bunion or Hallux valgus — relieving pain when your big toe is out of line

A pair of feet on powder-blue ground, both affected by hallux valgus.

© MasAnyanka | shutterstock.com

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Find Out Everything Important About What Causes Bunions and Discover the Best Exercises for Self-Help

Constant pain with every step you take is driving you crazy? It looks as if your big toe is leading a life of its own and shifting farther and farther towards the other toes? In addition, the ball of your toe pushes outwards more and more, you see a reddening and because of this askew position, shoes hardly fit anymore? Then you realize: you’re experiencing bunions.

After some time, blisters turn into painful calluses and in the end, you can hardly take a step without severe pain – an operation seems to be the only way out. But it does not have to come to that. We would like to stop this process together with you, so bunions no longer run your life!

Therefore, we want to clarify in this article:

We would like to be with you on your way to a better quality of life – even in cases where your toe is only slightly deformed –  and free you step by step from your pain and restricted movements.

Roland Liebscher-Bracht

Roland Liebscher-Bracht

Germany's most trusted pain specialist and author of several bestselling self-help books on the treatment of pain conditions.

 
Read more

Roland Liebscher-Bracht is Germany's most trusted pain specialist and author of several bestselling books on pain treatment. Together with his wife, Dr. med. Petra Bracht, he has developed a revolutionary method to treat pain conditions. With the help of the so-called "osteopressure", where you press specific points on your body, and special stretching exercises, pain can be stopped entirely without medication or surgical intervention. This pain treatment allows you to alleviate pain by yourself. Find out how exactly this works in this article or our numerous YouTube videos.

Roland Liebscher-Bracht

Germany's best-known pain specialist and author of several bestselling books on self-help against pain.

 
Read more

Roland Liebscher-Bracht is Germany's best-known pain specialist and author of several bestselling books on pain treatment. Together with his wife, the physician Dr. Petra Bracht, he has developed a revolutionary new form of pain treatment: With the so-called "Osteopressur", in which certain points on your body are pressed, and special stretching exercises, pain can be stopped completely without medication or surgical intervention. It is particularly important that this pain treatment gives you the opportunity to help yourself against your pain in a self-determined way. You can find out exactly how this works in this article and in the numerous YouTube videos.

1. A Bunion Overview

Hallux valgus or more commonly known as bunion is a deformity of the big toe. Your big toe slides with an internal rotation very closely towards its neighbors – the little toes. As a result, the joint at the metatarsal bone (metatarsophalangeal joint) at the ball of the toe pushes farther and farther outwards and over time sticks out and causes discomfort. This is why hallux valgus is also called bunion toe or crooked toe.

At the ball of the toe, a bony lump causes friction and redness in the initial stage, and then, as it progresses, develops pressure points, blisters, calluses and swelling, which can be extremely unpleasant, especially in shoes. In medical terms, this is known as an exostosis, or ganglion at the metatarsophalangeal joint of the big toe. Depending on how severe the deformity (exostosis) and the ganglion at the metatarsophalangeal joint of the big toe is and how sensitive you are to pain, you may find it difficult to walk without great pain. It hurts mainly when rolling off your forefoot.

Graphical visualisation of the hallux valgus malposition of the bones in the foot.

@ corbac40 | shutterstock.com

By the way, statistically speaking, hallux valgus (bunion) is the most common type of deformity or misalignment in the foot – physicians assume that about ten million people in Germany are affected. Within this group, women have this deformity in the metatarsophalangeal joint of the big toe significantly more often than men, at about 75 percent.1) In general, however, a change in the metatarsophalangeal joint of the big toe occurs more often with increasing age. The causes most often given are: shoes that are too high and too tight as well as too much stress on the forefoot. What the exact causes of bunions are, is something that you will learn in the next chapter.

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2. Symptoms, Causes and Diagnosis of Bunions


Your big toe leads a life of its own and keeps wandering towards the other toes on the foot? You constantly have blisters and pressure points on the ball of your foot, or your feet hurt? However, you are unsure whether this is a bunion? Let us help you in this chapter. We will first introduce you to typical symptoms and complaints of bunions. You can easily compare these with your own complaints. Then we explain the causes that can lead to a bunion. At the end of the chapter we, of course, will also explain how a bunion is diagnosed.

