As massage therapists part of our job is to help our clients become aware of, take responsibility for, and change behaviors that interfere with their ability to have a healthy relationship to their bodies. Many of our clients come to us because they have musculoskeletal pain, and often that pain is a result of unhealthy movement and postural patterns.

Unhealthy movement and postural patterns are a result of LIFE, specifically trauma and conditioning.

Trauma: We are born through trauma, and for the entirety of our lives we experience different forms of emotional, mental, and physical trauma. Every type of trauma can lead to physical compensation patterns.

Other Stuff: Trauma is not the only thing that can lead to postural or movement dysfunction. We also have cultural modeling, and overuse due to occupation or lifestyle to point to.

Whether it is overuse from lifestyle, occupation, cultural modeling or trauma the result is that everyone on the planet has some type of postural and movement dysfunction which can ultimately lead to pain in the musculoskeletal system. I like to call this job security.

When a client presents with a complaint of musculoskeletal pain we can sooth and support by providing the basic massage therapy manipulation we massage therapists provide in a session, but there is oh so much more we can do to support our clients in changing behavior that leads to pain from movement and postural dysfunction.

Truly, if we do not empower our clients with some form of awareness and self-care to move them into a healthier relationship with their own body and life, we are missing a huge opportunity to serve them. We are here to help long-term, not just apply lotion, rub, collect fee and reschedule.

We can interview, assess gait, do ergonomic assessments, assess posture, etc. and that’s all wonderful. The intent of this article is to share a very simple assessment hack that can provide a ton of feedback and support the fascinating and unfolding story of what is going on with your client, and how we can help them.

Look at their shoes!

• Ask your client if you can look at their shoes. If yes…
• Pick them up and look at the soles.
• Compare one sole to the other. Is one more worn out than the other? What does THIS tell you?
• Are the soles worn evenly, or is there some type of deviation?
• Look closer…

1. Are the shoes worn on the inside edge bilaterally or not?
2. Are the shoes worn on the outside edge bilaterally or not?
3. Are the shoes worn under the big toe bilaterally or not?
4. Are the shoes worn at the inside of the heel bilaterally or not?
5. Are the shoes worn at the outside of the heel, bilaterally or not?
6. Are the shoes worn down in the middle of the arch, bilaterally or not?
7. Are the shoes worn down evenly on the entire shoe, bilaterally or not?

Here is where things get interesting and your curiosity and that of your client’s should be stirred.

What I have found to be consistent imbalances over the span of my practice:

• If one sole is worn out more than the other we have a pretty big indicator of favoritism of sides here. At this point I would ask my client, are you right or left side dominant. Counter-intuitively, often the side that is not dominant is the one that is carrying the weight. Being a mom I know that I did the heavy lifting with my left side (kid on hip) while my right dominant side had to manage details (putting the key in the front door). I will then explore with them if they have ever injured the side that the sole is not worn on. Sometimes, information comes up that is very helpful in determining a treatment plan.

• Are the shoes worn on the outside edge bilaterally or not? Whether they are bilateral or not, the side or sides that have this indicator will often show up as lateral muscular aspects of the lower body in a state of hyper-tonicity with ischemia, and weak medial muscles including the adductors. This is a good time to explore the knee stabilizers and maybe check the tracking of the knee.

• Are the shoes worn on the inside edge bilaterally or not? Whether they are bilateral or not, the side or sides that have this indicator will often show up as medial muscular aspects of the lower body in a state of hyper-tonicity with ischemia including the adductors, and weak lateral muscles including the abductors. This is a good time to explore the knee stabilizers and maybe check the tracking of the knee.

• Are the shoes worn under the big toe bilaterally or not? Whether they are bilateral or not, the side or sides that have this indicator will often show up as medial and anterior muscular aspects of at least the lower body in a state of hyper-tonicity with ischemia including the quadriceps, and weak posterior muscles including the hamstrings. This is a good time to explore the hip flexors, abs, check for forward head posture, TMJ and especially the illiopsoas for issues.

• Are the shoes worn at the inside of the heel bilaterally or not? Whether they are bilateral or not, the side or sides that have this indicator will often show up as medial and posterior muscular aspects of at least the lower body in a state of hyper-tonicity with ischemia including the soleus, gastrocs, hyperextention and medial rotation of the knee, short internal hip rotators, and tight hamstrings.

• Are the shoes worn at the outside of the heel, bilaterally or not? Whether they are bilateral or not, the side or sides that have this indicator will often show up as lateral and anterior muscular aspects of at least the lower body in a state of hyper-tonicity with ischemia including the peroneals, and lateral rotation of the knee, short external hip rotators, specifically piriformis may be an issue.

• Are the shoes worn out on the entire sole bilaterally? This indicator will often show up as the need to get new shoes! 🙂

You can always attempt to replicate where they are favoring the weight on their feet to give you clues of where holding might be. In the end it seems whatever point that is being favored on the foot sends a line of tension through the body with corresponding tightness, and weakness in the antagonistic muscle groups.

An amazing instructor of mine once told me that whatever is going on in the feet will always send repercussions throughout the entire body. Having recently experienced my own foot surgery which resulted in false sciatica pain syndrome due to my protective and compensatory gait, I really get it. I can’t stress how interested you should be as an Massage Therapist in your client’s shoes…and the older the shoes the better!

Finally, you can help encourage your client to become more aware of their movement patterns and work towards balance in their body through stretching, strengthening, and receiving consistent awesome bodywork and massage therapy from YOU! As always, a mindful, and compassionate approach will support the highest level of success for you and your client.