Andrea Dowd at Precision Sports Therapy INC

12/30/2025

Do you suffer from Knee Pain? How Quad Imbalances & the IT Band Affect Your Knees

Struggling with knee pain ? Learn how the vastus medialis, vastus lateralis, and IT band influence kneecap tracking—and what actually helps relieve knee pain long term.

The Vastus Lateralis (VL), Vastus Medialis (VMO), and the iliotibial (IT) band all influence how the kneecap (patella) tracks during movement. When their forces are unbalanced, knee pain- especially at the front or outer knee- can develop.

Vastus Lateralis (outer quad- VL)
• Pulls the kneecap outward in a (lateral direction)
• Often becomes overactive or tight with repetitive activities like running, cycling or squatting
• Excessive lateral pull can cause the patella to track too far outward, increasing joint stress
• Commonly linked to patellofemoral pain and lateral knee pain

Vastus Medialis (inner quad/VMO)
• Helps guide the kneecap inward and stabilize it during knee extension
• Delayed activation or weakness reduces control of patella tracking
• When underactive relative to the VL, the kneecap is more likely to drift laterally
• This imbalance increases compressive forces behind the kneecap

IT Band
• A thick band of connective tissue running from the hip to the outer knee
• Connects to the lateral retinaculum influencing patellar position
• Tightness or excessive tension increases lateral pull on the kneecap
• Also contributes to outer knee pain through friction and compression of the knee

How this leads to Knee Pain?
When the VL and IT band dominate and the VM lacks strength or timing, the kneecap doesn’t glide smoothly in its groove. Over time this causes:
• Irritation of the cartilage under the kneecap
• Inflammation of the surrounding tissues
• Pain with stairs, running, squatting, or prolonged sitting

Key Take away:
Knee pain is rarely about one muscle alone. It’s about balance, timing, and load tolerance across the entire system-including the hip and foot. Addressing quad imbalance, IT Band tension, and movement mechanics together is more effective than isolated stretching and strengthening

See the videos below for exercise demonstrations:
https://youtu.be/mF_7CzkPYpU?si=WpXCkxf00fyQ1m8a
https://youtu.be/XWB5PrJASZU?si=e-f0G9g8A1mkdyDG
https://youtu.be/B9pbRKnLTHY?si=wEI2o8rd3OgSPYdX

12/18/2025

What Is a Bunion? What Causes It and Why It’s More Than a Toe Bump
A bunion is often thought of as a bump on the side of the big toe, but it’s actually a structural change in the entire front of the foot. A bunion develops when the bone behind the big toe shifts inward and the big toe slowly drifts outward. This creates the visible bump at the base of the toe and, over time, can change how you walk, balance, and absorb weight.
Bunions usually worsen gradually and can lead to pain, stiffness, and difficulty wearing shoes.
What Causes a Bunion?
Bunions don’t come from just one thing. They develop from a combination of foot structure, movement habits, and footwear.
Genetics can play a role by influencing foot shape, but most bunions don’t develop from genetics alone.
Shoes matter too. Tight shoes and high heels squeeze the toes together and place extra pressure on the front of the foot. While shoes don’t usually start a bunion on their own, they can speed up the process once problems begin.
The real issue is how the foot moves and handles pressure over time.
Why Big Toe Movement Is Important
The big toe plays a major role in walking. With every step, it needs to bend upward and stay aligned so the body can push off smoothly.
When the big toe becomes stiff or loses control, extra stress builds at the joint. Over time, this repeated stress encourages the toe to drift outward, contributing to bunion formation.
It’s important to work on big toe movement>
How Walking Patterns Affect Bunions
Many people believe bunions are caused by “flat feet” or too much pronation, but that’s not entirely true. Bunions often develop when the foot doesn’t move naturally at the right time during walking.
During a healthy step:
• The foot gently rolls inward after the heel hits the ground
• Weight is spread evenly across the forefoot
• The big toe bends upward to push the body forward
When this sequence doesn’t happen smoothly:
• The inside of the foot doesn’t share load well
• Pressure increases at the big toe joint
• The toe is forced sideways during push-off
Over time, this repeated stress leads to the bunion deformity.
The Role of Soft Tissue and Support Muscles
Bunions aren’t just about bones. The muscles, tendons, and connective tissue around the big toe help keep it straight and stable.
As a bunion develops:
• Some muscles that should hold the toe straight become weak
• Other muscles tighten and pull the toe inward
• The soft tissue around the joint becomes stiff and less flexible
This imbalance makes it harder for the foot to absorb pressure properly.
Bunions Are a Whole-Body Issue
Even though a bunion shows up in the foot, the problem doesn’t always start there. The foot is connected to the ankle, legs, hips, and core. Limited movement or poor control higher up the body can change how pressure travels through the foot, forcing the big toe to compensate.
That’s why bunions often return if only the toe is treated and the bigger movement patterns are ignored.
Key Takeaway
A bunion is more than a cosmetic issue or a shoe problem. It develops over time due to how your foot moves, how pressure is managed, and how well the big toe functions. Addressing movement, mobility, and support throughout the body is key to managing bunions and protecting long-term foot health.
https://youtu.be/C4NOPO0t7CU?si=MHtul3m5R6ZlhEcP
https://youtube.com/shorts/DK7BEotH2BM?si=EM7LpbDthXZow4CK

