Based on a lecture by Gray Cook

Simple tests can be used to reveal a lot about a person’s underlying issues.

The toe touch is one of those tests.

Just like the deep squat, the toe touch is a basic movement pattern that can reveal a lot once you start looking at it in greater detail.

Let’s look at why some people can’t touch their toes and what this tells us.

Why some people can’t touch their toes

When people have trouble touching their toes, they usually blame it on having tight hamstrings, because that’s what they feel when doing the movement.

But are tight hamstrings the actual cause, or merely a symptom of a different problem?

In many cases, it’s the latter. It could be due to a previous injury that wasn’t completely resolved, bad training habits, an imbalance of training such as too much anterior chain training as opposed to posterior, or the lack of full range-of-motion training, among many possibilities. All of these can reduce one’s natural ability to touch the toes.

Here are some common reasons why you or your clients may not be able to touch the toes.

• Insufficient posterior weight shift backward—If you’re unable to shift your posterior weight backward as the upper body half of your body leans down and forward, your hamstrings will contract to prevent you from losing balance and falling forward. In this case, the hamstrings are merely acting as parking brakes to stop you from hurting yourself.
• Stiff lower back—Some people are unwilling to round their backs in a toe touch. Oddly, these same people are more than willing to round their backs dangerously under load, for example when deadlifting.
• Stiffness in the cervical or thoracic spine—Similarly, stiffness in the cervical and thoracic spine can also limit the distance someone can reach toward the floor.
• Increased tension in the plantar flexors—Increased tension is mainly found in the gastrocnemius, which crosses both the knee and the ankle joint. Tension in the plantar flexors will almost always be felt in the hamstrings unless there’s associate pain.

How do you narrow down the cause? Do the FMS active straight-leg raise test.

If the raised leg is above or right at about 80 degrees while the other leg remains completely still and flat on the ground and the person still can’t touch the toes, the issue probably lies above the waist.

If someone can’t raise the leg anywhere near 70 degrees, the problem will probably lie below the waist, though this doesn’t exclude problems above the waist.

Note: In the Functional Movement Screen, the toe touch is part of a progression, but not part of the screen.

In the SFMA—the medical movement screen— toe touching is done first. If symptoms are provoked, a regression will be conducted to find out why.

Why you should be able to perform a toe touch before you deadlift

People who cannot cleanly touch their toes have compromised biomechanics and weight shifting when they do a sagittal-plane, low-velocity, high-tension move or a high-velocity, high-tension move.

They abandon the requisite core stabilization and spine stability needed for the maneuver, and try to perform flexion by using segments that should be stable and rigid through the first part of the motion.

What this means is they’re unable to perform a proper hip hinge. When they’re put in a position to deadlift even a small amount of weight, the initial movement is a rounding of the back. They end up putting the loading on the spine rather than letting the hips do the work.

Note: Rounding the spine in a toe touch is okay since this is an unloaded movement. Not rounding the spine in a toe touch is a demonstration of movement dysfunction, because it shows that normal weight shifting, body mechanics and alignment are distorted.

The toe touch teaches relaxation of tension in the lower back, and teaches how to shift weight from the heels to the toes in a smooth and consistent fashion—both of which are vital to deep squatting and hip hinging.

In short, by helping your clients touch their toes, you create a better environment to teach the deadlift and the deep squat.

When you work with fit and healthy-looking people, don’t assume they possess fundamental movement patterns like the toe touch unless you have evidence otherwise. Make sure to screen them and check that they can touch their toes before doing loaded movements like deadlifts and kettlebell swings.

How to help someone touch their toes

Most people who cannot touch their toes will demonstrate some degree of difficulty with the active straight-leg raise. If that’s an issue, always fix the active straight-leg raise first.

If the active straight-leg raise is perfect but toe touching is still not possible, there’s something happening during standing that prevents full range of motion through the movement.

When that’s the case, follow this simple toe-ouch progression, which requires no stretching or soft tissue mobilization.

Toe Touch Progression Phase 1: Toes Up

1. Stand with the feet side by side and the heels and toes touching. Elevate the balls of both feet one to two inches on a board or similar lift.

People who can’t touch their toes have a different balance in the sagittal plane movement. They’re not able to shift their weight correctly. Biasing them into plantar flexion and dorsiflexion challenges the equilibrium.

Having the toes up makes us less dependent on our legs and more dependent on the core and weight shifting ability to keep us balanced.

2. Bend the knees slightly without changing the position of the feet. Insert a foam roll or rolled-up towel between the knees.

