The Secret and Overlooked Connection Between The Foot and Ankle and Low Back Pain

#painrelief #posturecorrection #postureassessment #biomechanics #posturealignment #musclebalance #painfreelife #painfreeliving #correctiveexercise #balancethebody #reliefthepain #painfreeposturemn #debpreachuk

Do you suffer from chronic low back pain? Are you tired of the constant merry-go-round of chronic pain? You know the scenario. You wake up feeling good so while in your workout (and not knowing what you "did wrong), the pain symptom flares up again. Familiar pain forces you to stop working out. You're frustrated and mad. You find yourself in the pattern of negative self-talk. Lot's of "I shouldn't have done (insert movement/action), and self-creating yet another story trying to explain what you think you did "wrong."  

You now find yourself back in the cycle of self-medicating and visiting the pain relief providers that target the pain, hoping it works once more. The pain relief plan works temporarily, but it flares up AGAIN the next time you work out or a few months down the road?

Today, millions of Americans suffer chronic low back pain. Researchers estimate that at any given time:

  • one (1) million Americans are currently experiencing low-back pain (1)

  • 80% of Americans suffer from at least one significant instance of acute back pain in his or her lifetime (2)

It's normal to wonder what you're doing wrong or why the pain keeps coming back, and it's a scenario I see time after time when new clients come into work with me.  They just don't understand WHY.

It's Not The Activity Or Exercise Program That Hurts You

It's NOT Your Gender or Your Age

Most often, the site of the pain  ISN'T THE SOURCE OF THE PROBLEM

Often, chronic muscle and joint pain have more to do with your POSITION (your POSTURE) vs. your SYMPTOM (the PAIN you are experiencing).  

Let me explain. 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.

Just take a look at the image to the right, and start evaluating with an untrained eye from the ankle, on upward to the shoulders, neck and head. Do you think these positions go away once you are upright and standing? How about when you then go to exercise?

These imbalances are currently under research and suggest that inanition to postural imbalances, prolonged sitting can:

  • increase risks of obesity

  • cause organ damage

  • decrease oxygen flow to the brain

  • create disc compression in the spine  

  • [See The Health Hazards of Sitting

Now consider taking your body with just one load joint like your ankle not performing to fullest potential. Now ask it to show walking, running, jumping squatting and other athletic movements over and over again.

You may not have symptom-specific pain starting the activity, but because the alignment of the body is off, you'll be in compensation patterns to get movements done. It isn't much different than a car's alignment. We don't expect our vehicle to perform at top performance on a drive train that's slightly off. So why do we hope that our bodies can?

It is the failure to notice one's joint dysfunctions or muscle-length tension imbalances that leads to chronic pain. Not having the awareness and self-care tools and practice to address and correct these imbalances BEFORE exercise is a major contributing factor in why the constant pain cycle repeats itself over and over.

In my experience, chasing the symptoms of chronic muscle and joint pain (addressing the pain) is the other major contributor.

It's understandable to want to fix the pain. And I am in no way saying that there isn't a problem around the affected area. However, many health providers underlook, or completely dismiss the WHY.  

The human body has a form and function for all activities. When we do the same movements repetitively day after day, (think postural habits), the body adapts to said habits. Sometimes the movement pattern is good, and sometimes not. The thing about the human body is that in a less than ideal movement pattern, we don't always feel pain right away. Sometimes it can take years or a triggering event.  

Therein lies the problem. Human beings can get away with a boatload of dysfunctional movement problems for really long periods. Once the pain trigger is activated, now we have a problem. You'll feel pain and corresponding tissue and joint damage in the area of compensation. We start treating the pain and chasing the symptoms versus identifying the ROOT CAUSE.  

Meaning that the affected area is either stabilizing or moving in ways, it's NOT designed to do. And this may have been going on for a long time.

Traditional therapy is fantastic and works for a time, but it's only a part of fully healing because it designed to focus on the damaged area.  

