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Tuesday, June 6, 2023

Neutral Vs. Turned Out Feet

Brent Brookbush

Brent Brookbush


Panel Discussion: Neutral Vs. Turned Out Feet

Whether it is squats, dead-lifts, the Pilates V, or one of many yoga stretches with fee turned out - let's discuss the rationale for feet turned out versus a neutral position.

Moderated by Brent Brookbush DPT, PT, MS, PES, CES, CSCS, ACSM H/FS

This Panel Discussion was originally posted on my facebook page - https://www.facebook.com/brent.brookbush - on February 7th 2011

Andrew Dianiska, February 7 at 12:21pm: As long as there is proper foot-knee-hip rotational alignment, i see no issue-- and arguments can be made for variation between stances and the subtle differences in impact of movements.

additionally, since the notion of training as preparation for life & sport at least should [IMHO} be part of the underlying rationale of a coach's perspective, and since neither life nor sport are totally controlled environments, controlled variance prepares us better for adaptation to the uncontrolled environments we operate within

Brent Brookbush, February 7 at 12:25pm: Great points, so if we dialed it back to just resistance training… that is controlled strength training, not sport's specific training. Would you correct movement patterns to get someone to neutral, or let them turn out?

Andrew Dianiska, February 7 at 12:37pm: What's the point of some synthetic 'neutral'-- it isn't something to 'correct' toward IMHO. What is the point of strength training to begin with? Successful power-lifters use both wide and narrower DL stances-- and in each there is a different kinesthetic emphasis. Same with PL squatters . Since success has been achieved with a variety of variations, which is the correct one? and why is neutral 'better'? particularly if it is not truly 'transferable' as the sole modus operandi?

Short answer to your closing question-- I’d correct their turnout for rotational alignment, but unless I’m instructing them in Olympic lifts* I’d let them go with their natural tendency to start, eventually encouraging them to vary between as many stances as their rotational alignment can accommodate over time to provide maximum kinesthetic "fluency".

Shawn Fears, February 7 at 1:29pm: With regards to resistance training it depends on how wide the feet are. If feet are hip width then neutral, but the farther out the feel go the more external rotation for neutral alignment of the foot knee hip alignment. if the feet are foreword and wider than shoulder width then there is a varus alignment of the knees and the increase potential for medial meniscus damage. Of course the “screwhome” effect will counter this to some degree, but only if there is enough ankle mobility…and that is highly unlikely.

Benjamin Sabo, February 7 at 2:22pm: Just looking at the squat and dead-lift, my thinking has been that the "proper" stance is the one that allows the bar to stay centered over the middle of the foot while maintaining optimal leverages, which may vary according to individual anthropometry. For example, someone with relatively long femurs might need to turn their toes out a bit more when dead-lifting, which will allow them to sufficiently drop their hips and prevent the DL from becoming a lower back exercise. In other words, it would be better to encourage mobility at the hip rather than the lumbar spine. A case could be made to begin with a neutral stance and turn the toes out only as necessary to meet those parameters.

The Olympic lifts might be different because they focus is on power development in the hip extensors. If the hips are externally rotated, doesn't that shorten the primary hip extensors, which would then limit their contribution to the lift? I guess the idea I'm trying to convey is to coach each movement as being specific to that task. You're looking for carryover, but squats, dead-lifts, cleans, etc. aren't sport-specific movements and shouldn't be "corrected" as such.

It's a great question and I'm really seeking feedback more than I'm offering it! My opinions will surely change as I gain more experience, but I have to have some type of rationale for how i apply my current knowledge. I had a nice discussion with Rick at the workshop last weekend about a "toes-out" stance having the potential to put excessive stress on the SI joint and I'm still doing research on that.

Shawn Fears, February 7 at 2:32pm: If somebody has a longer femur just turning the feet out won’t solve the torso/femur ratio the feet have to be wider which will then make the feet turn out proportionately to foot width. You are completely right though about differences in torso/femur length.

