People often seek me out with low back issues, describing to me the sensations they are feeling in their low back while placing their hands on the quadratus lumborum (low back) and rubbing the area, then when I ask them to take off their shoes they look at me weird.
(Here is the cover of my first book, my second one will be out later this year.)
We have the tendency to place blame for pain on the area that is in discomfort, when the majority of our dysfunctions begin somewhere else. As bipedal animals, our first point of contact with the outside world is through our feet. This is why I have clients take off their shoes during an assessment (I later assess them wearing shoes to determine if the shoe is the culprit). With that said, pain and discomfort we experience in our back is commonly influenced by our feet’s effect on posture.
When examining posture, specifically our feet, I first look to see if a client’s feet are externally rotated (supination), neutral, or pronated (arch caves-in). If I see a client’s foot is overpronating, then I generally assume their same side psoas and adductors will be short and tight. This will result in a weak glute and sometimes lower crossed syndrome. Another give away of overpronation is a bunion on the big toe.
If when I examine a client’s feet and I see their foot externally rotating or supinating, then I know their vastus lateralis (outside of thigh) is strong. Knowing this, if the outside of their leg is strong, the inside will most likely be weak, so I check for weak adductors. Since they’re walking on the outside of their foot, their same side gluteus maximus muscle will generally be shortened and tight as will their quadratus lumborum. This is more often than not the result of their back pain, and I generally provide corrective exercise to remedy their foot external rotation and their back pain alleviates with time.
These corrective exercise strategies vary from person to person, but I mostly examine their arch and make adjustments observing how those adjustments affect the thoracolumbar-pelvic canister (entire torso, shoulders to hips). The foot can be thought of like your spine, they are both designed to have natural curvatures and if they are lacking these curvatures, issues arise.
Upon manipulating a client’s arch, if there is an improvement, I will recommend manual therapy for their lower leg as well as arch building exercises such as towel scrunches. Once their posture is back on track, we can begin strengthening and inhibiting the respective areas in the hips and back.
Our feet’s impact on our low back is another example of how our problems sometimes reside outside of our pain. For this reason, it is important we take note of different walking patterns, shoes, sleeping patterns, chairs, and other things of that nature in order to gain more detail into injuries. Please read parts one and two of the series to put the whole story together.