The Foot and Ankle Connection to Chronic Low Back Pain

The Foot and Ankle Connection to Chronic Low Back Pain


Do you suffer from chronic low back pain?  Tired of the constant merry-go-round of chronic pain?  You know the scenario.  Feeling good so you workout, not really knowing what you "did wrong", the pain symptom flares up again, forcing you to stop working out, self-medicate and/or go back to rehab or therapies that target the pain.  It works for awhile and you find some temporary relief, only to have it flare up AGAIN the next time you work out or a few months down the road?

Today, millions of Americans suffer chronic low back pain.  At any given time it's estimated that 1 million Americans experience low-back pain (1) and that  80% of all Americans will suffer from at least one significant instance of acute back pain in his or her lifetime (2).

Ever wondered what you're doing wrong or why the pain keeps coming back?  This is a scenario I see time after time when new clients come in to work with me.  

It's Not The Activity That Hurts

Maybe the site of the pain ISN'T THE SOURCE OF THE PROBLEM.  In my experience, I can tell you that chronic muscle and joint pain has more to do with your POSITION (your POSTURE) vs your SYMPTOM (the PAIN you are experiencing).  

Let's look at the typical desk dweller. Your posture adapts to the habit of sitting all day long at a desk job.  Over time, a myriad of muscle and joint imbalances can occur, not to mention increased risks of obesity, organ damage, decreased oxygen flow to the brain, and disc compression in the spine within the body from the habit of sitting. [See The Health Hazards of Sitting] 


So consider taking a body that is out of balance and asking it to perform athletic movements with ease.  You may not have symptom specific pain going into the activity, but because the alignment of the body is off, you'll go through compensations to get movements done.  It isn't much different than the alignment in a car.  You can't run a vehicle at top performance on an alignment that's slightly off.  If you have joint dysfunctions or muscle-length tension imbalances, most often it is our failure to notice, address and correct these imbalances prior to exercise that leads to the chronic pain cycle repeating itself over and over.

Chasing the symptoms of chronic muscle and joint pain is more closely related to a person's underlying posture, habits and movements of daily living.  It's not the activity itself that causes the pain.

Aside from acute trauma or an accident, it's the body going into the activity that is the limiting factor.  

As a Corrective Exercise Specialist, the first thing I do with a new client is a static postural analysis to see where your body alignment sits in reference to proper "blue-print" design and function.  

Postural Assessments are a structured and often missing component of fitness training program design provides insight to help my clients avoid repetitive exercise related injury and chronic pain.  

The majority of chronic low back pain cases are mechanical or non-organic in origin—meaning they're not caused by serious genetic conditions or accidents, but simply due to muscle, joint and postural imbalances.

Customary practice in western medicine is to address the issue by treating the symptom. You might massage, medicate, manipulate, rest the back or work on the "core".  

While I agree that all these things can and do make symptoms of low back disappear for a time, I can guarantee that the pain will return at some point.


Because none of those things addresses the underlying ROOT CAUSE of the pain, your POSTURE!  Corrective Exercise looks at bigger picture and seeks to address and resolve "Why" the low back pain occurred in the first place.

One of the first things I do is to take a look at the feet.  

Did you know that foot position and foot/ankle mechanics are directly correlated to low back pain?  

Low back pain is very often the symptomatic result of joint dysfunction and or muscle imbalance issues stemming from the feet and ankles.

Mechanical problems in the feet and ankles cause tension and friction in all of the structures that sit above them.  The ankles, knees, hips, shoulders and spinal joints will eventually experience pain or result in injury if left unattended.  

If this is the first time you've considered the connection, STOP reading right now and go take a look at the position and condition of your feet and toes.  Ask yourself the following questions. 

The Foot and Ankle Connection to Chronic Low Back Pain

1.  Do one or both of your FEET point away from your midline?  Do they point in?

If they point out (evert) or point in (pigeon-toed) or some disparity between the two there is a problem with your postural mechanics.

2.  How about your ANKLES?  Do one or both of your arches sit high (roll away from the mid-line of the body) or fall flat into the ground?  

If so, this is a SERIOUS posture distortion right at your first connection to the earth.

 Any disparity at the foot and ankle will throw off all the postural muscles throughout the rest of body. The feet are the foundation of human posture.  

You might say - "yep, I know all that.  That's why I wear prescription orthotics or inserts in my shoes".  

True, orthotic arch supports will provide support to the arches, but they WON'T CORRECT the stance (feet pointing in or out) or the the primary CAUSE of the dysfunction.    They merely try to re-create what your own foot musculature is designed to do on it's own WITHOUT addressing the underlying dysfunctional pattern at the foot and ankle.  

If you think you have any of these issues, then a corrective exercise program is RIGHT for you!  Programming is designed specifically to help retrain the distorted muscles in foot and ankle position and how those imbalances affect the entire kinetic chain which may be the underlying root cause of your unresolved low back pain.  


1. Jensen M, Brant-Zawadzki M, Obuchowski N, et al. Magnetic Resonance Imaging of the Lumbar Spine in People Without Back Pain. N Engl J Med 1994; 331: 69-116.

2. Vallfors B. Acute, Subacute and Chronic Low Back Pain: Clinical Symptoms, Absenteeism and Working Environment. Scan J Rehab Med Suppl 1985; 11: 1-98.

Stock Photo Credit:

Head Photo Credit:  Melissa Thome Photography

Author:  Deb Preachuk is a Certified Foundation Training & STOTT Pilates Instructor, Corrective Exercise & Posture Alignment Specialist, and the founder/owner of Pain Free Posture MN.   You can follow Deb on Facebook, TwitterGoogle+, and LinkedIn, or subscribe to her YouTubePinterest or Instagram pages.