Ankles and Low Back Pain

Low back pain is 0% fun. Some might say 0% is actually being generous. A stat thrown around from time to time is that 80% of people will experience low back pain at some point in their life, but I'll be the first to tell you that when low back pain shows up, you couldn't care less about anything else. There is no sympathy for anyone else, because the pain can be debilitating. With 80% of people dealing with low back pain at some point in their life, you would think a simple economic theory would apply here: supply and demand. There is plenty of supply (the actual pain) and a huge demand (need for effective treatment) to warrant a bunch of really smart people to figure out how to fix it. However, low back pain continues to be a mystery to practitioners everywhere.

What I'd like to do over the next couple of weeks is pose a joint by joint approach to low back pain, because I am a firm believer that low back pain is the final straw in the cycle, and something else is the actual problem. Someone doesn't just wake up with low back pain that hangs around for 20 years because they slept in a strange position. Today, I want to focus on the ankle and how the mobility of the ankle can lead to movement patterns that can lead to a manifestation of low back pain. This is outside of the box thinking, because how exactly does a bum ankle cause your back to hurt? We'll get there, just hang with me.

A rolled ankle is a fairly common condition that happens to the vast majority of people at one time, or another. It can occur while playing basketball and landing on another player's foot, or it can occur simply by stepping of a curb. The point is, ankle sprains are very common and are often treated with ice, an ankle brace, and maybe some Tylenol. After the pain is gone, the issue seems to be clear. But, what you lose when your ankle is injured is range of motion. The body doesn't want the ankle to flex and extend like it did before the sprain because it hurts. We're programmed to avoid pain, and this situation is no different. When an injury occurs, the body floods the injured area with blood and an inflammatory response occurs. Pain is the result, and we do everything in our power to keep the pain at bay by not moving the area unless absolutely necessary. And when we do move it, we move it just enough to accomplish our goal, whether that be walking, running, or driving a car. When the pain subsides, our brain is re-programmed in the 'new' range of motion we created during the injury, and if not rehabilitated, we lose a little bit of the motion we had pre-injury. Now compound that with the concept that a previous injury is the greatest predictor of a future injury, and we're talking a bunch of ankle sprains adding up to a significant loss of motion in the ankle.

So what does that have to do with low back pain? Think about bending down to pick up a box or walking up a flight of stairs. What do they have in common? Your ankle is very much involved in both of these actions. If your ankle doesn't move well, the motion is going to come from another area of the body...maybe the knee, the hip, or the low back. Over time, the area doing extra work can just get tired of having to pull all the extra weight, and pain can surface. Your ankles are the foundation to all of your movement that involves the lower body, so it would be a smart thing to make sure both have equal range of motion. Have a look at these two pictures:



Clearly, the right ankle is more mobile than the left ankle. This patient has dealt with low back for about 12 years, and has a history of multiple left ankle sprains. Over time, you can see the accumulation of injuries to the left ankle have decreased the ability to flex significantly when compared to the right ankle. This patient also has a lateral shift to the right when doing a squat pattern, which in all likelihood is a result of the inability to move through the left ankle.

Think about all of the motions that require the ankle to flex and extend. Every time you walk, the ankle has to move. If it doesn't move well, some other joint or muscle is going to work that much harder to accomplish what you are doing. Again, this can lead to pain and dysfunction popping up in areas that, on the surface, don't appear to be related at all.




To check your ankle mobility, you can do the exact same thing as you see in the pictures, or measure four inches off the base of a wall. Get in the same position you see in the pictures above, place your big toe on the 4" mark and try to bend your knee forward while keeping your heel on the floor. Being able to touch the wall with the knee AND keeping the heel on the floor indicates good ankle mobility. If you're not quite there yet, there are plenty of resources to help you with it, and I will be putting together a youtube channel in the coming weeks to provide mobility help for all of those tight and painful areas of your body.

The take home message is that pain is a crazy thing, and can manifest in an area simply because another area doesn't function properly. If you're struggling with pain, I would love to help you get to the bottom of it.

Email me with any questions, and thanks for reading!
activechiromadison@gmail.com
www.actmadison.com
Find us on Facebook!
Twitter

The Missing Link

Today I want to focus your attention on something that I think the medical profession is missing when evaluating and treating patients. Other than regular scheduled office visits, the main reason people will visit a healthcare provider is pain or sickness. If your tooth hurts, you see a dentist. If your back hurts, you see a chiropractor. If you have a fever, you see your MD. That's generally the cycle, and in most cases, medical professionals are very adept at dealing with these acute conditions. But, generally there is a reason these acute conditions arise in the first place. Your backache didn't just happen because your back decided you didn't want to go to work today. There is something else in the way that medical professionals have done a poor job of locating, so we're treating a symptom, not the cause.

Before I go on, I want to clarify that I am guilty of the same things I reference above. When a patient comes into my office, 95% of the time it is because they are in some sort of pain that they want me to help them get rid of. So, it's natural that my patient's focus, and mine for that matter, is the source of pain. But my question has always been, "What are we missing here?". 

Focusing on pain has its merit, but does it really tell us what's going on? Think about it this way: a runner comes into my office complaining of low back pain that occurs after a long run. I check the patient's low back and notice that range of motion is normal, though painful on forward flexion (bending over and touching the toes). Now, if I stop at pain, I'm treating an area at the doesn't need treatment. What this pain is showing me is that the low back is taking up the slack for another region of the body that isn't moving properly. Upon examination, I realize that the patient has very restricted left ankle motion. I could treat the low back pain, but would that change anything for this person in the long-term? They might feel a little relief, but once they run again, the low back pain is front and center. However, treating the lack of ankle motion allows for the patient to have proper running mechanics, decreasing the load that the low back has to take during a run.

I reference this story because the person I wrote about is me. I, and anyone that treated me, focused on my low back pain without taking into account how the rest of my body was affecting my low back. After locating the missing link in the chain, understanding how to properly address my issues have helped relieve my symptoms and let me get back to what I like to do.

Locating the actual cause of pain is key to relieving pain. Treating the painful area when it is not the actual pain generator is like putting electrical tape over the check engine light in your car. You won't see it, but it doesn't mean it's not there.  I encourage you to check out practitioners that help you understand the cause of your pain, not just throw treatment at the pain. 

If you'd like to understand the cause of your pain, I would love to help. Currently, I am the only Chiropractor in Madison with SFMA training that drills down to find the cause of your pain. Give me a call today and I can help you get to the bottom of your issue.

Stay healthy,

Dr. Jason Phipps

608-233-7750