2.1 Symptoms of Bunions

Not every patient suffering from hallux valgus is also in pain. The discomfort and pain usually only occur when the deformity or toe misalignment is already very pronounced. Usually, the first symptom is a visible deformity of the foot and a reddening of the ball of the foot. At this stage, you can work against the deformity with specific exercises, initiate treatment and hopefully never get any complaints. However, even if you already have problems with your bunion, you can immediately alleviate them.

Feet above flowers, with the toe nails painted red.

1. The Optical Change: Cosmetic or Medical Problem?

At its initial stage you can “only” see a bunion: you will notice a small bump on the joint of the metatarsal bones. At the joint, the skin of the ball of the toe is often also slightly reddened and it looks as if you have bumped into something. If the bunion is already advanced, the bursa (bursitis) in this area can also become inflamed and you can feel a swelling on the ball of your toe. This is exactly the right time to start with our exercises! This way you can be certain to prevent the toe from leaning more and more towards the little toes as the deformity progresses. At the beginning, hallux valgus is therefore a rather cosmetic problem that over time becomes a medical problem  you can prevent this with our exercises.

By the way, if you do not do anything about your hallux valgus, there will be long-term effects on the entire arch of your foot — the hollow space in the middle of your foot. A pronounced bunion will make the arch of your foot wider. In addition, claw toes, hammer toes, a hallux rigidus and further pain in the area of the metatarsus (metatarsalgia, pain in the metatarsal region) can occur. The falling of the transverse arch of the foot not only promotes further tilting of the big toe, but is also responsible for a splayfoot. 

A pair of feet on powder-blue ground, both affected by hallux valgus.

© MasAnyanka | shutterstock.com

2. First Onset of Pain:

The first time you feel pain, it is usually an unpleasant, pressing sensation. The metatarsal bone or metatarsal joint rubs against your shoes. Especially in high-heel shoes or shoes with pointed toes, walking becomes a torture. And to avoid the pain and calluses, you try to take load off your big toe, put it on the other toes and thus apply unnaturally excessive forces on your entire foot, especially the arch of your foot. Now, it is high time to use our exercises to get your feet relaxed again. This way you can correct or stop the deformity of the big toe joint and relieve your complaints.

A pair of feet standing next to a pair of heels.

© Maridav | fotolia.com

3. Then Comes Stabbing, Unbearable Pain:

Over time, the foot deformity gets worse and worse and taking weight off your foot will not bring any relief. The ball of the toe becomes increasingly thicker in hallux valgus situations and this ongoing irritation caused by the deformity almost always results in bursitis as a complication. The pain in this stage is often unbearable, movement restrictions are severe and walking in your daily life is hardly manageable.

This is the time when many doctors recommend an operation in a clinic. But this is not necessary, as we know from experience with many of our patients. With the Liebscher & Bracht therapy, many patients have already been able to eliminate their pain without surgery. Bursitis can also be brought under control in the long term using our therapy. The chapter Treatment will show you who to do this.

2.2 Causes and Risk Factors for Bunions

Since it´s mostly women who are affected by hallux valgus, high and too tight shoes are often named as both a cause and a risk factor for the development of hallux valgus. However, the development and progression of the deformity in the foot is a complex process that involve mostly tension in the muscles and fascia of the foot. But once again slowly and step by step: We will now answer the most frequent questions, refute false assumptions and explain the main cause of your bunion.

A Brief Overview of the Triggers of Bunions:

  • an acquired deformity by e.g. high heels,
  • genetic predisposition,
  • weak connective tissue – especially in women,
  • adverse precondition due to a fallen arch of the foot in case of a splayfoot or a pigeon-toed foot,
  • forms of arthritic joint changes, 
  • preexisting condition of the metatarsophalangeal joint of the big toe due to an a contracted foot, and
  • one-sided repetitive movements in everyday life.
DNA helices

What Role Do Genetic Factors Play in Bunions?

If you suffer from other growth deformities of the skeleton, you may also have a hallux valgus. In this case, incorrect footwear or excessive weight on the foot are not necessarily the first reasons for the deformities. Instead, irregular growth of the toe may be the cause. Often it is genetic and runs in families who pass it on to their next generations. In most cases one speaks of a genetic mutation when the information of a deformity is already encoded in the genes.

