Orthotics and hypermobility and strengthening work

Questions for physios/podiatrists/orthotists

5 messages
06/03/2013 at 13:25

So I've had on-off inner shin pain since last summer which took a while to track down. After eventually going to a podiatrist/orthotist to be fitted for orthotics, it turns out I have hypermobile joints causing 'over-stretching' similar to pronation and I also have collapsed medial arches.

It's more pronounced and also more painful on the right leg/foot than the left. I also notice my right leg isn't as strong and my right knee tends to waver in-the-way if I do squats.

So... Is there a chicken and egg situation going on here. Is it cause or effect? Is the knee thing causing the foot thing or is the foot thing causing the knee thing?

And are there exercises I can do with either to help alleviate the problems?

Are there any foot strengthening exercises out there? I've googled and found a lot of barefoot stuff (walking not running) - basically advice to get out of your shoes and go barefoot, but I go about barefoot a lot of the time already. I never wear high heels or tight shoes and I mostly wear trainers or Crocs.

Is hypermobility just something that is always going to cause muscle over-stretching?

Any advice would be great. Thanks in advance.

07/03/2013 at 09:49

I'm interested in this too as i have similar problems! Hopefully someone might have answers

23/03/2013 at 12:23

I have HMS (hypermobility syndrome) too and have in the past 6 months I have fallen foul of a torrent of running injuries! I have also found out a fair bit about HMS along the way.

From my research, the whole barefoot school of thought is basically out where HMS is present - it would be tricky to be consciously moniter each joint and stop yourself from hyperextension/over pronation etc. I did run for a while with a heal raise from my NHS pod but eventually the HMS got me and I was at the sports injury doc again! I'm going to try custom orthotics and see if I have any joy. I would avoid shoes like crocs and trainers in favour of something with a slightly raised heal (hypermobiles tend to be flatfooted so generally more support the better).

In terms of chicken and egg situation - yes, it probably is, but the bottom line is that if you are hypermobile you are just prone to injury. I first injured my knee, then my achillies and then foot (not to mention the chronic back pain!). The way I see it, if you fix the misalignment of the foot, this should have a knock on effect up the body but it has to be supported by postural awareness and overuse causes injuries for everyone! I have read that it takes longer for people with HMS to heal and I think this is why overuse injuries are so common among HMS patients (not enough rest after runs for example). Hypermobility is a condition which affects collagen which, unfortunately for us, is present in the muscles, tendons and ligaments. Strengthening the muscles around the joint is key (but proceed with caution if you already have an injury). However seemingly paradoxically, people with HMS often feel quite stiff and like they constantly need to stretch. This is because the body is woring harder to keep you steady and upright all day and therefore builds up more tension in the muscles.

I do loads of yoga and find the deep understanding of my body gained is invaluable. The docs normally recommend pilates and then there is alexander technique as well. Whatever suits you best really, but if you go down the yoga route make sure you don't hyperextend your joints to get into postures. Some of the best advice I ever had was to focus on what doesn't come naturally to you (as in strength if you are hypermobile) also having a teacher who understands hypermobility is definately an asset!

Hope that helps and good luck with your trainging!

23/03/2013 at 12:26

Almost forgot - glute (particularly glute medius) strengthening is often the prescription for lower leg running injuries but you still have to remember to activate the glutes while you're actually running! Also, heelfixkit.com for foot strengthening

Edited: 23/03/2013 at 12:27
25/03/2013 at 11:54

Beeb - thanks very much for your long reply. Very helpful! I don't think my HMS is very severe or even particularly limiting, not compared with some of the horror stories I've read on here from other people who have it. I used to do a lot of weight training and am fairly muscular (for a girlie!) and I guess that maybe helps hold everything in place a bit. If I overstretch my arms without thinking about it I can easily hurt my shoulder joints but apart from that I don't have much bother, just the shinsplints which are really an overuse injury I think...

So far the new orthotics seem to be helping a LOT and that's before I've been back to get them checked and potentially adjusted for a perfect fit. So that's good.

And you're right again on the glute medius - that just got picked up on and pointed out to me last week by a sports masseur I just started going to. Question: How exactly do you 'activate the glutes' while running?

I read ages ago that running up hills shouldn't hurt your calves, if it did you were working the wrong muscles, and that you should use your glutes to power up hills. I can do that okay and feel it in my butt not my calves, but I'm obviously not using the glute medius and I'm not even sure what it feels like to do so! I'm going off to study some anatomy diagrams to hopefully help me visualise the right muscle while I'm running. That used to help me work the right bits while lifting weights...

Thanks again for your answer.


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