In my post I am strictly referring to the lateral meniscus' posterior movement in the squat position with the feet wider than hip width. Upon terminal knee extension the screwhome effect is the anterior movement of the lateral aspect of the knee. I don't know about SI in different stances, that would seem to me to be more of a LPHC issue than a foot position issue but I don't really know.

Benjamin Sabo, February 7 at 2:40pm : Hi Shawn, I wasn't addressing your comment as I hadn't seen it yet, but I would agree: a greater toe angle would necessitate a wider stance.

Shawn Fears, February 7 at 2:49pm: The rationale for my thinking is even weight distribution on medial and lateral meniscus. Just a small difference(as little as1mm) in varus or valgus will change the load and the kinematics of the knee. In the bottom squat position I keep the foot in alignment with the femur to reduce the chance of uneven meniscal loading

I would also have to do more research on the hip and SI joint as far as foot position goes.

Shawn Fears, February 7 at 2:52pm Maybe we could get Professor Richey to chime in here…Brent does he have a FB page?

Scott Pullen, February 7 at 6:04pm: PL and Olympic lifting lifts are specific acts, with a start and finish. How you get there is not strictly regulated, so a lifter will make body position alterations to accomplish a higher weight moved, but rarely with concern to the affect on structures. I feel lumping this into athleticism and everyday movement rationale for a variation on a lifting technique is a poor fit. Running, jumping, accelerating/decelerating, changing direction…these are what come to my mind when I think of training an athlete for athleticism. BTW, this is not a dig at Pl or other lifting sports, but the breadth of athleticism is significantly narrower in these types of specialized lifting vs football, basketball, soccer, etc. Using a heavy squat with a wide stance and toes out does not have much direct carryover to athleticism in field or court sports. What is trained is reinforced is performed.

Scott Mitchell, February 7 at 6:15pm: Is there really a black and white answer for this?

Shawn Fears, February 7 at 7:10pm: Where did athleticism come into this conversation..the question was about neutral and turned out feet and the rationale for such.

Brent Brookbush, February 7 at 9:26pm Wow you kats are awesome, I am going to try and do my best to address everyone in reverse order.

Shawn: Athleticism came into the picture as a goal of a training program that may or may not be a rationale for feet turned out.

Scott Mitchell: IMHO yes there is a black and white answer for this. Resistance train for optimal mechanics, allow your sport to train you for your sport.

Shawn Fears: Yes, Rick is a very close friend, business partner, and has a face book page. He will chime in shortly.

Benjamin and Shawn: Great posts. A wide stance does increase forces on the knee, changes recruitment patterns, and will eventually lead to pattern overload.

Andrew: You have really brought up a bigger argument, and a topic for another discussion. An "Un-natural Alignment" that we deem as optimal is based on the premise that the body adopts compensation patterns when movement is restricted leading to relative flexibility. If these compensations are natural we would have to argue that allowing the compensations is the best way to train… hence the feet turning out is necessary… What do you think?

Derrick Price, February 7 at 11:58pm: A few questions we may want to address here:

1) Do we believe the body can move 3-dimensionally?

2) What does the Principle of Specificity mean and how does it apply to this question?

3) What about Davis' Law?

4) What about Wolff's law?

Larry Husted, February 8 at 1:06am; ‎"let's discuss the rationale for feet turned out versus a neutral position."…(pretty vague) When the body needs the feet turned out, turn them out. When it doesn't, don't.

Brent Brookbush, February 8 at 9:08am:

Hey Derrick,

The body certainly moves 3 dimensionally, and the SAID principle would imply that we should train for specific adaptation we seek. If we resistance train with feet turned out we will becoms stronger in that position, but at a price. If we consider Davis' Law (a correlary of Wolff's law) than soft tissue, inlcuding ligaments and fascia, may adapt to accomadate that position. This is going to have a considerable effect on all movement. What were you thinking in regards to Wolff's law… bone spurs?

Brent Brookbush, February 8 at 9:10am:

Hey Larry,

Unfortunately, posting a question on facebook is a lot like tweeting. You often have to make things short and sweet to catch attention. However, just to challenge your statement. If someone has tight calves and needs to turn their feet out to reach parallel with the floor during a squat, that okay?