However, other skeletal diseases are also possible causes of hallux valgus. More often than not, a splayfoot is the trigger because in this case the metatarsal bone is already misaligned and allows the foot to fall and then widen. The big toe has to take on excessive stress which it then compensates by moving, resulting in a bunion.

By the way, even if you have a genetic predisposition, in our experience, too much tensile pull on the muscles and fascia still may play a major role in your bunion. This is because this tensile pull is not balanced out properly and so your big toe is not pulled towards the little toes anymore, thus encouraging the deformity. Learn in the next chapter how you can do a lot of good for your feet despite your genetic disposition. This way you won’t have to suffer from the pain that a bunion can cause.

Visualisation of the placement of feet in shoes and heels.

@ alphabe | shutterstock.com

What Does Wrong Footwear Have to Do with the Bunion?

Particularly regarding bunions, high-heels or tight shoes often have a bad reputation: high heels and healthy feet  they usually don’t go together well. High heels mean that the rolling off movement of the foot is no longer fully executed, and the weight is almost entirely on the forefoot. In addition, certain shoes are not only very high, but also tight. The toes are pushed together and slide over each other.

For us, this is not a dogma. After all, there are also men with bunions and at the same time a lot of women wear high heels every day and still have no problems with their feet. So, you don’t have to lock away your favorite high heels just yet.

The important thing is that you do regular balancing exercises to relax your muscles and fasciae, which are particularly stressed in tight shoes or high heels. We will show you which exercises are particularly suitable for this in the chapter Exercises.

Reddened feet in a bed.

Does Weak Connective Tissue Promote Hallux Valgus?

Unfortunately, almost all people with weak connective tissue have a stronger tendency to develop hallux valgus. The tissue bends out more easily and the pressure on the joint capsule in the ball of the big toe increases. Arthrosis is a long-term consequence of damaged joint capsules and the wear and tear that goes along with it.

And again, it´s mostly women who are affected by this. The hormonal influence of estrogen can lead to connective tissue weakness, especially during menopause and thus promote the development of hallux valgus. But here is the good news for you:

You can easily exercise your connective tissue, i.e. your fasciae, and the supporting muscles in your feet at home. This way you won’t develop bunions or can significantly alleviate your symptoms. Click here for the exercises that will bring lasting freedom from symptoms

Bone structure of a foot.

What Role Do Untrained Muscles Play?

If the muscles of your legs and feet are not exercised equally or not at all, their muscular-fascial balance changes. Tensions and pain can be the result. Restriction of movement – whether intentional or unintentional – should therefore never be a permanent situation and should always be compensated.

By the way, even shoes in general are not necessarily good for your feet. They make the muscles in your feet “lazy” because they support your foot so much that the muscles have nothing to do anymore and become weaker and weaker. Therefore, here is our tip: Walk regularly barefoot and on as many different surfaces as possible. A barefoot path is particularly suitable here.

A shortening in the Achilles tendon or calf muscles as well as complaints in the lower leg can also promote the formation of a bunion. The shortening in the calves and the Achilles tendon puts more strain on your forefoot. You will find uneven weight distributions in the toe-off phase when running. With a Hallux valgus your entire gait pattern changes. Additional exercises for your thighs and hip joints can therefore have a lasting positive effect on your complaints.

Remember: Only if you use the full range of motions your foot has to offer, the associated muscles can ensure the anatomical stability of the musculoskeletal system. Your feet are then well stretched, exercised and tension-free, so that pain has no chance.

2.3 Diagnostics: How Hallux Valgus Is Diagnosed

Although a hallux valgus is actually rather easy to spot, you can, of course, have it diagnosed by a doctor. To do this, your doctor will first look at your foot while taking your medical history and examine it for pressure points, blisters and a painful bursa (bursa/bursitis).

