Assessment of the cause of back pain and simple remediation.

Foot stability, plantar fascia stiffness.

The human kinetic chain starts at the feet. The foot needs adequate stability as it is the body’s base of support and to allow proper ankle mobility. Check for flat feet or foot arch collapse during movement. Plantar fascia is a part of the superficial back line which connects the toes to the eyebrows. Tight plantar fascia can cause tension in superficial back line which can travel up to the erectors of the lumbar. Check for tenderness or stiffness, if any; roll with trigger point ball to release fascia, work on strengthening foot arch and practice walking barefoot with toes splayed.

Ankle mobility.

Ankle mobility is required for proper knee and foot stability. Limited ankle mobility can cause issues with foot & pelvis stability which may cause back pain. Limitations in ankle mobility are usually due to tight calves or the talus bone not gliding posteriorly well enough to allow adequate dorsi flexion. Use the five-inch wall test to assess the available range of motion. 5” or more is adequate. Less than 5” needs some work. If ankle mobility is limited; release the soft tissue of the calves and achilles then work on band distracted ankle mobility, focusing on pushing the knee as far forward with heel planted and foot arch strength maintained.

Knee stability.

Knee stability is often affected by lack of foot stability or ankle mobility, or lack of strength in the muscles responsible for knee stability i.e. the external rotators of the hips. If there is limitation; Work on foot and ankle as discussed above. Check the hip for internal and external rotation limitation in mobility and strength. If the foot supinates with knee tracking over or outside the little toe during movement, work on internal rotation. If the foot pronates and knee collapses inwards, work on external rotation.

Hip mobility.

The hip moves in four ways, internal and external rotation, flexion and extension. If there is limited range of motion in any of these, it will create uneven tension in the hip joint and affect pelvic stability. With affected pelvis stability, lower back pain may be experienced. Assess to see which movement is limited. All four movements of the hip should be within standard ranges for the hip joint to function optimally, thus it is recommended that one works on internal and external rotation, flexion and extension range of motion.

Pelvic stability.

The pelvis is directly connected to the lower back. Often, lower back pain can be linked to inadequacies in the pelvis stability. The most common inadequacies are dysfunctions in the myofascial lines connected to the pelvis i.e. the posterior oblique sling, anterior oblique sling, deep longitudinal sling, and lateral sling. Another cause for back pain is often due to anterior or posterior pelvic tilt caused by limitations in the hip and foot/ankle joints. Before working on pelvic stability, ensure that the hips, knees, ankles and feet are functioning optimally as discussed above.

Often, back pain is a symptom of dysfunction somewhere else in the body, usually from the pelvis down the leg to the foot or vice versa, unless there has been an injury caused by external factors unrelated to movement patterns or congenital related causes of which one would have to see a specialist. However, if it is due to disruptions in movement patterns it can always be resolved with assessment and correction according to the principles of human movement patterns.

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