Derrick Price, February 8 at 10:57am: If we believe the body has the capability of moving 3 dimensionally, but I restrict it to moving in one dimension (anatomical neutral), then am I not contradicting my own beliefs? Neutral is simply a reference point. We have the capability of performing movements with various footprints, but if I restrict my training to move with only 1-2 footprints (neutral and/or feet turn out) than I will become inefficient at moving in other footprints (SAID principle) and the soft tissue and bone will remodel itself to make sure I become efficient at moving in only these two footprints (Davis' and Wolff's law).

Performing movements in one fashion repeatedly will lead to pattern overload. In this case, you will get a neutral pattern overload (if you believe movement should always be performed in a neutral position) or a feet turned out pattern overload (if you always move with the feet turned out). Either case, it's overload. Would it not be more efficient to help our clients perform movements in various footprints and patterns to avoid this pattern overload?

Bone has the ability to remodel itself as well. If I always perform movement in one position, bone will become denser along those lines of stress, and less dense in areas where less force is received. This can lead to a higher potential of fractures and breaks through the weaker sections of the bone when we have to move in other dimensions we are not use to moving in (especially when we add load, speed and greater ranges of motion)

One last point that we need to consider is that every individual is unique. While we all have the same bones, muscles, ligaments, etc (actually not completely true, some people may have extra or be missing certain parts of their anatomy), the shape and structure of each of these is different in all of us. It's what makes us unique and plays a huge role in what we can and cannot do. For example, some people will never be able to perform the splits no matter how we train them because they have a thicker femoral neck or a different neck angle which won't allow the femur to fully abduct. Another example is the upper to lower leg length ratio is different in all of us as well which will play a role in how I can perform a squat.

So in our example, there may be some people who are anatomically positioned to move more efficiently in one position vs another so of course we have a bias to moving in that more efficient position. It's probably not best to force people to move one way but rather ask the body what it can do and teach it to move in various positions to lessen our risk of injury. One reason why there is not a black and white answer to this question is because we are not all anatomically the same.

Appreciate you bringing more discussion to the world BB. It only enhances everyone involved so thank you for leading the way.

John Sinclair, February 8 at 1:57pm: I am with DP on this one gentlemen- another factor though that was not presented was is the squat loaded? With Mass or acceleration(powerplate) the reason I ask is when we load mass to the body at some point the compressive members(bones) are brought closer together and will change the ROM about each joint- so really the toes out or ER of the hips depends entirely on that person and hip flexion will depend on the width of that persons hips, the length of the femur the angle of the femoral neck and to what verticality do we want the squat to end at? The only way to be sure is to watch them squat- now that is the compressive members- but what about the tensional structures- do they have adequate mobility in the ankles and are the fascial structures allow for the force to be mitigated throughout the ankle and hip. So mechanics depends on more than just foot stance but the entire ability of that movement to reach the functional outcome for that sport! I recall when competing in WL that pattern overload is a good thing! Did not help my football so much but i could lift more weights!

Thanks for this amazing discussion

Larry Husted, February 8 at 2:17pm: Brent, squatting to parallel with feet turned out could be a necessity. I would not train a client that way if ext. rotated feet are a compensation.

Brent Brookbush, February 8 at 2:19pm: If it's a necessity, isn't it also a compensation pattern?

Larry Husted, February 8 at 2:22pm: Nope

Brent Brookbush, February 8 at 2:29pm

Hey Derrick,

I have a couple of comments…. One, I believe that the view you pose on "pattern overload" does not consider the multitude of studies and texts that have lead to the creation of movement prep/corrective exercise routines. Overload patterns are not simply doing to much of one thing, but the result of dysfunction that leads to synergistic dominance, altered arthrokinematics, and the inability of these supporting structures to accommodate stress that should be mitigated by prime movers.

I get what you’re saying about Wolff's law, but I have a really hard time considering this variable when we do not have research that shows an increase in "non-contact" fractures, but we have plenty of research to support soft tissue injuries without contact. In essence, will various foot positions lead to damage of soft tissues before we ever saw a change in bone structure.