Enjoy the videos and music you love, upload original content, and share it all with friends, family, and the world on YouTube.

12/08/2025

Is Your Posture Destroying Your Back Without You Knowing?

You can work out regularly, stretch every day, and still live with back, neck, or hip pain — and the real problem might be your posture.

Most people don’t realize that the way their spine curves at rest can quietly change how their muscles work, how their joints move, and how their body handles load. One of the most common patterns is a kyphotic–lordotic posture, where the upper back rounds too much and the lower back arches excessively.

The Kyphotic- Lordotic posture silently steals your mobility, weakens your core and glutes, overloads your lower back, and sets you up for chronic pain — even if you’re active and strong.

In this blog, you’ll learn how this posture pattern affects your mobility, flexibility, and strength — and why so many people feel tight, weak, and unstable at the same time.

How This Posture Silently Destroys Your Mobility
Your Mid-Back Locks Up

When your upper back becomes overly rounded, it loses its ability to rotate, extend, and expand properly. This makes overhead movement harder, limits breathing, and forces your lower back to overwork.

Your Lower Back Moves Too Much (The “Fake Mobility” Problem)
Because your thoracic spine won’t move, your lower back takes over. This creates instability, pain with bending or arching, and a constant feeling of tightness.

Your Hips Slowly Shut Down
An excessive arch in your lower back pulls your pelvis forward, locking your hip flexors in a shortened position and turning off your glutes. This reduces your stride and creates that “pinching” feeling when you bend forward.

Your Rib Cage Stops Expanding
A rounded upper back and flared ribs limit how well you can breathe and brace your core, leading to shallow breathing and poor stability.

How This Posture Creates Muscle Imbalances- You Can’t Stretch Away
Muscles That Become Chronically Tight
• Hip flexors
• Lower back muscles
• Neck and upper traps
• Chest muscles
Muscles That Become Long, Weak, and Unstable
• Glutes
• Hamstrings
• Deep core
• Mid-back muscles
• Deep neck flexors
This is why many people feel both tight and loose at the same time.

See the attached videos for exercise and stretch demonstration to help correct your posture and fix your back pain today!!
https://youtube.com/shorts/-H8_frQpVh0?feature=share
https://youtube.com/shorts/6aSAPP8ISxc?feature=share
https://youtu.be/YxWJhDWt6uU

12/02/2025

Why does my hip hurt as I age?