Without a posture analysis and a movement assessment, it is easy to fail to make the connection between position (posture) and condition (pain).  

You were designed to move. The activity itself isn't harmful or the action that is causing the pain. Aside from acute trauma or an accident, it's the body going into the event that is the limiting factor. When a movement challenge presents itself, the body is asked to function appropriately for the demand, but it can't due to compensations.

As a Corrective Exercise Specialist, the first thing I introduce my clients to is a static postural assessment. Identifying where the body currently holds its position relative to a "blueprint" and isolating faulty movement patterns is KEY in the rehab process.

Postural Assessments are a structured and an often missing, yet vital component of fitness training program design. The information about muscle and joint position(s), relative to how the body should hold itself both static and in movement provides a wealth of insight. This information helps you avoid repetitive exercise-related stressors, flare-ups of old injuries, and helps reduce and eliminate chronic muscle and joint pain.    

Research shows that the majority of chronic low back pain reports are mechanical, or non-organic in origin. Severe genetic conditions or accidents do not cause them but caused by muscle, joint, and postural imbalances.

The 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."

I agree that traditional therapies are helpful, and do make symptoms of low back disappear for a time. However, I can also guarantee that if you don't address the underlying root cause, the pain will return at some point.


Sadly, none of those things addresses the underlying ROOT CAUSE of the pain, your POSTURE! Postural analysis and an adequately designed Corrective Exercise program identify the root cause — the bigger picture addressing and resolving "Why" the low back pain occurred in the first place.

One of the first things I do as a mobility and movement specialist is take a look at the feet. Low back pain can often be direct correlations to foot position and foot/ankle mechanics?  

Research shows that low back pain is very often the symptomatic result of joint dysfunction and muscle imbalance issues from the feet and ankles.

Problems in the structure and mechanics of the feet and ankles cause tension and friction in everything sitting above it. Remember the song "'Dem Bones"? The ankles, knees, hips, shoulders, pelvis, and spinal column will eventually experience pain or result in injury if left unattended.  

If this is new information for you, STOP reading and take a look at the position and condition of your feet and toes. 

The Foot and Ankle Connection to Chronic Low Back Pain

1. Evaluate your FEET. Is one or both of your feet pointing away from your midline? Do they point in toward the midline? Perhaps you have one of each?

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. It's essential to assess your ANKLES. Look to see if the arches are too high or low. Do they roll away from the mid-line of the body or fall flat to the ground?

Both high arches and flat feet are SERIOUS joint imbalances of the ankle and affect your posture and function. Ankle mobility issues every single step you take on the earth each day.  

Even the smallest disparity at the foot and ankle will throw off all the postural muscles throughout the rest of the body. The feet are the foundation of human posture, and your foot and ankle health is a cornerstone of healthy movement.

You might be thinking to yourself - "yeah, I know all that, and that's why I have 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 primary CAUSE of the dysfunction. They merely try to re-create what your foot musculature is designed and ought to be to doing naturally by design 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! Posture assessments followed up with a therapeutic corrective exercise program are specifically in design for each individual's needs. They help:

  • Retrain the stabilization function of the foot muscles 

  • Help restore the joint mobility of the ankle

  • Address how imbalances in the foot and ankle position cause the muscles from the calf up to the hips to compensate, then correct it 

  • Retrain the movement patterns from the ankle to the hip

Do you have questions? Please reach out! I'm here to help.


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, BRS, BPE, CF-L1, Pn-1, is a Comprehensive Certified STOTT Pilates Instructor, Level 2 Foundation Training Instructor, TBMM Corrective Exercise & Posture Alignment Specialist, and the founder/owner of Pain Free Posture MN.   

In addition to running PainFree Posture MN, Deb is an Orangetheory Fitness Coach and teaches regularly at the Shakopee and Apple Valley, MN locations.

You can follow Deb on Facebook, Twitterand LinkedIn, or subscribe to her YouTube, or Instagram pages.

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