Although I agree that everyone is different, the differences are slight. It has been my experience that less than 5 percent of the population have a structural abnormality that would prevent optimal flexibility.

Most importantly, I am glad to be back at it again. I have missed these discussions… Thank you, thank you, thank you for participating.

Brent Brookbush, February 8 at 2:30pm: Care to explain Larry?

Larry Husted Just thinking back to when I was a kid and had to lift my dad's TV. In those days, big screen also meant "big pain in the ass to move". To lift this monstrosity by myself I had to turn my feet out to get my hips close enough to it so that I had leverage to pick it up from the ground. Keeping a neutral alignment put me at a mechanical disadvantage in 2 ways:

1. my knees ran into the TV and didn't allow me to secure a grip

2. my hips were so far away that I would fall towards the TV before

Brent Brookbush, February 8 at 3:31pm: In previous posts, I tried to point out the difference between resistance training, and sports specific activity. Although your example is spot on, would you resistance train a professional mover using parallel feet, knee, and hip alignment or would you train them using sumo squats, dead-lifts, etc…

I was always taught practice for sport, train for balance… What do you think?

Larry Husted, February 8 at 4:14pm: I always train them parallel/neutral provided my assessment doesn't uncover some strange anomaly. Using DP's definition as neutral being a reference point, I aim to give the professional mover's body the best understanding of where to generate movement from and where to return once the demand has subsided.

Benjamin Sabo, February 8 at 4:42pm: Brent, if hip rotation is undesirable when resistance training, why would it be anatomically correct to train movements with thoracic rotation?

Brent Brookbush, February 8 at 5:12pm: Having your feet turned out during a squat is not hip rotation. Its adduction and extension from an externally rotated position, which places the hip knee and ankle at greater risk for injury. Hip rotation is fine… For example… Axe chops

Matthew Bleistein, February 8 at 6:25pm: I've always loved this debate. i have a rare bone condition in my feet (at least for a few more weeks until I see my orthopedic surgeon) , accessory navicular http://en.wikipedia.org/wiki/Accessory_navicular which prevents me from going any lower than parallel to the floor which some db's call half squats. If I go any farther it forces ankle pronation, causing pretty serious pain since the bone is fused to several bones along the arch of my feet, along with a lot of other functional problems that are included in the link I've provided. My point being, it all depends on the structure and functionality of the individual, the right choice is what best suits the client at that exact moment in time with the information collected during evaluation.

Shawn Fears, February 8 at 7:21pm: Brent in what way does having the feet turned out (as in my example feet in line with the femur) increase risk of injury? I don't see how having the knee and ankle lined up with the femur increase injury please explain.

Brent Brookbush, February 8 at 10:23pm: We have to consider a couple of caveats:

1. We are not only considering acute injury, but chronic dysfunction leading to chronic pain.

2. We are considering the effects of the chronic reinforcement of what is likely a compensation pattern.

When we turn the feet out there are effects on all systems (muscular, skeletal, fascial, and neuromuscular). By turning the legs out we are reinforcing a movement pattern (neural) that may be adopted during athletic activity and activity daily livings. This position changes the length tension relationships of all involved musculature increasing the strain on synergists. For example, this externally rotated position is likely to reduce the efficiency of force production of the gluteus maximus increasing reliance on the adductor magnus, biceps femurs, and deep external rotators of the hip, as you know… this may cause imbalance in the deep longitudinal, posterior oblique, and lateral subsystems. These musculature changes also increase the strain on fascial systems, namely the thoracolumbar fascia and sacrotuberous ligament. Last, this changes the position of the femoral head in the acetabulum increasing load on the anterior and superior aspects of the femoral head and acetabulum respectively. This could lead to pattern overload and wear of the hyaline cartilage and hip labrum.

And that’s just the hip, we could analyze the knee and ankle as well… Every decision effects everything. The question I pose is, "What's optimal?", rather than "What's possible?". The body is miraculously adaptive, but remarkably fragile when one considers wear and tear over a lifetime.

Shawn Fears, February 8 at 11:43pm: I just ordered Myers' Anatomy Trains to learn more about fascia. As far as the hip goes I see what you are saying to certain extent. It the same reason I won’t misalign the foot and femur.