The gluteus Medius and often gluteus minimum helps stabilize the pelvis during running
and standing on one leg. Tendinopathy occurs when the tendon tissue breaks down due
to overload, poor recovery, or repair capacity.
Common causes are:
 Hip abductor weakness or imbalance
 Poor Pelvic control
 Increased load (running hills, side sleeping)
 Hormonal or systemic influences- like low estrogen
The role of estrogen in tendon and collagen health:
Estrogen is a key regulator of collagen metabolism in both muscle and tendon tissues.
When estrogen levels fall (e.g. during menopause, perimenopause, or amenorrhea:
 Collagen synthesis decreases (less type 1 is produced)
 Tendon stiffness changes- tendons become less elastic and less capable of
handling load.
 Tendon healing slows down-fibroblast activity (cells that rebuild collagen)
declines
 Inflammatory cytokines rise which can further impair tendon repair.
Research shows that estrogen receptors are present in tendon tissue, including the
gluteus Medius and minimus region. So, when estrogen drops, tendons literally lose
some of their ability to repair and remodel.
Collagen changes in Low Estrogen States:
Low estrogen=decreased collagen type I and III synthesis= weaker tendon matrix.
Practical effects:
 Microtears in the gluteal tendons don’t heal as well.
 Tendon structure becomes more disorganized and fragile.
 The tissue becomes more prone to degeneration, leading to chronic tendinopathy
or partial tears
Management Strategies:
 Hormonal Support- hormone replacement therapy or localized estrogen therapy
can sometimes help improve collagen metabolism and tendon health in post-
menopausal women
 Exercise therapy- Heavy slow resistance training- focus on hip abduction, single
leg stance and controlled eccentric loading
 Avoid prolonged stretching of the tendon (crossing legs or side lying)

Video-exercises- clam shell, 90-90 IR, look up eccentric glut med exercises

Enjoy the videos and music you love, upload original content, and share it all with friends, family, and the world on YouTube.

11/17/2025

Why is the Popliteus effected when you have Knee Osteoarthritis?

The popliteus muscle can be affected in knee osteoarthritis (OA) due to its role in stabilizing and unlocking the knee joint, especially during activities like walking and transitioning between sitting and standing. Here’s why:

1. Altered Biomechanics:
a. in O.A, joint space narrowing, cartilage degeneration, and osteophyte formation can alter how the knee moves.
b. The dysfunctional movement can put a strain on stabilizing muscles (popliteus)
2. Increased Demand on Stabilization:
a. the popliteus helps prevent excessive external rotation of the tibia and aids in the initiation of knee flexion (unlocking the knee).
b. As O.A. compromises the joint integrity, the demand on the popliteus to stabilize increases, potentially leading to a tight popliteus.
3. Joint Effusion and Inflammation:
a. There is often swelling and inflammation with O.A. and this can inhibit the function of surrounding muscles (popliteus)
b. Chronic inflammation may also lead to muscle atrophy or tightness in the popliteus.
4. Pain and Guarding:
a. Pain from OA often causes muscle guarding- the popliteus may become tight or overactive as a result.

What can we do if the popliteus is tight?
• Trigger point the popliteus muscle. Take a lacrosse ball behind the knee, sink into the ball as you move the ball up and down, side to side.
• Ensure your glutes are strong creating stability for the knee
• Strengthen the Vastus Medialis Obliques- walking backwards on a treadmill on an incline
• There are also injections you can get: Platelet Replacement Therapy, Synvisc or Monovisc to help lubricate the O.A. knee

05/07/2025

Knee Pain: Find your balance, Unlock the Secret to Stability

The Tibialis Posterior muscle can contribute to knee pain through its influence on foot mechanics and alignment of the lower kinetic chain, here are some examples:

1. Tibialis Posterior Function:
• It supports the medial longitudinal arch ( maintains arch and supports foot)
• It controls pronation- especially eccentrically during GAIT (foot falling in)
• It assists in inverting and plantarflexing the foot (pointing toes down and in)

