Exploring Tibial Torsion, or "Why do my feet point one way and my knees the other?"
So, those of you who know me know about my knees, which look like this:
Knees clearly pointing in, feet pointing out -- a classic example (or so I thought) of tibial torsion where the tibia (shin bone) is twisted along its length, resulting in knees that face a different direction than the feet. A lot of people have similar looking knees, though maybe not all as extreme as mine!
I've seen childhood pictures of myself with this same classic look -- knees in, feet out. I had always assumed that this was an issue at the bony level, nothing that could be changed. Of course, bones can and do change and adapt to how we use our bodies, but could this large of an issue be fixed?
What never occurred to me was how the fascia (connective tissue) and other soft tissues (muscles, etc) in our bodies could be pulling on and changing the visible alignment of bones. During my Restorative Exercise™ certification week, I had a wonderful one-hour session with Master Teacher Tim Harris. And at the end of that one hour, my legs looked like this:
I thought I was seeing the impossible -- straight legs!! It rocked my world. Seriously.
But what did this mean? It meant that what appeared to me to be tibial torsion, a twisting of the bone that even with proper use would take a long time to untwist, was actually an issue primarily with my soft tissue and how I was aligning and using my legs. We spent an hour awakening muscle fibers that I probably haven't used in this way in a very long time, along with mobilizing areas of connective tissue that were underused and stiff. And the result? Knees and feet that pointed in (almost) the same direction. After one hour.
Since then, it's as if that soft tissue has remained nearly as mobile, and my legs can now assume a more straight alignment. Of course, if I stand relaxed and without thinking they still revert back to my original position, because that is currently "normal" for my tissues. But I know now that my legs can be straighter, and the tibial torsion I thought was there is, for my legs, a myth.
Given how most of us use our bodies and legs, it would not surprise me if the majority of people who think they have tibial torsion actually have soft tissue patterns and constraints that lead to the appearance of tibial torsion but can actually be changed. How to do this? Some steps (following roughly what I did in that miraculous hour) are below (instructions are written assuming your knees point in, feet point out, rather than the reverse, though if you have the reverse you can just rotate the thighs inward instead of outward, allowing the feet to adjust as needed and using the same alignment markers).
Slowly work up to doing all of the following -- don't just jump into them all at once! Remember, your body takes time to adjust and change.
1. Sit with your legs bent in front of you. Keeping one heel on the ground and that same knee stationary, rotate the shank (lower leg) in and out. You might first have to use your hands to help, but eventually try to do this without using your hands. Make sure the entire shank is rotating, not just the foot.
2. Stand with the feet ASIS (hip bone)-width apart, the outside edges of the feet pointing straight ahead. Outwardly rotate the thighs until the knee creases point directly behind you (use a mirror or a partner to check). Make sure to allow your feet to roll onto their outside edges if needed to do this. Then, maintaining the position of the thighs, work on reaching the balls of the feet and the toes back down towards the ground. If you have any discomfort in the knees, lessen the work that you are doing and feel more of a gentle reach of the ball of the foot. The balls of the feet do not need to touch the ground for this exercise to be effective. (my left leg needs a bit more work -- that crease isn't quite facing back yet!)
3. Sit facing a wall with your legs extended, soles of the feet up against the wall. Align the outside edges of the feet so they are pointing directly up towards the ceiling. Repeat the same movements as the previous exercise: outwardly rotate the thighs until the knee creases point directly towards the ground, allowing the feet to roll onto their outside edges. Then begin to reach the balls of the feet towards the wall. If you can get the balls of your feet to touch, then gently reach the toes to the wall as well. (see the third image from the top)
4. Lie on your back with your pelvis propped up enough so that your legs can comfortably reach towards the ceiling with straight knees. (If you are tight in your hamstrings, do this exercise with the legs at an angle and resting up against a wall or on the back or seat of a chair). Rotate the thighs until the knee creases point directly to the back. If there is space between the knees at this point, fill the space with a rolled up towel that is just large enough for the legs to hold gently without pushing the knees apart. Without changing the rotation of the thighs, bring the heads of the first metatarsals (where your big toe connects to your foot) together until they are touching. Then, begin to reach your medial malleoli (ankle bones) towards one another, without losing the rotation in your thighs. Essentially you are doing a similar movement to the previous two exercises, but without something for your feet to brace against. This forces the soft tissue of your body to adjust to make the movements happen.
Stand and repeat the second exercise, noticing if it is any easier to reach the balls of the feet down.
5. Stand with one foot on a block (or phone book, if they even make those anymore) and align the outside edge of the foot straight forward. Press up onto that leg so that your pelvis is level (not tipped to one side) and the other leg dangles. Try to find the same alignment on your standing leg as you did in the previous standing exercise (outwardly rotate the thigh, reach the ball of the foot down). Allow the ball of your floating foot to touch down for extra stability or support while you work on the standing leg. Then switch sides.