It’s not just the anterior or posterior chain that can impair forward bending. The lateral lines—the IT band and the TFL— can also interfere with forward bending. If the knees aren’t touching, the lateral hamstring and IT band become biased and we unlock our knees. This stops the hamstrings from firing to protect the posterior of the joint.

Having something between the knees also has a carryover effect. When we fire our adductors, we get a carryover firing in our abdominals. Then we get reciprocal inhibition and relaxation in the back.

This position will feel awkward. If your client can’t keep the feet in position, swap the foam roller or towel for something smaller.

3. Now, have the client reach for the ceiling with the arms, palms facing forward.

4. Pull the stomach in as deeply as possible without altering breathing.

5. Now, slowly and gently reach down to the toes. Squeeze the foam roll or towel at the sticking point.

When the person gets to a sticking point, he’ll squeeze the foam roll or towel between the legs. This will activate the abdominals and relax the outer thigh and back, allowing the person to reach further.

Remember to keep the abdominal area pulled in.

Keep doing this until the person can touch the toes.

6. If your client can’t touch the toes, cheat.

If your client still can’t touch the toes, cheat by bending the knees without changing the foot position.

Exhale and then reach down.

It’s very important to have success every repetition, even if it means cheating by bending the knees slightly.

Tell your client, “Each time you do it, try to cheat as little as possible and keep improving until you don’t need to cheat.”

Toe Touch Progression Phase 2: Toes Down

Phase 2 is the same except with the heels are elevated. This shifts the equilibrium and teaches proper weight shifting.

1. Stand with the feet side by side and the heels and toes touching. Elevate the heels of both feet one to two inches on a board or similar lift.

2. Bend the knees slightly without changing the position of the feet. Insert a foam roll or rolled-up towel between the knees.

3. Now, reach for the ceiling with the arms. The palms should face forward.

4. Pull the stomach in as deeply as possible without altering breathing.

5. Now, slowly and gently reach down to the toes. Squeeze the foam roll or towel at the sticking point.

6. If the person can’t touch the toes, cheat.

Re-test 

Once these two phases are completed, get rid of the block and the foam roll or towel and perform the toe-touch movement.

Reach up to the ceiling, pull in the abdominals and reach for the toes.

The person may feel slightly more tension in the lower back and hamstrings, and slightly less tension in the calves than in phase one.

This should be much closer to touching the toes following the toe-touch progression.

What if it doesn’t work?

You’ve seen other people try this process and sometimes not have success. Why? They didn’t check the active straight-leg raise first.

If the active straight-leg raise is compromised, you’re going to have to do something to deal with that first. A simple active or passive leg-lowering drill can get the lower body prepped.

However, if you do exactly what we’ve outlined, you’re going to get see great improvement the toe touch.

How to make the improvement ‘stick’

Not touching the toes is a bad habit. Touching the toes without pain is obviously a good habit.

How do you break a bad habit? You have to replace it with something better.

Since this is not about stretching and strengthening a particular muscle but changing a pattern, you want to upload new information into the system the minute you break through the faulty pattern.

Once you break through that pattern, you have a small window of opportunity before the pattern reverts.

You could try putting a stick on the person’s back so the spine will remain straight and erect.

Rehearse some deadlifting mechanics. A simple way to do that is to step about a foot away from the wall, try to reach back as far as possible with the butt to just touch the wall—but don’t lean on the wall.

One good instruction for somebody who’s just now getting the toe touch back is, “It took us less than five minutes to get you on your toes. You have five minutes to do that before you leave the house in the morning and before you go to bed at night. Simply do that for me.”

If you’re going to do any type of exercise like a deadlift, a kettlebell swing or any type of hinging movement with the hips, or more ballistic activities like jumping, hang cleans or power cleans— make sure your clients can touch their toes before you do.

In closing, we’d like to leave you with three case studies of using the toe touch to help different patients. These will help you see how powerful and practical something as simple as a toe touch can be.

Toe touch case study 1: Elderly woman with low back pain

Gray Cook tells the story of when he and a colleague dealt with an elderly lady who had some low back pain. As they started evaluating her, they found her balance was unbelievably compromised. Her low back pain was in extension, but she had a limited toe touch.

It didn’t hurt to bend forward. It hurt to bend backward. She also had an extremely complicated balance. Gray said, “It was amazing she even walked into the clinic.”

When they asked her to balance on one foot, she was all over the place and had to catch herself or put the other foot down within three seconds. Her left and right side single-leg stance was compromised. Forward bending was not painful, but she couldn’t do it, and backward bending was painful.