2. Chain Reaction to Knee:
a. Tibialis Posterior Dysfunction (Weakness or Tendinopathy):
i. Leads to overpronation and collapse of the medial longitudinal arch (common in flat foot)
ii. Causes tibia (shin bone) to internally rotate ( rotate in) excessively during GAIT
iii. This alters the alignment of the knee joint increasing stress on the following:
1. Medial knee structures (MCL & Medial Meniscus- inside of the knee)
2. Patellofemoral joint (kneecap maltracking)
b. Knee Valgus Stress:
i. Overpronation from poor tibialis posterior function contributes to dynamic knee valgus (knee caving in)
ii. This increases shear and compressive forces on the knee, especially during running, squatting and single leg activities.
3. Compensation and Muscle Imbalance:
a. When the tibialis posterior isn’t stabilizing the foot effectively, other muscles may compensate, creating tension and imbalance throughout the leg.
b. Over time, this can lead to pain patterns in the knee (especially anterior and medially- at the front and inside of the knee)

04/28/2025

Unlock the secret to beating IT band pain: The hidden role of Hip Rotation:

When runners or active individuals complain about persistent lateral knee pain, IT band friction syndrome (ITBFS) is often the culprit. The usual suspects- weak glutes, poor footwear, overtraining, get plenty of attention. One biomechanical issue that flies under the radar is limited hip internal rotation.

What is hip Internal Rotation:
The movement of the thigh rotating inward to the midline of the body. It controls the leg alignment during running, squatting.

The connection to IT Band friction Syndrome:
The IT band is a thick band of connective tissue that runs along the outside of the thigh, travels from hip to knee. The job of the IT band is to stabilize the knee. In ITBFS, the IT band becomes irritated generally from repeated rubbing over the lateral femoral condyle, especially when the knee is repetitively bent and straightened.

Why is Hip Internal Rotation important?
You need to have hip internal rotation as it allows us to put force into the ground when running. During hip extension moving towards 0 degrees (when the foot is directly under the hip) Internal rotation needs to happen so the sacrum can rotate forwards and the hip can rotate backwards.

Hip internal rotation also needs to occur during 60-100 degrees of hip flexion (squatting), the posterior internal rotators of the hip- gluteus Medius, gluteus minimums, and the TFL help in producing more internal rotation of the hip, and thus improves the sacrum moving forwards.

What does Limited Internal Rotation cause:

1. Limited internal rotation causes the entire leg to rotate outwards, shifting the stress to the outside knee.
2. Limited internal rotation can cause pelvic instability due to lack of pelvic control. When the pelvis drops excessively during movement, tension along the IT band increases.
3. Limited Internal Rotation causes altered GAIT mechanics, the restricted movement changes stride length, leading to inefficient movement and strain on the IT band.

Why does lack of internal rotation get missed?

Most rehab protocols focus on foam rolling, stretching, and strengthening the glutes- particularly the gluteus Medius. It’s important to address the hip immobility and the hip restriction to ensure things are moving properly.

Test:
• Lie on your back, having your knees at 90 degrees, rotate your knee inwards towards the midline of the body.

Check out the hip mobility level 1 and glut level 1 videos here to assist with hip internal rotation: https://precisionst.ca/hip-videos-1

04/14/2025

What Happens to the Shoulder and Low Back when you have excessive T-spine Kyphosis?

Excessive thoracic spine (T-spine) kyphosis often called “hunchback” creates a chain reaction affecting the shoulders and low back. Here is how:

1. Forward Shoulder Posture: the excessive curve pulls the scapulae (shoulder blades) into a rounded position, leading to muscle imbalances.
2. Reduced Shoulder Mobility: the rounded posture limits overhead reach, and shoulder external rotation increasing the risk of impingement and rotator cuff injuries.
3. Weakening of the Posterior Shoulder Muscles: The Rhomboids, lower traps, and rear delts become overstretched and weak. While the pecs and anterior delts tighten.
4. Increased Risk of Shoulder Injuries; Can contribute to shoulder bursitis, rotator cuff tendinopathy, and frozen shoulder.

Low Back:
1. Compensatory Lumber Hyperlordosis: To maintain balance, the lower back often curves the opposite way (hyperlordodis) increasing stress on the facet joints.
2. Increased Risk of Low back Pain: The excessive Lumbar extension can lead to disc degeneration, and facet joint irritation.
3. Core Muscle Dysfunction: A rounded upper back often leads to poor engagement of the deep core stabilizers, making the lower back more vulnerable to strain.
4. Pelvic Tilting: the excessive lordosis can cause anterior pelvic tilt further disrupting the posture and biomechanics.

