Foot in relation to core? ive been talking about the co-activation between deep and superficial trunk systems at a right timing for lumbopelvic hip stability. If they are failing, failed load transfer through the lumbopelvic hip region can present. We know that poor activation of deep core system is associated with lower limb injuries, especially overload lower extremities. Therefore, it is important to enhance motor control, strength and endurance of the lumbopelvic hip area. However, think differently. When do we load our body naturally? Yes, it's when we weight-bear. As soon as ground is contacted by our foot, the ground forces are transmitted through the heel to the pelvis. Then, the pelvis has to be able to properly distribute the forces upward and downward. What if a foot dysfunction is the culprit for this supoptimal load transfer? There is a great possibility that the dysfunctional foot can be one of the contributing factors to this problem. Lets talk about how problematic it can be? During push off, we need an ability to propel forward, which requires hip extension. Prior to being able to increase hip extension, our first ground contact is essential. Yes, heel strike. This needs to be done with dorsiflexion, eversion and hip internal rotation for shock absorption. Conversely, push-off should be done with plantar flexion, inversion and hip external rotation. When you push off with good hip extension during walking, it fires your glutes that are needed for force closure to the lumbopelvic hip complex. Gluteal contraction massively contribute to lumbopelvic stability. However, if no proper push off, this decreased hip extension can cause reduced force closure. How does it happen? What do you need right before hip extension? Yes. Plantarflexion, inversion and hip external rotstion. So.... what makes the foot plantar flex? Yes. 1st metatarsophalangeal joint (MPJ). If there is no good 1sr MPJ extension, you are not getting enough plantarflexion and hip extension for gluteal firing. Think of people with hallux valgus. Their stiff great toe can not extend and flex sufficiently but over-adduct. Due to this adducted toe misalignment, you are losing this important 1st toe extension mechanism. Why should this problem be fixed? Long stroy short, lack of hip extension is associated with reduced 1st MPJ extension, which should be 30 degs at least but ideally 90 degs. Especially females who like to wear high heels. What can normalise it? - Think of deep frontal line including tibialis posterior. Abductor hallucis is connected to psoas, pelvic floor and diaphragm in order. This means that strengthening abductor hallucis plays a key role in stabilising the core and vice versa. Plus, abductor hallucis is needed to increase the medial arch of the foot to counterattack overpronation of the foot. What is overpronation of the foot? Combination of foot eversion, hip internal rotation and dorsiflexion. Again, to generate enough gluteal power, you need good range of motion of 1st toe extension, ankle inversion and hip external rotation. Lets start to work on the range of motion of your 1st toe. Get it corrected into a good straight alignment rather than hallux valgus. Have a look at your shoe toe box. Isnt it too narrow? If yes, it can squeeze your toes in. Yes. This can develop hallux valgus. Wear toe spread to fan your toes into a correct alignement. Release adductor hallus and calf muscles. Motor train and strengthen abductor hallucis, core and glutes together. Work on this big picture by facilitating the deep front (abductor hallucis, psoas, pelvic floor and diaphragm), superfical back (calf, glutes, SIJ) and spiral (peroneal longus and obliques) lines. Your patient with LBP may feel better after your manual therapy by releasing Lx muscular tension but may come back with the same pain.