So I guess the big question is then… At what point is the line drawn between foot position for the least compensatory neuromuscular recruitment pattern and soft tissue damage in comparison to optimal strength gains in regards to a specific goal?

Shawn Fears, February 8 at 11:45pm: GREAT TOPIC Brent!!! I love your discussion topics by the way.

Benjamin Sabo, February 8 at 11:46pm: Maybe I asked the wrong question earlier. What I'm unclear on, is what determines which resistance exercises may be taken out of the neutral position?

Also, if it's true that maximal surface contact between the femoral head and acetabulum is acheived by simultaneous hip flexion, abduction and lateral rotation, then wouldn't that be the strongest position for the hip joint?

I would take issue with the statement that active hip rotation isn't involved when squatting with a feet/knees out stance. Hip flexion only = knees push in. Flexion + abduction only = knees push out. Adding rotation keeps the knees aligned with the feet, and potentially maintains the greatest amount of structural contact at the joint.

I'm not dismissing the other factors involved, and I'd like to hear more regarding fascial systems.

Brent Brookbush, February 8 at 11:48pm: Great book, and a great question.

If you can create a program that improves neuromuscular efficiency you will get optimal strength gains. When you are resistance training work for optimal neuromuscular efficiency, but set time aside to train for your sport. My sport is basketball, obviously there are foot work drills that are specific to the sport that I would not load or even try to train during a resistance training routine.

Brent Brookbush, February 8 at 11:49pm: Thanks Shawn… I love that you actively participate… you have brought a ton to this discussion.

Brent Brookbush Hey Benjamin,

I thought you were implying that there is active hip rotation during a squat… that is different than knees push out, or knees push in… unless we are getting really technical and talking about pronation and supination of the lower body during loading. Can you help me understand what you are asking.

When someone asks about hip rotation, I assume you mean turning like you would during a chop pattern, or transverse plane movement.

Benjamin Sabo, February 9 at 10:44am: I may be using the wrong term, if so I apologize. I'm trying to describe rotation at the femoral head. So, if you begin a squat with the femur in an externally rotated position, and you want to keep the knees fixed in the transverse plane, then additional hip rotation will be required as the pelvis moves back and down in the sagittal.

The reason I bring that up is it ties into the issue of structural integrity, in terms of maintaining maximal contact area at the hip joint. I feel like that's a powerful argument for a toes-out stance, not to the exclusion of any other factors.

Benjamin Sabo, February 9 at 10:47am: Shawn, Anatomy Trains is very high on my long list of books-to buy! Are you familiar with sportsrehabexpert.com? Thomas Myers just did an interview, and if you or anyone else is interested I can send you the link, which I think will expire for non-members very soon.

Linda Whelden Bapisteller, February 9 at 11:16am: I'm still in training to be a trainer and much of this is over my head but it's really great to read so many perspectives; lots of food for thought. I am in awe of the knowledge of & obvious passion all of you have for this! Thank you so much for sharing.

Scott Mitchell, February 9 at 6:18pm: Brent, you said, " yes there is a black and white answer for this. Resistance train for optimal mechanics, allow your sport to train you for your sport."

I'd be careful with black and white answers. I am not sure what distinction you are making between the two. How is resistance training and "allowing my sport to train me" different. Both are forms of force being applied to the body.

Brent Brookbush, February 11 at 12:20pm: Hey Scott,

You make a great point. For me, the difference between what I do in the weight room and what I do on the basketball court would be the best way I could describe the difference between resistance training and sport. The black and white answer above started with IMHO (In my humble opinion)… As in… this is black and white to me, but I am fine with the varied opinions, rationales, and practices of the individuals on this panel. Sometimes, however, you just want someone's opinion without a list of conditions, and in the case above that is what you got from me. Just, as I might ask you… would you train someone to do a squat with their feet turned out… yes or no. I just want to know what you think… no judgment, no explanation needed… all I want is the nitty gritty from a professional whom I respect. Hope that makes sense…

© 2014 Brent Brookbush

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