falls

We have long ago ditched any Victorian shyness around showing our ankles, thank goodness. In fact, they have become a fashionable part of the body to celebrate with short pants and an ornamental tattoo. But unfortunately for our ankles, the picture is often not so rosy as the years go by…

Healthy ankles can serve both fashion and function! Image from Pickpik.com

You might be surprised to learn that some of the fastest growing orthopedic surgeries are for ankle fusions, and partial and full ankle replacements. Though still less common than the 790,000 knee replacements and 544,000 hip replacements¹ done every year in the U.S., the number of total ankle replacement surgeries has grown to over 10,000² per year, and these are expected to overtake fusion surgeries.

Surgeries have pros and cons

When ankle damage is beyond the reach of physical therapy, ankle surgery is an option. Various procedures are used for treating post-traumatic, osteoarthritic, and inflammatory arthritic ankle conditions. While we recognize that continual improvement is being made in these surgeries, and welcome the mobility life-line they offer to many, ankle surgery can also leave patients with a relatively small range of motion in the joint, wound complications, and residual pain.

Maintaining quality of Life

Good ankle function is clearly important for enjoying life’s pleasures, such as dance, sports, and being in nature—but it is also about being pain-free, being able to keep a job, avoiding fall injuries, and maintaining independence. 

       
Being able to walk with ease and pain free ankles (left) makes life more doable and enjoyable. Image from Pexels(left img, right img)

What causes ankle pain and degeneration?

Ankles become problematic for a number of reasons. Some of our students trace their issues back to old injuries, such as broken bones or “rolling the ankle” and tearing ligaments. And it is true that less than optimal healing or poor rehab can have ongoing consequences, or issues that surface in later years. 

The muscle spindles within and the bands of ligamentous tissue that bind the ankle are especially rich in sensory organs called proprioceptors. These are important for sensing our balance and how we perceive the location and movement of our body parts. Thus, incomplete recovery from ankle injuries can leave us more prone to poor coordination and falls.  The long tendons running from the various lower leg muscles through the ankle to move the bones of the feet want to be strong, as do the connective tissues, giving our legs power and stability. 

The tendons of long muscles such as the tibialis anterior (shown in red) cross the ankle, inserting to work the toes and forefoot. The ankle is bound by strong ligaments. Wikimedia

People sometimes tell me that they have inherently weak ankles, like one of their parents. While our DNA clearly shapes our structural inheritance, a more likely cause for the actual manifestation of ankle problems is poor use of the joint due to problematic posture. A poor gait pattern is often learned from our parents, or role models, influencers, or well-intentioned but misguided coaches. 

Motion is lotion—plus strength and flexibility

From a Gokhale Method® perspective, the root cause of ankle problems in our society is varying combinations of poor posture and insufficient use. Even on flat terrain, walking as we were designed to involves a considerable range of motion—the back of the ankle and Achilles tendon gets stretched as the back heel stays toward the ground, and then the front of the ankle is opened wide as we push off using the toes.  

As we came to work ever more sedentary jobs, walking shorter distances along flatter surfaces in our offices and malls, our ankles do less and less. In centuries past our feet would work hard to grab the textured surfaces of rough earth or cobblestoned streets on which we walked barefoot, or in lighter-soled shoes. Going uphill and downhill makes even more demands on our ankle structure, as do naturally challenging surfaces such as tussock grasses and scree-covered hills. 

Traditional dance forms as diverse as the Indian Bharata Natyam, classical ballet, Irish dancing, and Samburu tribal dance from Kenya, all employ considerable ankle strength and flexibility. Image from Pixabay and Wikimedia

Let’s strengthen our ankles 

Consider your starting point. Don’t go straight into a new or strenuous activity if your ankles have been used to taking things easy! At best you could feel very sore, at worst you risk an injury—the very opposite of what you want. If you are recovering from injury or surgery, we advise you to check with your preferred health practitioner.