What Happens to the Shoulder and Low Back when you have excessive T-spine Kyphosis?

Excessive thoracic spine (T-spine) kyphosis often called “hunchback” creates a chain reaction affecting the shoulders and low back. Here is how:

1. Forward Shoulder Posture: the excessive curve pulls the scapulae (shoulder blades) into a rounded position, leading to muscle imbalances.
2. Reduced Shoulder Mobility: the rounded posture limits overhead reach, and shoulder external rotation increasing the risk of impingement and rotator cuff injuries.
3. Weakening of the Posterior Shoulder Muscles: The Rhomboids, lower traps, and rear delts become overstretched and weak. While the pecs and anterior delts tighten.
4. Increased Risk of Shoulder Injuries; Can contribute to shoulder bursitis, rotator cuff tendinopathy, and frozen shoulder.

Low Back:
1. Compensatory Lumber Hyperlordosis: To maintain balance, the lower back often curves the opposite way (hyperlordodis) increasing stress on the facet joints.
2. Increased Risk of Low back Pain: The excessive Lumbar extension can lead to disc degeneration, and facet joint irritation.
3. Core Muscle Dysfunction: A rounded upper back often leads to poor engagement of the deep core stabilizers, making the lower back more vulnerable to strain.
4. Pelvic Tilting: the excessive lordosis can cause anterior pelvic tilt further disrupting the posture and biomechanics.

https://youtu.be/R0UwVZdqgTs

02/27/2025

What is the interosseus membrane, and what does it have to do with my forearm pain?

The interosseus membrane (IOM) is a fibrous connective tissue that helps distribute forces between the radial and ulna, stabilizing the forearm during movements like gripping, lifting, pronation and supination.

How do we get pain?
1. Increased Tension on forearm muscles:

• If the membrane becomes tight or restricted, it can alter muscle function, leading to increased strain on surrounding muscles like the flexor digitorum profundus, pronator quadratus, and supinator muscles.
• This can result in aching, burning or sharp pain especially gripping or twisting.

2. Overuse and Repetitive Stress:
• Activities that involve repeated wrist and forearm movement (typing, weightlifting, racquet sports, or climbing) can cause microtrauma, leading to stiffening of the interosseus membrane.
• This overuse can create chronic tension in the forearm, restricting movement and causing discomfort.

3. Radial and Ulnar Joint Dysfunction:
• The IOM plays a key role in the force transmission between the radius and ulna.
• If the IOM becomes tight, it can affect the joint mechanics, making forearm rotation (pronation/supination) painful or limited.
4. Compartment Pressure and Nerve Irritation:
• Increased tightness in the IOM may contribute to increased compartment pressure, potentially irritating nearby nerves (anterior interosseous nerve or posterior interosseus nerve).
• This can lead to radiating pain, weakness or even difficulty with motor movements.

What can help?
• Forearm stretches (wrist flexor and extensor)
• Soft tissue mobilization (massage and myofascial release
• Strengthening Exercises (eccentric loading of the wrist and forearm)
• Manual Therapy if there’s stiffness in the radius/ulna joint

02/20/2025

The Relationship between the Popliteus and Knee Osteoarthritis (O.A)?

The popliteus muscle tends to get tight in people with knee O.A. due to a combination of joint instability, altered movement patterns, and protective muscle guarding, here is why it happens:

1. Protective Muscle guarding:
a. When O.A. causes pain, inflammation, or instability in the knee, the body naturally responds by activating muscles to protect the joint.
b. The popliteus, which plays a key role in stabilizing the knee (esp. during walking and weight bearing), the muscle often becomes overactive and tight as a protective mechanism.
2. Increased Knee Joint Instability:
a. The popliteus helps control internal rotation of the tibia and prevents excessive movement of the posterior cruciate ligament (PCL)
b. In O.A. the cartilage wears down, leading to increased joint laxity. This forces the popliteus to work harder to compensate, leading to tightness and discomfort
3. Decreased Knee Extension Range of Motion:
a. Many O.A. patients struggle with full knee extension due to degeneration.
b. Since the popliteus is responsible for initiating knee flexion, a lack of full extension can cause it to remain in the shortened position, further increasing tightness

