The Walking Code: Form Follows Function
Chapter 2
Form Follows Function
"Whether it be the sweeping eagle in his flight, or the open apple-blossom, the toiling work-horse, the blithe swan, the branching oak, the winding stream at its base, the drifting clouds, over all the coursing sun, form ever follows function, and this is the law. Where function does not change, form does not change."
Louis Sullivan
The above quote was written by the famous architect, Louis Sullivan, a mentor to Frank Lloyd Wright. It is the origin of the well known adage, "form follows function." Sullivan was discussing the concept in the context of the architecture of buildings, but as his quote suggests, it is the law of all things, including human form and function. The human form is one of truly elegant design, and this design follows from its function. One of the most important and unique functions of the human body is to stand and walk upright. We are the only animals that can sustain upright posture. This has in turn allowed humans the use of our hands, giving us advantages over all other animals. Maintaining upright posture requires not only a remarkable physical design but also a powerful nervous system that manages to perfectly coordinate each movement.
Our bodies are meant to function in a particular fashion, and it is this fashion around which all of our joints are desiged. Maintaining proper alignment of the joints requires functioning according to the body's design. Altering the way we function throws our alignment out of balance, leading to a slow erosion of the joints and connective tissues. People flock to chiropractors on a regular basis to have their bodies realigned. This should make people wonder, why is it that many of us seem to require so much external realignment? It would imply that the human body was not designed very well, and that is not the case. The problem is not with the design of the body, it is with how so many people use it incorrectly.
One of the most common reasons for visits to the chiropractor is lower back pain. People go in to the chiropractor expecting to get the spine realigned. But even if this were possible, it would at best be a band-aide. Whatever the reason for the misalignment, it cannot be solved by the chiropractor. It must be solved by the person with the misalignment. And that requires correcting function. The following 3 figures will illustrate how changing the way we walk can completely change the alignment of the spine and trigger back pain.
In the first figure (Figure 6), we see an image of a person walking. The figure on the left marks the initiating point of a normal step, which occurs at the moment of heel contact, before the forefoot is lowered. The right leg is forward and the left is back in this image. This is followed by the lowering of the forefoot in the figure on the right. With correct walking technique, the weight is changed to the right leg during the lowering of the right forefoot. The rooting of the left leg is released as the rooting on the right leg takes hold. The correct weight changing process maintains the pelvis in neutral, or vertical position. You will notice from the picture that the spine remains upright as well as the pelvis as the weight shifts forward to the right leg. The right arm will begin to swing forward as the weight is changed to the right leg
Figure 6. This figure shows the transition from the initial contact phase of a step to the completion of the change of weight. Initial contact is made with the right heel. In correct walking technique, this marks the end of one step and the beginning of the next. When the core is used correctly, the pelvis is tucks under on the right as the weight shifts forward onto the right leg. This keeps the pelvis and spine in a vertical position as the weight is transferred in a controlled fashion.
In the second figure (Figure 7), the person begins the same step but fails to change weight correctly. The weight remains rooted on the left leg which trails behind. The pelvis is not brought into alignment with the right leg as the right forefoot lowers. The failure to change weight correctly causes the body to fall into the step, with the entire spine and pelvis tilting forward. The vertical posture is immediately disturbed. The spine is no longer vertically aligned over the pelvis and hip joints. This adds stress to the spine, which is meant to remain vertical, like a well built stack of building blocks.
Figure 7. This figure shows the same step initiation demonstrated in figure 6. The difference is the core is not activated at the correct time to change weight to the right leg. It remains rooted on the left leg as the center of gravity shifts forward, leading to a forward pitching of the pelvis and the spine. People who walk in this manner do not activate the weight change until after the lowering of the forefoot. The essentially start the next step too late. Once this happens, the body will remain pitched forward with each step unless the correct walking technique is used.
There are a good number of people who walk around like this. You will notice that the head is tilted down so the person is looking at the ground in front of them and not at the horizon. People who walk like this appear to be falling into each step. It may give the impression that they are in a hurry. The posture may be totally fine as long as the person is standing vertical, but once they begin to walk, it is all over for the posture. You will notice in people who walk like this that the arm swing does not begin to move forward as the forefoot lowers. The next step, and thus the change in arm swing, is not initiated until after the forefoot has lowered. This faulty walking technique and posture is easy to spot.