They had responsibility as clinicians to deal with her low back pain, but there were two exercises she could have done from the very first day that wouldn’t have exacerbated her symptoms. They wouldn’t make her back worse because they wouldn’t have to work in the direction of her pain. Rather, they would work in the direction of her dysfunction, which would be forward bending and single-leg stance.

Single-leg stance is complicated. It requires a lot of motor control, but not a lot of motion. Gray always wants to gain mobility before he tries to change stability or motor control.

They checked this elderly woman’s active straight-leg raise and it didn’t look that bad. Had we seen her lie on her back and show how much she could flex one hip with the knee straight while keeping the other one down, we all would have said, “There’s no way in the world this person shouldn’t be able to touch her toes.”

Yet in standing, she couldn’t.

They had her sit with her legs stretched out in front of her in a long-sitting situation. She could touch her toes in that position, further demonstrating that she possessed the mobility to touch her toes. She just couldn’t touch them when standing.

They proceeded with another toe-touch progression that challenged her balance. They were right there spotting her, talking her through it, making sure she was breathing and not holding her breath. They went through about 10 toe touches with the toes up, then took a rest break.

Next they went through about 10 toe touches with the toes down, and took a rest break. Then Gray said, “Stand up. Touch your toes for me.”

She had a full toe touch.

“Would you mind also showing me how you balance on one leg?”

He said they probably quadrupled her ability to balance on a single leg.

Then they put a bow on the cake by saying, “Would you mind bending backward?” She bent backward with probably twice the range of motion she could before and only had a little bit of discomfort at the end range.

How did they end up improving her ability to balance on a single leg by helping her improve her toe touch? They changed her sagittal plane movement. They improved her movement. Any time that movement improves, the sensory input coming in also improves.

The more mobile something is, the more information comes in. The instant that information hits a barrier, the information stops like a bottleneck and gets clogged up. Everywhere there’s a mobility restriction, there’s reduced information coming in. When reduced information comes in, reduced refinement is the result.

Stability or motor control is simply the brain working out the information coming in and allocating the right amount of muscle tension.

Stability and motor control are never maximal efforts of any muscle. It’s not slamming on the brakes. It’s tapping the brakes. If you tap the brakes too hard, you go into a skid. If you don’t tap them enough, you’re not going to make the turn. Those subtle adjustments require input.

How do we create quality input without talking somebody to death? Create more mobility. Then check to see if it changed anything.

In this case, they were lucky and normalized her toe touch, and her single-leg stance quadrupled in ability for both time and quality.

Toe touch case study 2: Post-surgery knee patient

This patient had not extended his knee fully past 20 to 25 degrees in about a month. He had had surgery and probably didn’t participate as well as he should with his previous rehabilitation. Maybe he didn’t do his home exercises or somebody just didn’t answer his questions sufficiently and demonstrate how important it was to do his exercises.

So in this case, Gray and his partner had somebody who couldn’t extend the knee. They did some dry needling on his posterior chain, then did some mobilizations.

They taped the guy’s knee and got almost full extension, but as a therapist, Gray thought it wasn’t going to hold because he also had a behavior pattern to consider. The patient had walked around with a flexed knee for four weeks. Fifteen minutes of knee extension wouldn’t have been enough to change his behavior and make him use what they helped him gain.

He’d been used to that knee being flexed for quite some time and would have had a lot of doubt and fear about straightening it. They needed to put him in a situation where he’d be extending his knee without thinking about it.

How about the toe-touch progression? In the toe-touch progression he’d be squeezing the knee.

Sure enough, they put him through a toe-touch progression, and each time through he gained more motion in extension.

Toe touch case study 3: Neck pain

This patient had a neck issue, but they couldn’t find a thing wrong with his neck. He had pain when he moved his neck, but they couldn’t find any restricted motion or reduced strength.

His shoulders look pretty good, but he had one of the stiffest postures ever seen.

They observed him walking and saw that his core, pelvis and low back were not working together. They then asked him to balance on one foot. He had to shrug the same-side shoulder just to balance. He had to use his neck and shoulders as if they were his core. When his core should have been engaging, he was using his upper body instead.

What they had was a painful neck that moved pretty well and a non-painful low back that didn’t move at all.

So what do they use? The toe touch.

They did things clinically to make sure his back could handle the toe-touch progression. They they did the toe-touch progression, broke right through that bad pattern and got him touching his toes.

They they went back and visited the single-leg stance. He could now balance on one leg without using his traps.

Think about how strong the traps are. We could probably shrug more weight than we can squat. Most of us can can probably shrug almost as much as we can deadlift unless you’re an expert deadlifter.