How to Relieve Popliteus Tightness:

• Sit upright, have your leg supported by two books/yoga blocks
• Place a lacrosse ball behind the knee- on the books or blocks
• Take the other leg and place on the bottom leg to create weight. Sink into the ball and roll the ball in the back of the knee up and down and side to side.
The Relationship between the Popliteus and Knee Osteoarthritis (O.A)?

The popliteus muscle tends to get tight in people with knee O.A. due to a combination of joint instability, altered movement patterns, and protective muscle guarding, here is why it happens:

1. Protective Muscle guarding:
a. When O.A. causes pain, inflammation, or instability in the knee, the body naturally responds by activating muscles to protect the joint.
b. The popliteus, which plays a key role in stabilizing the knee (esp. during walking and weight bearing), the muscle often becomes overactive and tight as a protective mechanism.
2. Increased Knee Joint Instability:
a. The popliteus helps control internal rotation of the tibia and prevents excessive movement of the posterior cruciate ligament (PCL)
b. In O.A. the cartilage wears down, leading to increased joint laxity. This forces the popliteus to work harder to compensate, leading to tightness and discomfort
3. Decreased Knee Extension Range of Motion:
a. Many O.A. patients struggle with full knee extension due to degeneration.
b. Since the popliteus is responsible for initiating knee flexion, a lack of full extension can cause it to remain in the shortened position, further increasing tightness

How to Relieve Popliteus Tightness:

• Sit upright, have your leg supported by two books/yoga blocks
• Place a lacrosse ball behind the knee- on the books or blocks
• Take the other leg and place on the bottom leg to create weight. Sink into the ball and roll the ball in the back of the knee up and down and side to side.

02/05/2025

How the Vastus medialis Obliques (VMO) keeps the kneecap tracking properly and then helps with knee pain

The VMO is a crucial muscle for proper knee function, particular in patellar tracking and knee pain reduction. Here is how it works:

1) Keeps the kneecap tracking properly: the VMO is part of the quad muscles and attaches to the inner (medial) side of the patella. The VMO exerts a medial pull on the kneecap balancing the lateral pull from the vastus lateralis, this balance ensues the patella moves smoothly within the trochlear groove of the femur. Weakness in the VMO can lead to lateral patellar maltracking, which may cause conditions like patellofemoral pain syndrome (PFPS), or runners knee.

2) Helps with knee pain: Shock absorption-a strong VMO helps dissipates forces travelling through the knee joint, reducing stress on the cartilage. Stabilization- the VMO supports the knee during movements like squatting, running, and jumping preventing excessive strain on ligaments. Injury Prevention, weakness in the VMO can contribute. Injury prevention, weakness in the VMO can contribute to conditions like patellar tendinitis and chondromalacia patellae, both common causes of knee pain.

Sterengthening the VMO
• Terminal Knee Extension
• Step ups and downs
• All sits with ball squeeze
• Short Arc quad exercises
• Single leg squats

How the Vastus medialis Obliques (VMO) keeps the kneecap tracking properly and then helps with knee pain

The VMO is a crucial muscle for proper knee function, particular in patellar tracking and knee pain reduction. Here is how it works:

1) Keeps the kneecap tracking properly: the VMO is part of the quad muscles and attaches to the inner (medial) side of the patella. The VMO exerts a medial pull on the kneecap balancing the lateral pull from the vastus lateralis, this balance ensues the patella moves smoothly within the trochlear groove of the femur. Weakness in the VMO can lead to lateral patellar maltracking, which may cause conditions like patellofemoral pain syndrome (PFPS), or runners knee.

2) Helps with knee pain: Shock absorption-a strong VMO helps dissipates forces travelling through the knee joint, reducing stress on the cartilage. Stabilization- the VMO supports the knee during movements like squatting, running, and jumping preventing excessive strain on ligaments. Injury Prevention, weakness in the VMO can contribute. Injury prevention, weakness in the VMO can contribute to conditions like patellar tendinitis and chondromalacia patellae, both common causes of knee pain.