Illustration of the hallux valgus angle

@ corbac40 | shutterstock.com (bearbeitet)

Often, X-rays of your feet are also taken for a diagnosis. With the help of the X-rays your doctor can determine the exact severity of your hallux valgus. A certain angle is calculated for this. It describes the distance or deviation of your big toe from the other toe bones.2)

  • mild hallux valgus: angle 21-30 degrees
  • moderate hallux valgus: angle 31-40 degrees
  • severe hallux valgus: over 40 degrees3)

Interesting fact: Two small bones called sesamoid bones also play a role in the diagnosis. These sesamoid bones are located under the metatarsal heads (part of the metatarsal bone) at the foot ray of the big toe, and numerous important muscles, ligaments and tendons are connected to them. During the toe-off movement they transfer the force of the big toe to the floor. The farther the metatarsal head and the sesamoid bone move away from each other, the more pronounced your hallux valgus position is – this can also be seen in X-rays. Over time, this does not only lead to a crooked position, but also to arthrosis in combination with joint wear and stiffening of the big toe.

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3. Treatment of a Hallux Valgus


In this chapter we will introduce you to various treatment options for a bunion. Especially if you are considering surgery, we would like to show you alternatives – without painkillers and without surgical intervention.

We will therefore first explain how we could help many patients with a bunion. Then we will go into detail about the methods and therapies used in conventional medicine. This will give you a comprehensive picture of all the options available to you. Then you can decide for yourself which treatment path you would like to take.

3.1 Treatment of Bunions with the Liebscher & Bracht Pain Therapy

With the Liebscher & Bracht pain therapy, we would like to walk with you on your way to freedom from pain – and the chances are good. In the treatment of patients with hallux valgus, we were able to observe that surgery was actually recommended for only very few patients. Painkillers have also almost always proved to be unnecessary in the long run. After all, drugs do not treat the cause, but only the symptoms. In order to be really pain-free for good, you have to understand what actually triggers your pain! And this is exactly what we are going to explain to you now:

We at Liebscher & Bracht are of the opinion that neither age nor gender can be used as a comprehensive explanation for pain caused by a hallux valgus. Statements like: “Women just get it” are pithy but also oversimplifications.

Someone pointing at marked points on a skeletal foot.

Our experience in the decades of treatment of pain patients shows that a permanent and incorrect load on your feet and the narrow use of the wide range of motions your foot offers causes your pain. Repeated one-sided stress causes the muscles and fasciae of the feet to develop excessive tension. In the long run, the big toe is forced into the wrong position and the tendons are pushed out of place. Finally, the increased tensile stress in this situation causes the pain. It is a warning sign of your brain not to continue as before

Osteopressure as an Acute Measure

In order to get these pains permanently under control and promote healing, a special manual therapy developed by Liebscher & Bracht helps. Without surgery and painkillers possessing many side effects, it is possible to release the cramps with this osteopressure technique and finally walk again without pain!

Osteopressure Tool

This involves specifically influencing receptors in the periosteum. As a result, the excessive tension in the muscles and fascia will normalize and the alarm pain will be switched off. For most of our patients, this is a truly beneficial experience.

Stretching Exercises for Long-Term Success

Here YOUR help is needed: To prevent the pain from returning, it is important in the long run to change the movement patterns that led to the pain. Our special exercises with their bottleneck stretches will help you do this. They are aimed precisely at the problem areas of your feet, help you to regain your natural range of motions and usually make surgery something far, far away.

Tips for Everyday Life and Prophylaxis

We also have two tips and preventive measures for your everyday life:

A pair of feet standing on wooden boards.

1. Walking barefoot on different surfaces! If your feet are always stuck in firm and rigid shoes, this does not exactly help in exercising your foot muscles. Insoles are also often detrimental to a healthy foot. You should walk barefoot on sloping and uneven surfaces, sideways, backwards and forwards. For example, don’t always pick up a dropped handkerchief with your hands, but also use your toes! Running barefoot trains and strengthens the foot muscles and provides more stability.

A selection of different types of heels.

2. Buy your shoes in the evening! Your feet have to take so much load every day that they are swollen up in the evening. This could make a difference of a whole shoe size! So, shoes that you buy in the morning may not fit you at all later in the evening. In order to prevent this in the first place, always try on your new shoes in the evening.

Regain the wide range of natural movements your feet allow and thus overcome your complaints. With our exercises, we would be happy to show you how this can work within a few weeks.

3.2 Conventional Treatment of Hallux Valgus

Special Shoes, Toe Pads and Ball Rolls

In conventional medicine, there is usually a conservative form of treatment that alleviates the symptoms and discomfort of bunion toe but does not correct the cause. For example, you may be advised to wear shoes with a large toe box, put on orthopedic footwear with insoles or insert toe pads.