If we are lucky, we will gain healthy ankle strength and flexibility as we grow, and maintain it throughout life. But many of us in our society need help to do that. Image from Pexels

Rather than rotating your ankles, which is a commonly given exercise, we recommend you take a look at our free Inchworm and Toe Tap videos (below). Start each exercise gently with a minute’s work on each foot daily, and build up from there.

These are highly functional exercises that can immediately benefit your walking. Although you focus on moving your feet, you will feel your ankles and lower leg muscles working hard as well.

In time, these movements, and others we teach on our in-person Foundations course, one-day Pop-up course, online Elements course, and Gokhale Exercise program, will help to make your walking more balanced, smooth, and powerful. After all, walking well is nature’s way of maintaining your foot and ankle health, giving you the thousands of reps per day that your feet were designed for. 

For our Alumni, we are pleased to announce the return of our popular Advanced Glidewalking course, starting Monday, October 7, 12 p.m. (PST).  You can book your place here.

Best next action steps 

If you would like to improve your ankle function and comfort, get started by booking a consultation, online or in person, with one of our teachers. 

You can sign up below to join any one of our upcoming FREE Online Workshops…

References:

¹ “Joint Replacement Surgery.” n.d. Rheumatology.org. https://rheumatology.org/patients/joint-replacement-surgery#.

² Penner, Murray J., Gregory C. Berlet, Ricardo Calvo, Eric Molina, David Reynolds, Paul Stemniski, and W. Hodges Davis. 2020. “The Demographics of Total Ankle Replacement the USA: A Study of 21,222 Cases Undergoing Pre- Operative CT Scan-Based Planning.” Foot & Ankle Orthopaedics 5 (4): 2473011420S0038. https://doi.org/10.1177/2473011420s00381.

We assume in our culture that aging will necessarily be accompanied by a loss of height, increasingly stooped posture, loss of muscle strength, and a precarious inability to balance. But is this really the inevitable trajectory? Here we look at why this occurs and focus on how a healthy gait can help us maintain good balance throughout life, including into old age.

Walking sticks and poles help prevent falls but are poor compensation for loss 
of natural stability and balance from the feet and buttocks. Unsplash

Falls can have fatal consequences for the elderly, potentially resulting in broken bones and a cascade of problems that can ensue from hospitalization, injury, surgery, and immobility. Scientific data followed by the U.S. Department of Health and Human Services (HHS) has linked several known risk factors, attributing most falls to muscle weakness and problems with balance and gait. Conversely, elderly people who maintain their strength and ability to balance have been shown to mostly avoid trips, slips, and falls.

The importance of the glutes

When it comes to balance, there is good evidence to confirm that the role of the gluteal muscles (buttocks) is key. Research¹ has shown that having strong gluteal muscles and hip abductors differentiates non-fallers from fallers. These muscle groups include gluteus medius, a muscle that we pay a good deal of attention to in both our online Elements course and in-person Gokhale Method Foundations Course. 

 
The gluteus medius muscles form the
upper outer quadrants of the buttocks. Wikimedia

 
Healthily developed gluteus medius muscles are clearly visible 
in these Ubong tribesmen. (Borneo, Indonesia)

The attachments of gluteus medius high on the pelvis and wide at the hip joint position it to play an important role in steadying us when we walk. With a little coaching, it is easy to monitor its degree of engagement with the fingertips. This is also a good way of ensuring that other important muscles in the area are performing their function.

People who walk well use their back leg and glute strongly 
to propel themselves forward and maintain their balance.

Should I do glute exercises?

Well-targeted exercises are an effective intervention for jump-starting weak and sleepy glutes, and are therefore included in our courses. But your glutes would like around 5000 reps a day to maintain a good baseline tone—enough to drive most of us crazy. Fortunately, Nature has a saner solution—walking. Rather than dedicating a large percentage of your disposable time to doing exercises, if you walk well, squeezing your glutes, each step becomes a rep.  

Note the bean-shaped contours of this woman’s feet. (Odisha, India, 2017) 
She has strong, even inner and transverse arches 
giving the foot convexity rather than a collapsed shape.

