quantity. As soon as quality is lost, the exercise or movement is over. This will eliminate excess volume, prioritize good quality movement, and reduce the likelihood of injury.

Let’s cover a few examples to better explain this…

Distance running is a sport where you are rarely limited by your form but rather cardiorespiratory fitness, endurance, and pain threshold. It’s common for runners to push their limits to the point of exhaustion and/or the onset of pain. If running was more self-limiting in nature, as soon as form breaks down that would be the end of training for that day. This places quality of running over quantity, and will most likely lead to a significant reduction in running-related injuries.
Jumping rope can be viewed as a great example of a well-known self-limiting exercise. It’s rarely the strongest or most fit person who jumps rope the best. But, rather the one that’s able to maintain proper posture, form, timing, and coordination. As soon as one of these characteristics is lost, you quickly lose rhythm and have to start over. We all know how frustrating it can be when jumping rope but that’s why we rarely see injuries from this form of training.
The last example I’d like to describe is single balance work. You can’t muscle yourself through poor balance. This type of training has more to do with an efficient neuromuscular system than brute strength of individual muscles. It’s self-limiting in that once balance is lost, you have to regain your footing and completely start again from where you left off.

Hopefully each of these examples accurately conveys the difference between self-limiting exercise and the formal type of exercise we have adopted over the years. As a society that readily thinks more is better, I’d love you to start thinking more deeply about how you can get more from less. And with less I mean as much as necessary with adequate form and proficient movement.

While digesting a lot of information over the years from different professionals and groups, such as Gray Cook, Erwan Le Corre, and The Foot Collective, I’ve really gravitated to the balance beam as a tool to prioritize self-limiting exercise. This is an environment that requires balance, stability, and control to execute a series of drills properly so you don’t lose balance and fall.

Of course, I don’t complete entire workouts on the balance beam but rather specific drills in a warm-up or cool-down fashion, and on recovery days. This will provide you more “balance” between our modern lifestyle and the benefits that self-limiting exercise can provide to movement proficiency.

Below are a handful of my favorite drills utilizing the balance beam…

Forward & Backward Walking

Balancing 4-Way Toe Taps

Balancing Split Squat

I hope you enjoyed this article! If you have any questions at all about how to start implementing more self-limiting exercises into your routine, don’t hesitate to click here and contact me directly. The thought process of quality over quantity will work wonders for your body to enhance movement quality, create a better mind-body connection, and ultimately achieve longevity to express yourself through movement later in life.

By: Garrett McLaughlin, MS, ATC, CSCS, ART

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