Manual Therapy

What High Heels Do To Your Posture

High heels may be pretty or spectacular to some but let’s look at what they do to your posture. First and the most obvious is that they point the toes causing constant contraction of the calves. This places the plantar fascia in a shortened state and causes the feet to become stiff and tight. Contraction of the calves places strain on the knees and weakens the shin muscles, predisposing one to shin splints.

Due to the changes in the foot position and tightening of the calves, the hip flexers and quads have to contract to keep the body’s center of gravity neutral. This pulls the lower back into extension or into anterior pelvic tilt, giving the illusion of full rear end.  The new position of the lower back disrupts breathing, tightens the back muscles and weakens the glute muscles, predisposing one to lower back and hip pain.

With the buttocks pushed back and the pelvis tilted forward, the mid back has to round out for balance. The shoulders begin to round with the mid back and the head shifts forward realigning itself over the body. The neck muscles tighten predisposing one to shoulder and neck pain along with headaches.

All of these changes occur due to wearing high heels. The center of gravity is changed completely stressing not just the spine but many of the joints throughout the body. All of this occurs just because you wanted to wear those pretty little heels.

Counteracting the effects of wearing high heels is not as simple as taking them off. The effects they have on the body cause long term changes in posture and center of gravity. We suggest 5 activities to start the counteracting measures necessary for high heel wear.

1. Self Myofascial Release-Foam rolling or using a ball to release your own plantar fascia, calves, hip flexors, and thoracic spine can help lengthen the muscles and mobilize the joints that are most effected.

2. Activate Weakened Muscles-Glute, core and breathing exercises are essential in reversing the compensating factors that occur with high heel wear.

3. Increase Ankle/Foot Mobility-Your feet need to move to function correctly. Increasing mobility will increase the proper function of your feet.

4. Retrain Center of Gravity-Exercises like squats and hip hinging will help push your center of gravity backwards were it belongs.

5. Stop Wearing High Heels-The most important and most logical way to counteract the negative effects of wearing high heels.

See exercises by clicking here to get started.

Yours in health,

Dr. Justin Hildebrand

Active Care Rehab, Manual Therapy

The Importance of Hip Mobility: The Posterior Hip

In this weeks post we are going to discuss the importance of the posterior hip and what the lack of movement in the hips does to the body.

Being able to move through the hips is very important in any athletic movement but also in day to day activities. Every time one goes to sit down, squat, or bend over proper posterior hip movement is crucial and necessary for injury prevention.  Without proper posterior hip movement the lower back and knees are put under tremendous stress and have to work much harder than they should.

The posterior hip is made up of primarily six muscles, a fibrous joint capsule and the hip joint. These muscles help rotate the leg and control pelvic stability. When they have to over-work to control the pelvis they become tight and restrict hip motion. Once motion has become restricted, the hip capsule then begins to shrink further limiting motion. Treatment of the posterior hip is a combination of mobilization, soft tissue techniques such as Active Release Techniques and/or Graston, and home rehab exercises.

Individuals that lack posterior hip mobility and have tight hip external rotators commonly have a posture that is termed “Butt Gripper”.  This is due to the appearance that one is squeezing the buttocks muscles together and the flattening of the low back.

The “Butt Gripper” appears to not have a well-defined back side and is aware that they are not very flexible, especially in the hamstrings and hips. Their lower back will be very flat if not rounded and may have trouble finding pants that fit or stay up on their waist. This individual may be guilty of showing off his “plumber’s crack” when bending over or stumping down.

“Butt Grippers” appear to have very strong back, hip and core muscles, but they actually have very weak core and glut stabilizing muscles. This posture and weakness places them at higher risk for lumbar disc injuries and low back pain. If you or someone you know is a “Butt Gripper” check out the posterior hip exercises by clicking here.

Yours in health,

Dr. Justin Hildebrand

Active Care Rehab

Desk Job Hurting Your back?

Our bodies are bipedal, meaning that we were meant to stand on two feet. Sitting for long periods of time is biomechanically insufficient and places large amounts of stress on the spine. Sustained sitting can cause specific muscles to become shorter and joints to become hypomobile.

Classic seated posture:

Classic Seated Posture
Classic Seated Posture
  • Places one’s head forward and rolls the shoulders, shortening muscles that commonly cause headaches.
  • The shoulder blades more upward and outward increasing tension in the neck and shoulder muscles and inhibiting the stabilizing muscles of the shoulder blades.
  • The mid back and low back round out forming a kyphosis, placing the disc of the spine under uneven pressure.
  • The hip flexor muscles are shortened and the gluts are inhibited which can lead to Lower Cross Syndrome.