Feet

At the other end of our walking gear are our feet. We treat our feet somewhat like prostheses to be shoved into shoes, with little regard for their function. But healthy feet are critical in gripping and grabbing the contours of the ground, even through shoes, as part of maintaining our balance. 

Natural gait includes a grabbing action by the foot as the glute contracts, with the back heel staying down
on the ground well into the step.

Glidewalking

A natural gait that makes good use of the glutes and feet is so rare these days that Gokhale Method teachers call it “glidewalking” to distinguish it from the various poor gait habits and compensations that most people develop in industrialized societies. 

Walking distortions

Monty Python’s “Ministry of Silly Walks” comedy sketch, starring John Cleese. 

The Monty Python “Ministry of Silly Walks” sketch shot to fame in 1970 and is still absurdly comic. Its silly walks are hilarious and clearly extreme, but some of their genius lies in their exaggeration of truth as they magnify the distortions and quirks that can be observed in our individual walking patterns.

A common walking distortion occurs when the pelvis is tucked under. Tucking the pelvis disadvantages the muscles of the glutes and feet which are designed to propel us forward. Without this propulsion from behind, muscles in the front of the body such as the psoas and quadriceps are obliged to take their place and pull us along. These muscles cannot give us the same stability however, and our ability to balance or catch ourselves from falling is reduced. 

Non-industrialized populations the world over, despite their varied environments and cultural habits, share a common gait pattern. This photograph (Laurence K. Marshall) reveals no appreciable differences in walking between individuals, male or female, child or adult. 

By contrast, if you observe a tribe or family of Kalahari Bushmen you might detect slight nuances, but each individual shares the same essential gait pattern. This is also observable in our young children and is preserved in the art and film of our ancestors prior to the 1920s.

All of the upside, none of the downside

While it’s true that any type of walking may bring benefits such as cardiovascular fitness, interaction with others, connection with Nature, and a low carbon footprint, there will be downsides for your balance if you have a poor gait pattern. A habit such as landing heavily means that your weight is committed forward too early in your step, removing the ability to side-step a loose tile or slippery floor. Many people lean backwards slightly as they walk, making them more prone to their heels slipping underneath them. By contrast, glidewalking is well balanced and stable, which lends it an innately peaceful and dignified quality. 

Gokhale Fitness teacher Eric Fernandez and Gokhale Moving Meditation teacher Kathleen O’Donohue take online participants through balance exercises and movements.

It’s not just an age thing

Many younger people with poorly developed walking muscles and a “flat butt” find themselves prone to falls and injury but are likely to put it down to poor coordination and clumsiness. Whatever your age, if you often feel unstable, trip frequently, notice that you struggle to stand on one leg in yoga classes, or cannot shift your weight smoothly in Tai Chi/Qigong, it is definitely worth looking at ways to improve your balance and movement.

Strengthening the gluteus medius muscles prepares you for glidewalking.

Learning to glidewalk

The best and safest starting point for learning glidewalking is to strengthen and become very familiar with using your gluteus medius muscles. You can find our favorite glute strengthening exercise, “leg raise,” in the exercise appendix of my book (pg. 213), “8 Steps to a Pain-Free Back”.

Or watch our Online University video clip here.

For those who are willing and able to follow detailed instructions, Lesson 8 in “8 Steps to a Pain-Free Back” takes you through the phases of glidewalking step-by-step. 

If you have the resources, I recommend contacting a Gokhale Method teacher who can coach you and tailor lessons to your needs. 

You are also invited to join me for the Free Online Workshop, Sturdy, Upright, and Tall: Posture for Aging, on June 29 (5 p.m. PT). Best foot forward!

          1. Mario Inacio et al., “Gluteal Muscle Composition Differentiates Fallers from Non-fallers in Community Dwelling Older Adults,” BMC Geriatrics 14, no. 37 (March 2014), https://doi.org/10.1186/1471-2318-14-37.