Why the toe touch matters

Can you reach down and touch your toes with your knees straight?  I consider a proper toe touch as a demonstration of basic competency in the multisegmental flexion pattern and aim to improve it with most of my clients (exceptions being flexion intolerance such as acute disc pathology).  While it is true that genetic variations in connective tissue and limb proportions (short arms and long legs) make this movement more difficult for some than for others, lifestyle is often the bigger variable. Being unable to touch ones toes is likely to negatively affect other movement patterns such as picking things up from the ground, getting into an aerodynamic cycling position or a powerful rowing position.

What limits the toe touch?

The answer to the question: “Why can’t I touch my toes?” seems obvious; you aren’t flexible enough. But what exactly isn’t flexible enough? The typical response is that the limitation is the hamstrings, but this is an oversimplification, indeed any structure of combinations of structures in the posterior chain could be the culprit. A toe touch could be limited by the hamstrings, or by the sciatic nerve and spinal cord, the lumbar spine or simply a lack of coordination in the toe touch movement. There are scores of stretches aimed at improving the toe touch, but if you don’t know what the limiting factor is, you could spend your time doing the wrong ones. This may result in a lack of progress or just a waste of time

An algorithmic approach to touching your toes

I developed the algorithm below to help people self assess and then improve their toe touch. If you can already touch your toes, this algorithm will be too basic for you, I am working on an algorithm for more advanced flexibility and will post that when it is ready.

In order for the algorithm to work, you must be consistent in your measurement. Comparisons over time are only valid if measurements are taken at the same time of day. In some cases flexibility in the evening is double what it was in the morning simply due to the motion of the day and the loss of disc height.  Small differences in the amount of knee bend will make a big difference in the range of motion. When you reach a test in the algorithm, read through the test description before testing. Write down your measurements as you go along. Repeat testing improves accuracy and a spreadsheet is a handy way to quickly calculate the averages.

You’ll need:

1. A ruler
2. A wall
3. Something to record your numbers

*None of the information in this article or algorithm should replace the advice of your own health care provider and is not intended to diagnose 
or treat any condition.

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Test Procedures

The Toe Touch

*Thanks to Steve Florence for the idea of using a ruler for self measurement

1. Hold a ruler lightly between the pads of your two middle fingers with the 0 mark facing down.

2. With the knees straight but not hyper-extended, shift the hips back and reach for your toes

3. Allow the ruler to touch the floor and slide your hands down the ruler as far as you can while keeping your knees straight. When you reach the end, pinch the ruler tighter and bring it back up, being careful to keep the fingertips in the same place on the ruler.

4. Record the mark where your fingertips reached in centimeters. This is your distance from the floor.

5. Repeat 5x total

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The Heels Elevated Toe Touch

1. Same as toe touch but heels are elevated 5cm. Be sure to measure the surface you are using to elevate the heels. I picked 5cm because it is high enough to make a difference but not so high that it is hard to balance. You could use another height if you want.

2. Repeat 3x

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The Long Sitting Wall Touch

1. Sit with the soles of your feet on the wall

2. Hold a ruler lightly between the pads of your two middle fingers with the 0 mark facing down.

3. With your knees straight but not hyperextended, reach for the wall.

4. Allow the ruler to touch the wall and slide your hands down the ruler as far as you can while keeping your knees straight. When you reach the end, pinch the ruler tightly and bring it back up, being careful to keep the fingertips in the same place on the ruler.

5. Record the mark where your fingertips reached in centimeters. This is your distance from the wall.

6. Repeat 3x

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The Cross-Legged Wall Touch

1. Keep your buttocks in exactly the same place as you were for the long-sitting wall touch.

2. Cross you legs, they need not be completely crossed

3. Test using the ruler the same way as the long-sitting wall touch

4. Repeat 3x

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The Slump Test (Distal Initiation)

1. With your hands behind your back, sit on the edge of a firm and level surface that allows your feet to dangle

2. Bend the ankle back as far as you can (dorsiflex)

3. Straighten the knee as far as you can without moving anywhere else.

4. Note the location and intensity of stretch sensation.

5. Bring the chin to the chest allowing the upper back to flex without moving the lower back, hips, knee or ankle.

6. Note any change in the intensity of the original stretch sensation.

7. Extend the neck and note any change in the original stretch sensation.

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Interventions

For Impairments in Stability & Motor Control

 

Thanks to Ross Dexter MHK, CSCS, SFG1  for showing me how hip flexor stretching can improve the toe touch.

For Impairments in the Neurodynamics of the spinal cord and sciatic nerve (tibial biased)

 

For Impairments in the length of the Hamstrings and related fascia

 

For Impairments in Flexion of the Lumbar Spine &/or Hip