The so-called bunion roll is particularly popular. This is a special toe-off aid that is designed to take load off your middle and forefoot joints. The ball roll is mounted in a special orthopedic shoe behind the metatarsophalangeal joints.

Medication, Foot and Toe Exercises

Doctors usually prescribe anti-inflammatory ointments and painkillers to treat pressure sores and blisters on the soft tissues. Although we can understand that this is appealing at first, since it relieves your pain. But in the long term, you should work on the cause of the problem — i.e. training the muscles and fasciae in the foot. Because muscles that pull in the wrong direction lead to misalignment in the foot.

If the hallux valgus is still in an early phase, doctors also rely on physiotherapy, including foot and special toe exercises during your treatment. We do not think this is a bad approach. This is because physiotherapy (hopefully) trains exactly the right muscles when you work on the foot. You are welcome to use our exercises as a supplement. Because it is not only important to strengthen your muscles with toe exercises but also to stretch them in the right places to prevent hallux valgus from progressing further.

A rolled up bandage.

Taping, Bandages and Orthoses

Again and again we see that the big toe is taped in a way that pulls it away from the other toes. Different orthoses (Hallux splint, toe spreader) and bandages have the same idea. Sure, at first glance it makes sense to pull the big toe into its correct position. But more effective and longer lasting than a splint is a targeted stretching of the muscles and fascia. The orthosis or splint do not ensure that your foot gets settled in the new position all by itself.

If nothing else seems to help, an operation is considered a last resort. However, surgery is not always necessary and the best option — on the contrary: In our experience, in many cases it makes no sense at all to operate

3.3 Surgery for Hallux Valgus — Why Surgery Is Not Necessary!

Are you about to have an operation for hallux valgus? Then your complaints must be very serious. We strongly recommend that you always consider an operation as a last resort and exhaust all other possibilities first. After all, what do you have to lose?

Many doctors quickly advise you to correct your valgus position surgically (conversion surgery). Here, after a physical exam an apparently suitable surgical procedure is chosen, depending on the extent of the deformity.4)

Surgical Procedures

  • The conventional method: In the case of a slightly pronounced hallux valgus, a soft tissue operation is performed close to the big toe joint. During the operation, the metatarsal bone is cut through (osteotomy) and then pushed back into its original position. It is fixed with wire or a screw and the excess bone is shaved off.This is how this surgical procedure works in detail: Often the chevron osteotomy or the Reverdin-Green-Laird-Osteotomy is used as surgical procedure. Both procedures are very similar: Via a small skin incision on the inside of your metatarsophalangeal joint, the head of the first metatarsal bone (metatarsal head) is aligned in a straight line and at the correct bone angle to the big toe. The head of the metatarsal, which is displaced in an external rotation, is then fixed in place either with a self-dissolving screw or a titanium screw. This implant is not removed after healing and remains in your foot.
  • If the hallux valgus is already very advanced, the operation is performed in the area of the metatarsus. The surgical technique is similar, but the incision is not made near the joint. This procedure to correct the valgus position often also corrects the beginnings of arthrosis, which may have developed due to the hallux valgus. However, if the ball of the big toe is progressing too much, a stiffening between the 1st metatarsal bone and the 1st tarsal bone may be warranted. This surgical procedure is called arthrodesis (arthrodesis according to Lapidus) by orthopedists.
Kicking up your feet.

After the surgical procedure, the foot often has to be protected for a few days while being elevated, after which walking is possible again with a so-called forefoot off-load shoe. The forefoot off-load shoe shifts the body weight to the heel alone, so that slow walking is possible without pain.

Nevertheless, this is a surgical procedure that can be accompanied by pain and complications in post-op. In addition, it usually takes several weeks before you can use your foot properly again. To make matters worse, the excessive tension in the foot can return and a new hallux valgus could form. These risks and limitations do not exist with our exercises. 

Have you already had surgery on your big toe? Then try our exercises to prevent a new hallux valgus.

Roland Liebscher-Bracht is performing a pain-free exercise.

