It starts with the feet...

5 weeks post-ACL surgery (mirrored image)

Do you see a slight difference in my knee height / position?

For many years, I preferred to stand with "knock knees". Even when my feet were shoulder-width apart, you would see that the gap between my knees is smaller than between my feet.

One would naturally think that I have to fix my posture, as visually, "knock knees" do not appear to be good structure. Others may argue that it's natural for me to have "knock knees" because of my female anatomy and wider hips.

There is always a debate about what it means to have "good posture", and the short answer is that it's an incredibly complex solution to an individually specific need.

The evidence for my specific need...
Many will notice that I'm not the tallest in the room, but I also have a tendency to round my shoulders forward. For many years, I've been told that I need to have my shoulders back and down, with my chest up. 

And yet, I consider myself relatively more mobile than others when it comes to my thoracic spine and shoulders. I do not have any pain in these areas, and that the only time I experience pain and limited range of motion is when I actively pull my shoulders back and down, or have excessive emotional and mental stress.

And then there's my low back pain, which I initially experienced when standing for prolonged periods of time. Actually, I remembered the reason why I hated my family trips as a child because of the amount of standing and walking we did each day.

If we take a further look at that low back pain and add the significant history of my injuries on the right leg:

My right ankle grade 2 / grade 3 sprain occurred at excessive ankle inversion.

Ankle pronation (eversion)

My normal standing position today

My previous tendency was to stand with my ankles pronated, especially the right foot.

If we think about this critically, my body is most familiar with allowing my ankle to move into areas of pronation. It's not the most scientific explanation, but the idea that "if we do not use it, we lose it" does apply here. The brain is very well equipped to remember what you use most often. 

If I do not train my brain to recognize that I can enter areas of ankle supination / eversion, then it will not have the strength to mitigate a risk when I enter into that end range of motion.

What was the biggest game changer in starting to relieve my low back pain symptoms?

Learning foot mobility.

1. I stopped using orthotics / arch support things.
2. As part of my ankle sprain rehab, I started to perform ankle rotation and strengthening exercises.
3. Remember the 5-week-post-op photo I showed earlier? It was then when I realized that I continued to stand with ankle pronation. I then started to actively train how to contract my foot arch, and restarted what I once called "toe yoga" to actively control my toes in the many ways that make my husband laugh today.
4. I stopped wearing running shoes, especially with the thick soles, which were previously my favorites growing up.
5. Due to the ACL surgery, I had to stop wearing high heels. While I mostly wear flats today, I do wear high heels on occasion, but I will have a pair of flats ready to go at all times.

And then I attended the Functional Range Conditioning® seminar, and realized how I no longer was the only one who could control my toes "weirdly". If anything, it was even more humbling to notice that I have more work to do.

I do not train ankle eversion and inversion as actively as I should, but I do use the Morning CARs Routine to maintain the end ranges that I have. Actually, I have to do a little better in daily journaling anyway, so I'll add it to the list of next projects.

And this is how my feet and toes look from the top view today - ample space, naturally neutral ankle positions, and no big toe valgus. And yes, no back pain when standing for prolonged periods of time. (If anything, I prefer it more today.)

No toe spacers/trainers used. Just mindful training to move my own body.