Commonly, sitting at a desk for a sustained period of time causes headaches, shoulder and/or neck pain, mid back pain, or low back pain. All of these can be prevented or decreased by taking microbreaks and performing a simple exercise.

A Microbreak consists of standing up, stretching and walking about for 30 secs. This should be performed every 30 minutes to an hour that one is sitting. Performing microbreaks will decrease the risk of muscles becoming shorter and joints becoming stiff.

Bruegger’s exercise will help relax short muscles and help strengthen inhibited muscles due to sitting.


  1. Sit down and spreading your feet shoulder width apart and your toes out.
  2. Pretend there is a string pulling your chest up and out, extending your upper back.
  3. Your arms should be at your side with your head looking straight in front of you.
  4. Gently tuck your chin and rotate your palms forward.
  5. Hold position for 30 secs every 30 minutes seated.
Corrective Exercise for Seated Posture
Corrective Exercise for Seated Posture


– You might feel a slight muscle squeeze between your shoulder blades, but not a strong contraction.

– You should still be able to talk when your chin is tucked, if you are unable to talk, relax a little bit!

Next time you are at your desk and you start to feel tension or pain, try taking a microbreak and performing Bruegger’s exercise. You will notice that you can sit for longer periods without pain.

Yours in health,

Dr. Justin Hildebrand

Active Care Rehab

Corrective Exercise: Fighting Injury Reoccurrence

I recently read a quote by former Kansas City Chief Art Still, “Regular exercise may be the single most important lifestyle activity that will make people healthier.”1(web-link to mag) As true as that statement is, those of us in pain my not be able to get the exercise needed to be healthy. This brings me to today’s topic: Corrective Exercise.

Corrective Exercise may be the single most important activity when dealing with an injury. Many therapies, physical rest, and treatments can decrease pain associated with injury.  However, if one does not correct the cause and subsequent muscle imbalance that lead to the injury, the pain will likely reoccur. A Corrective Exercise regimen will target the dysfunction, muscle weakness, and overactivity that predisposed one to injury and decrease the likelihood its recurrence.

Injury occurs due to excess stress placed on a joint or muscle. Repetitive activity or movement causes overuse of specific muscle groups and this overactivity inhibits opposing, or antagonistic muscles. When a muscle is overused, or injured the body, lays down scar tissue in response. This scar tissue can cause decreased range of motion, nerve entrapments, and decreased blood flow. Pain results at immediate site, but more often pain is experienced in another joint.

Since Kansas City has a high rate of knee surgeries, medial or inner knee pain can be used as an example. Quadriceps and/or hip flexor dominance produces weakness in the hip stabilizing glute muscles. During activity such as going down stairs, jumping, or running, stress is placed onto the knee since the hip stabilizers are not functioning at optimal strengths. This commonly places the knee in a position that stresses the medial meniscus and ligaments, leading to pain. Many therapies and treatments can decrease the pain, but unless the muscle imbalances are addressed, the pain will likely return.

The National Academy of Sports Medicine (NASM) breaks corrective exercise into 4 categories: Inhibit Lengthen, Activate, and Integrate.2 An effective corrective exercise program will contain these principles and progress though the stages. This process will address the overactive muscles, the tight muscles, the weak muscles, and finally incorporate the whole body to reduce chance of reoccurrence of injury.

  1. Inhibitory techniques are used to reduce tension or decrease activity in muscles. This can be accomplished by myofascial release techniques performed by a DC, DO, PT, etc. or by self myofascial release with the use of a foam roller. These techniques are Active Release Technique (ART), Graston Technique, FATKR, and many others.
  2. Lengthening techniques are used to increase length and range of motion of the tissues and joints. These techniques can be as simple as stretching (static or tri-planar) or neurological. Practitioner lengthening techniques are Post-Isometric Relaxation (PIR), Post Facilitated Stretch (PFS), Post Neuromuscular Facilitation and others.
  3. Activation techniques are used to reeducate and increase activation of underactive tissues. This techniques range from functional rehab to positional isometrics.
  4. Integration techniques are used to retrain the collective function of all muscles involved in movement. This is done through functionally progressive movements using dynamic exercises. Integration is the last step and involves whole body movements.

A good, effective corrective exercise program is given to incorporate all facets of the problem, not just to alleviate the pain. By eliminating pain, and addressing the cause of the pain, one can enjoy an exercise program to become a healthier and happier individual. After all, “Regular exercise may be the single most important lifestyle activity that will make people healthier.”

Yours in health,

Dr. Justin Hildebrand

 1. Still, Art. “Six ways regular exercise can help overall health.” Kansas City Sports & Fitness. March 2012. Pg 10: Print.

2. NASM. NASM Essentials of Corrective Exercise Training. Lippincott Williams & Wilkins; 1 Har/Psc edition (September 25, 2010).