The ability to touch our toes is a skill many of us take for granted in everyday life. Whether it’s in a Sit and Reach test as part of a P.E lesson, a work physical or simply putting on our socks, a surprising amount can be learned about the movement competency of an individual through this incredibly basic pattern.
As part of any new clients introductory movement screening and assessment at IFT, we’ll run through firstly a Functional Movement Screen to establish a baseline of competency, as well as modified version of the Selective Functional Movement Assessments – Top Tier, included within is a Toe Touch pattern.
Not only will this be formally assessed on intake, but it also forms part of each and every warm up we do prior to a session. Whether this be in the guise of a a standalone assessment or a simple Toe Touch to Inchworm Walkout, its something we place huge value on with everyday clients.
At some point all of us within our lives will have performed this movement. We may also have heard, or hold the belief, that when we can’t touch our toes, its our hamstrings we have to blame and some serious stretching is needed.
Over this insight, we hope to dive far deeper into why this may not actually be the case and why more range may not actually be better…
So what are we actually assessing within a Toe Touch Pattern?
As be began, whilst many will consider this an assessment of solely hamstring length or flexibility, what we are actually further assessing is the integrity of our lumbar (lower back), thoracic (upper back) and cervical (neck) junctions. Can we therefore achieve the appropriate degrees of Multi-segmental Flexion to achieve an unloaded forward bend posture?
However in addition to spinal integrity, we must also consider that due to the coupling of the pelvis and spine, there is an element of pelvic orientation the comes into play here.
Does this individual therefore not only have full spinal flexion, but do the have the ability to achieve a pelvic orientation that allows for the needed posterior (backward) glide of the femoral head into the acetabulum… i.e. can the ball move back into the socket and allow uncompromised rotation.
This is the basic concept of joint centration, can we achieve optimal joint position to enable full range of movement to occur.
Yet while this may look like a purely biomechanical assessment, underpinning the Toe Touch, we also have a neurological consideration at hand.
Our Toe Touch assessment provides an insight into the nervous system of an individual by using movement as a proxy. This is based on Bernsteins’ degrees of freedom problem of motor control, which is beyond the scope of this insight. However in layman’s terms our ability to touch our toes is indicative of an individual who can turn down sympathetic tone (“Fight, Flight, Freeze”) to enable a more relaxed, parasympathetic (“Rest and Digest”) response.
Because sympathetic activity is naturally extension based, and when we extend, we reduce the ability to move in alternate planes of motion. As a practical example, when something startles you, you’ll likely inhale sharply, extend the spine and notice the effects and heart rate increases and perspiration begins. This is our stress response in action.
If we lack the capacity to inhibit this mechanism, and my day-to-day activity keeps me shifted more towards this sympathetic, extension, stress-filled response, muscles that support extension become overactive. When we then challenge someone to fully flex we may see significant restrictions to overcome this neurological drive to extend.
So whilst the hamstrings may play a role in preventing an individual from touching their toes, we have far more at play here!
From an assessment standpoint, most individuals will fall within one of three categories. Either they can touch their toes, they can’t, or they are not only able to touch, but can achieve full palms to the floor.
Each of these scenarios should result in a different thought process from a training and programming perspective and can provide an incredibly useful guide when it comes to individualising training for the client’s independent needs.
* Please note that if an individual experiences pain or discomfort within a Toe Touch pattern and you are NOT a regulated healthcare professional (Physiotherapist, GP etc…), refer the individual to a recognised practitioner. Pain is a health issue, not a fitness issue.
Barefooted with feet together, knees must remain locked without allowing flexion to occur at the joint. Measure the distance achieved from the floor. Categorise as; *Painful, No Touch (record cm), Touch, or Full Palms.
Did Not Touch…
In our first scenario, the client cannot touch their toes. Regardless of how hard they strain, or how often they attempt to reach ballistically, the movement is beyond them. Traditional understanding would recommend stretching of hamstrings and a return to assessment at a later date as a measure of progress. Yet what we already know is that we have numerous mechanisms beyond purely tissue extensibility issues that may be a limiting factor.
We began by highlighting three spine regions that movement is being assessed in, the Cervical, Thoracic and the Lumbar. Using a side-on view of the assessment, we may see restrictions in movement of any, or a combination, of these areas that are limiting the capacity to Toe Touch.
In limitations in the lumbar spine, such as in the example below, we have clear flexion of the upper spine and a neck that seems unrestricted, yet a look at the lumbar spine shows a clear ridge that isn’t moving into the required flexion needed.
In this case, we have clear overactivity of the muscles that we use to extend the spine. Whether this be through daily activity, previous trauma or our individual behaviours, this individual is incapable of inhibiting the tone in this area to perform the movement asked.
Take a look at the diagram below… Notice that as the pelvis rotates forward, the ribcage opposes by rotating upwards. Stand yourself up, take a deep inhale and take note as this movement occurs. Feel as the ribs come up on the front, feel as the pelvis rotates down and your lower back begins to kick in.
You may even begin to feel a slight tightening of the hamstrings…
Now return to the diagram, and take note of the direction of pull on the muscles on the anterior (front) and posterior (back) sides of the body.
With this rotational pattern at the pelvis and ribcage, our hamstrings are being “pulled” into contraction, this is due to pelvic orientation, we haven’t moved!
If the hamstrings are already being put on stretch before we’ve began, the likelihood is that we will see restriction in forward bending. Not because of my “short” hamstrings, but by the pelvic orientation stealing from my ability to get any more range from them.
This individual cannot achieve joint centration, allowing the femur to posteriorly glide into the acetabulum to enable the required rotation into hip flexion.