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4. Hallux Valgus and Children


A bunion (hallux valgus) in children is rather rare, but a predisposition to hallux valgus can often be detected at a young age. Studies have shown that about 36 percent of 8 to 18-year-olds have an incidence (new disease) of hallux valgus5)

Girls are affected much more frequently than boys. Often these are children whose parents also suffer from bunion toe. The conclusion that this is genetic seems obvious. However, we do not share this opinion. Children are often simply in a growth phase and have the same one-sided movement patterns as adults, at the latest during their school time.

A little child's feet on asphalt.

Parents are often advised to have their children undergo surgery in order to quickly restore their quality of life. But especially in their growth phases, we believe it is much better to reduce the excessive tension of the muscles and fasciae in the foot with targeted exercises and to train the muscles in the right places. In this way, if things go well the deformity can simply be outgrown.

5. Exercises for Bunions


Due to one-sided stress on your feet, muscles and fasciae shorten so much that the joint at the ball of your foot is pulled farther and farther outwards and causes problems. With specific exercises for the inner side of the foot and the sole of the foot, which pain specialist Roland Liebscher-Bracht explains to you in the video, you can counteract these unequal tensions yourself. With regular training, your hallux valgus can improve significantly, and your discomfort and pain can disappear. In many cases, you can save yourself a stay in a clinic, an operation and follow-up treatment, which often takes several weeks.

A short note: If you are not yet familiar with our exercises, please read our checklist under Exercise Description first.

Exercises for stretching, relaxation and strengthening of the foot muscles in hallux valgus:

Woman doing a foot exercise.

Stretching Exercises Against the Deformity:

  1. Stand up straight and take a step with your problem foot.
  2. Now shift your weight to this foot and kneel slowly with the other leg on the mat.
  3. As soon as you are standing securely, move your knee of the leg with the aching foot forward until you feel a strong pull running from the sole of your foot to the heel.
  4. Support yourself with your arms on the mat so that you can assume a stable position.
  5. As soon as the pain subsides, you can move your knee a little bit farther forward again.
  6. Increase continuously for two to two and a half minutes.
Woman performing an exercise against hallux valgus using a fascia roll.

Foam Rolling Massage with the Mini Foam Roller:

  1. Then place the inside of the front of your foot on the mini foam roller and pull your foot forward millimetre by millimetre using your toes.
  2. When you have rolled past the toe base joints, you can also tilt your knee inwards so that the arch of the foot is evenly loaded.
  3. Now shift your weight farther and farther forward so that you can continue rolling hard with the back of your foot.

📌 Checklist for Liebscher & Bracht Exercises

To make sure nothing goes wrong with our exercises, we have put together seven important tips. They should help you to easily integrate the exercises into your daily life and achieve optimal results.

✅ Practice six days a week and do each exercise at least once a day.

✅ For each exercise you should invest two to two and a half minutes. If you are just starting to do the exercises or if the pain is still too much, you can also gradually increase the intensity. Remember, however, that stretching for only a few seconds has little or no effect.

✅ Always use your personal pain scale of one to ten as a guide. The best results are achieved if you work on a scale of eight or nine for each stretch. Nine means: You feel an intense pain but can still breathe calmly and do not have to muscled-guard.

✅ A pain that is still bearable is the most important point of reference for you. So, don’t be afraid of it: Your body will tell you that you are counteracting the muscular “contractions” in exactly the right place.

Be patient — even if it is difficult. It may take some time for your brain to store new movement programs. But if you stay on the ball and make the exercises your daily routine, you can regain your freedom from pain.

✅ Use professional aids and not cheap products to treat your pain. If you rely on a defective product here, this can have a negative effect. We have therefore taken great care in the development of our aids and developed them especially for pain treatment.

✅ If the pain increases due to the exercises, there is no reason to panic. That things get worse initially can be a normal reaction of your body. If your overall body statics change as a result of regular exercise, the musculoskeletal system will have to adapt to this gradually. If, however, you feel worse all the time instead of better after the exercises, your body signals that you may be overdoing it. Then simply take a break for a day or two and/or reduce the intensity a little bit during your next training sessions in order to increase it again in small steps. In this way, you gently guide your body to the eight or nine on the pain scale that is right for you.

Roland Liebscher-Bracht is performing a pain-free exercise.

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Sources & Studies [+]