The third figure (Figure 8) is a much more common occurence than the second. It is based on the same mistake made in the second figure, the failure to change weight after heel contact. The difference is the person in Figure 8 realizes being bent over when walking is not correct, so they arch the back to bring the upper back and head back to the vertical position. In doing so, they feel like the posture is great because their head is vertical. The problem is that they fail to fix the pelvic position, which remains tilted forward, and the curvature of the lower back is exaggerated. There is only the illusion of good posture. This type of forward pelvic tilt and exaggerated spinal curvature is one of the most common issues treated by a chiropractor. Unfortunately, it doesn't matter how many times the back and pelvis are adjusted, it will continue to fall out of alignment because it is based on the nature of the walk. This type of walk is harder to spot if you don't know what you are looking for. One of the easier signs to look for is that the arms will have an exaggerated backward swing on account of the overextension of the upper back and shoulders. A large percentage of my patients with chronic back pain stand with this type of posture becasue they walk with this type of walk. Consequently, it is impossible to correct this posture without correcting the walking technique.
Figure 8. In this figure, we see the same step initiation from figure 7. The person again fails to change weight correctly. The difference is that this person compensates for the forward lean by arching the back. You can see the exaggerated arch in the lower back, giving the appearance of correct posture, but it is not. The pelvis is tilted forward, called an anterior pelvic tilt. The lower back is in a nonfunctional alignment that places strain on the vertebra and connective tissues and eventually contributes to back pain. Therapists and chiropractors try to help patients with anterior pelvic tilt by strengthining muscles, but without correcting the gait, the problem will not be fixed
When a person walks in the manner shown in Figure 8, the resulting posture will eventually become fixed and difficult to correct. The posture will exist whether walking or standing still. Since the pelvis is held in a continuously forward flexed position, the hip flexors begin to shorten and tighten. The lower back muscles do the same. Eventually, assuming a normal, well aligned, posture becomes impossible. Form changes because of a change in function. It's like your mother told you, if you make that face long enough, it will stay that way. There is some truth in that.
The alignment of the spine is not all that changes when walking technique changes. Pitching forward with walking has the effect of concentrating the center of gravity over the insides of the feet and the knees. This occurs because of the nature of the core movement which will be described later. The effect of this is eventual collapsing of the arches. This is why so many people need arch supports. The concentration of the weight over the insides of the knee joints also leads to eventual wear and tear, deterrioration of the joints, and arthritis. In Figure 9, you will see an xray of the knee joints in a person with arthritis. You don't have to be a radiologist to see the collapse of the joint space on the inside portion of each knee. This is the most common location of knee arthritis, and I believe it is a direct result of incorrect posture and walking technique over many years. The fact that the arthritis is so symmetric gives you a clue that it is not related to a previous injury.
Figure 9. The picture to the above is an x-ray of the knee joints of a person demonstrating "bone on bone" arthritis in the inside knee joint spaces which can be caused by years of asymmetric overloading of forces on the inside portions of the knee. The fact that both sides are the same can allow one to infer that this was not the result of an injury. Compare this asymmetric wear to the car tire.
Even the shoes we wear can alter our function and then inadvertently alter our form, often with detrimental side effects. When women wear heels too often, their achilles tendons may shorten, making it hard to walk barefoot or in flats. People who wear flip flops on a regular basis often unconsciously begin walking with their feet turned out. This helps keep the flip flops on the feet, but it eventually becomes their default walking style. As the weight rolls over the inside of the feet with each step, the arches are more susceptible to collapse. Most people don't pay any attention to the way they walk, so they don't notice as these changes are happening. The first thing that may bring the problem to their attention is pain, and then it may be too late.
Part of the focus of this book is on the mechanics of walking, but equally important is calling attention to the need for people to be consciously aware of the way they walk. Only by being aware can people even begin to prevent problems before they start. Walking is one of the most important functions that we perform, yet we pay so little attention to it. The physical signs of destructive changes in our form are common. Bunions and hammertoes on the feet, collapsed arches, and exaggerated curvture of the spine are just a few. In my opinion, they all relate to improper function and not to random genetic defects or bad luck. When people pay attention to the way they function, the human form is designed to endure for a long time.