If our pelvis has already orientated forward, “tipping” without tipping over, maybe the reason our hamstrings feel tight in the Toe Touch is a neural protective mechanism. The brain’s way of saying, “if I let you go any further, you’re going to fall flat on your face, so I’ll tighten these up to protect us”.
In this scenario, with the best intentions in the world we could stretch our hamstrings till we’re blue in the face, but we’ve done nothing to address pelvic orientation. We may therefore continue to feel neurological “tightness” purely as a method of protection not an indicator of tissue length.
In this scenario, individuals need to learn how to inhibit the muscles that are preventing flexion (Spinal Erector group etc…) and restore position using the muscles that bring the pelvis from an anterior tilted position to a posterior tilted position. For this we need hamstrings and abdominals…
In our next example, we see lumbar flexion occurring, so we know there is possibly no actual tissue length issues in the hamstrings or any neural protective mechanisms in place, but there still remains concern regarding the degree of thoracic or possibly cervical flexion.
Returning briefly to our pelvic diagram above, as our pelvis tips forward, our ribcage rotates upwards. This is a position of inhalation.
Bring yourself back to standing, take an inhale and now fully exhale…
Notice as the ribcage rotates downwards (internal rotation), the pelvis tucks underneath (posterior tilt) and the abdominal muscles begin to fire.
If we lack the ability to flex through the thoracic spine, a contributing factor is often that we also lack the ability to achieve this position of rib internal rotation. In short, I suck at exhaling…
As an extreme example, imagine hugging a Swiss Ball into your chest, now try to Toe Touch. No chance!
Imagine taking out 50% of the air out the Swiss Ball, better but still not touching….
Now deflate the Swiss Ball…
This is a basic metaphor for our ribcage mechanics when we lack the ability to fully exhale. In this scenario, what good would hamstring stretches do in enabling a more agreeable Toe Touch?
These people need to learn how to control airflow within the body and achieve full exhalation.
Two examples both providing the same outcome, but in need of very different strategies.
Here we have an individual capable on touching their toes without noticeable restriction through the lumbar, thoracic or cervical spine, demonstrating posterior translation of the hips (moving backwards). This is our ideal scenario.
From this we simple continue with progression into more dynamic activities. This also acts as a useful indicator of an individuals readiness to move into hip-hinge activities such as the Deadlift. They’ve demonstrated through this simple movement that they have the capacity for posterior hip translation without compensation, a fundamental requirement of a true hip-hinge.
Be careful to note however, that individuals able to touch their toes may still demonstrate restrictions similar to those unable to touch. The outcome of touching is not an example of achieving full unrestricted multi-segmental flexion…
This leads to the final categorisation of individuals, those that can “Palm the Floor”.
Palm the Floor…
This scenario often occurs in individuals who’s activities require the extremes of flexibility and mobility. Dancers, Gymnastics, Yoga Teachers and the like.
In this scenario, individuals are demonstrating the symptoms of hypermobilty, they’re capable of moving the beyond natural limits of range of motion that should occur at a joint.
There are again, numerous considerations that need to taken into account with these individuals. The first of which is, is this a tissue extensibility concern in that they have developed pathological (over-lengthened) hamstring length?
Once we continue to lengthen the hamstrings through continued stretching, we lose the pelvic stability that this muscle group provides. A likely response is an increase in the anterior rotation of the pelvis and subsequent changes in muscle tension relationships that occur (Diaphragm 1.). This can have ramifications in numerous systems, from the way we breathe to the capacity of our pelvic floor muscles.
By nature of the activities these individuals often perform, they often will have an extensive background in stretching practices when hypermobility is an acquired, rather than congenital, trait. Yet often when we perform a stretch, we fail to appreciate where we are actually introducing length, is it to the muscle, or are we actually over-stretching the surrounding ligamentous structures?
Unlike other tissues within the body, once ligaments are stretched over time, they don’t return back to previous length. We therefore lose the stability function that ligaments provide.
Though beyond the scope of this simple assessment insight, these individuals may demonstrate pathologies such as illiolumbar ligament (connects the lumbar spine to the illium) laxity or anterior hip stability. In this case, we know there is a strong likelihood that they don’t have proper joint centration to perform the movement without compensation.
Whilst it may be the goal of many individuals to either palm the floor or achieve full toes to shin, it may come at a cost to achieve such ranges.
Those individuals with examples of hypermobility whether congenital or acquired, often find the only method of creating stability to be through the compression of bone-to-bone contact. They utilise passive rather than active (muscles) structures to provide their support. Whilst they may comfortably pass a Toe Touch assessment with full palms to floor, that is not to say it hasn’t still brought about cause for concern.
In our hypermobile scenario, these individuals need to relearn how to use muscle as a supporting structure.
In the case of our Toe Touch, we firstly need hamstrings to counterpose the forward pull of the pelvis, but bear in mind these will likely be neurologically weak due the constant lengthening, it may take time to rebuild strength and control.
In turn, we need to ensure their ribcage can achieve full exhalation, and abdominals can begin to play a part. We may further benefit from providing these individuals with activities that engage muscles of adduction and internal rotation (Adductors, Gluteus Medius etc…), which will also assist in countering the anterior tilt and associating abduction and external rotation of pelvis.
From one assessment of the most basic of movement patterns, the Toe Touch, we have provided five unique scenarios that each require a train of thought that moves far beyond the traditional “stretch your hamstrings” approach.
As the complex, dynamic biological systems we all are, there are many answers when it comes to the questions of the how and why we move the way we do. As a profession, we’re benefitting from a greater appreciation of how respiration and neurology may restrict or improve our biomechanics on the field or in the gym.