Sterengthening the VMO
• Terminal Knee Extension
• Step ups and downs
• All sits with ball squeeze
• Short Arc quad exercises
• Single leg squats

01/21/2025

How does the Toe Extensor Contribute to Hallux Rigidis?

The extensor Hallucis Longus (EHL) and Brevis (EHB) are the primary toe extensor muscles- they can contribute to the development or worsening of hallux rigidis through biomechanical and functional mechanisms:

1. Excessive pulling on the 1st Metatarsophalangeal (MTP) joint: the EHL and EHB extend the big toe during gait, especially during the swing phase. In cases of overactivity or compensation (due to weakness of other stabilizers like tibialis posterior), these muscles may exert excessive tensile force on the dorsal aspect of the 1st MTP joint. Repetitive or excessive tension can irritate the joint capsule and lead to micro trauma or inflammation accelerating cartilage wear and joint degeneration.

2. Increased Compression Forces at the Dorsal Joint Surface: When EHL is overactive, it can pull the proximal phalanx of the big toe upward (dorsiflexion) excessively, leading to impingement at the dorsal aspect of the joint. This impingement can result in the formation of osteophytes (bone spurs), a hallmark of Hallux Rigidis, further limiting range of motion.

3. Compensation during GAIT: When the Plantar flexor muscles (i.e. flexor hallux longus, or stabilizers (tibialis posterior) are dysfunctional, the extensors of the toes may compensate by engaging more to stabilize the foot. This leads to overuse of EHL/EHB causing additional stress of the MTP joint.

4. Muscle Tightness or Imbalance: tightness or hyperactivity of the extensor muscles can limit natural big toe plantar flexion. This increases mechanical stress on the first MTP joint over time, contributing to cartilage wear and stiffness.

Prevention and Management:

• Strengthening and Stretching: Stretch tight extensors and complementary muscles (towel crunch, roll bottom of foot with a gold ball)

• Orthotics: Can offload excessive stress on the 1st MTP joint

• Joint Mobilization: helps improve range of motion
How does the Toe Extensor Contribute to Hallux Rigidis?

The extensor Hallucis Longus (EHL) and Brevis (EHB) are the primary toe extensor muscles- they can contribute to the development or worsening of hallux rigidis through biomechanical and functional mechanisms:

1. Excessive pulling on the 1st Metatarsophalangeal (MTP) joint: the EHL and EHB extend the big toe during gait, especially during the swing phase. In cases of overactivity or compensation (due to weakness of other stabilizers like tibialis posterior), these muscles may exert excessive tensile force on the dorsal aspect of the 1st MTP joint. Repetitive or excessive tension can irritate the joint capsule and lead to micro trauma or inflammation accelerating cartilage wear and joint degeneration.

2. Increased Compression Forces at the Dorsal Joint Surface: When EHL is overactive, it can pull the proximal phalanx of the big toe upward (dorsiflexion) excessively, leading to impingement at the dorsal aspect of the joint. This impingement can result in the formation of osteophytes (bone spurs), a hallmark of Hallux Rigidis, further limiting range of motion.

3. Compensation during GAIT: When the Plantar flexor muscles (i.e. flexor hallux longus, or stabilizers (tibialis posterior) are dysfunctional, the extensors of the toes may compensate by engaging more to stabilize the foot. This leads to overuse of EHL/EHB causing additional stress of the MTP joint.

4. Muscle Tightness or Imbalance: tightness or hyperactivity of the extensor muscles can limit natural big toe plantar flexion. This increases mechanical stress on the first MTP joint over time, contributing to cartilage wear and stiffness.

Prevention and Management:

• Strengthening and Stretching: Stretch tight extensors and complementary muscles (towel crunch, roll bottom of foot with a gold ball)

• Orthotics: Can offload excessive stress on the 1st MTP joint

• Joint Mobilization: helps improve range of motion