If one trap has to engage every time your foot hits the ground because you don’t have any other way to stabilize, think about how much stress you’re putting through your neck.

There was nothing wrong with this person’s neck. His neck was being abused because his core was working with the rest of the body in sagittal plane movements.

When to use the toe touch progression

Gray Cook writes—

A young clinician once said to me, “Cook, you’re a one-trick pony. You give everybody toe touch progression.”

I said to him, “You can think that or you could stay here for another two months and you may not see me ever do this again, or you may see me do it 30 more times.” 

I don’t just use the toe touch because I prefer it. I do it when the situation calls for it.

I could have got the third patient’s core firing better if I had used side planks. But what would it have done to the already overactive neck and trapezius? The toe touch provided a way to help the core fire without loading the problematic areas.  

I could have easily told the person who couldn’t extend his knee to go home and do some quad sets, but how functional would that have been? Would he have used that knee extension when he stood up? In a toe-touch progression, he was already standing. His knee was already learning to be extended in a loaded position.

The elderly lady didn’t just have low back pain. She had a balance pain. By doing the toe-touch progression, we improved both without ever asking her to obsess about her balance. 

For most people with balance problems, if they try to balance harder, it gets even worse because if they knew how to balance, they would do it. Trying harder is actually more effort in the wrong direction. This is why the toe-touch progression works so well.

In all these cases, I didn’t use the toe touch because I wanted to or because I believe it’s a catch-all remedy. I used it because the situation called for it.

This article was adapted from Gray Cook’s lecture, “What’s the big deal about the toe touch?” For more on the toe touch, you’ll also enjoy this article on graycook.com.

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If you liked this information from Gray Cook, here some more resources you may find helpful.

Gray Cook: Movement [Book]

If you’d like to find out more about how to integrate the toe touch with a complete fitness screening system or medical assessment system, check out Gray’s Movement book.

In Movement, Gray outlines a movement system aimed at providing clinicians and fitness professionals with a common language to identify and improve movement issues. This system is now being used across the world in NFL teams, NHL teams, the military, universities, and countless other clinics and training centers.

This system provides a standard operating procedure and a common language for movement-pattern screening, assessment and correction in fitness and rehabilitation. It will allow you to better identify potential risks, and to create better rehabilitation and exercise programs based on each person’s unique movement profile.

If you’ve ever wanted to—

• understand why people get injured, and why their pain keeps returning
• improve a patient’s recovery process
• give people a strong foundation before loading their exercises with weights
• eliminate training mistakes that delay results
• improve your client’s chances of making it through the athletic season without suffering a non-contact injury
• restore the quality life in people who have suffered in pain due to movement problems
• help build more functional, longer-lasting athletes
• avoid frustrations and improve patient outcomes when working with other healthcare and fitness professionals by learning a standardized language for communication

… then you’ll love the Functional Movement System Gray outlines in his book Movement.

Click here to find out more about Movement.

Key Functional Exercises You Should Know [DVD]

After you’ve identified a movement problem, you have to know how to restore function with the right exercises.

The toe-touch progression is just one of the tools you should have in your toolbox. But what are some others you can use?

In Key Functional Exercises You Should Know, Gray Cook shows which functional exercises to use to get maximum results for your clients in the minimum time.

He gives the key exercises that stand out in a library of functional exercise options, and shows you when to use them, and how to modify them for your clients.

In the DVD, Gray will explore—

• His three key functional exercises: the chop and lift, the Turkish getup, and the deadlift
• The hierarchy of these exercises: which to work on first for the quickest results
• Gray’s favorite regressions and progressions on each exercise, and when to use each
• The subtle verbal coaching cues he uses to maintain correct alignment and stability through the movements
• What most people do incorrectly on the movements, and how to coach and correct them (he coaches these in live demonstrations)

…and much more.

You’ll walk away knowing how to use these key exercises as functional and corrective tools with your clients, and will never again be stuck using ineffective corrective exercises that don’t actually help your clients improves.

You’ll have a deeper level of understanding of why and how these exercises work, which to use in each specific case, and how to modify the exercises to change the difficulty level or target area.

Click here to find out more about Key Functional Exercises You Should Know.

Tap Into the Brains of Some of the World’s Leading Performance Experts

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Inside the OTP Vault, you’ll find over 20 articles and videos from leading strength coaches, trainers and physical therapists such as Dan John, Gray Cook, Michael Boyle, Stuart McGill and Sue Falsone.

Click here to get FREE access to the On Target Publications vault and receive the latest relevant content to help you and your clients move and perform better.