WHY YOU NEED TO WORK ON YOUR ANKLES AND KNEES IF YOU’VE GOT BACK PAIN

Your body is a web of connective tissues, which are all connected. 

When you feel pain in one area, it may actually be due to an injury in a different spot. 

You’ve got muscular and neural pathways that connect your feet to your head and also link your ankles to your knees and your back.

Unfortunately, your ankles, knees and your back are often overlooked or ignored by many practitioners in their treatment approach to relieving back pain.

WHAT’S THE CONNECTION?

Lower back pain may actually start in your feet if, for example, at some point in your life, you’ve acquired some toe, foot or ankle injuries.

One of the first questions I ask my clients with sacroiliac joint pain is “tell me about your feet and ankles” because I see a lot of ankle instability manifesting as SI joint trouble.

Here’s the kicker: 

Any lower body injury creates injurious instability. This means that those lower extremity injuries may eventually lead to stress and injury on those joints above and below your injured area.

Under ideal circumstances, these lower body injuries would benefit from a medical consult, some period of healing, maybe some post-injury rehabilitation, like physical therapy.

But…. how many times have you hurt yourself and just ignored it until it didn’t hurt as much?

I know you are reading right now and nodding your head!

If you were a youth athlete you’ve probably shrugged off a half dozen ankle and/or knee sprains! 

But hold on a sec.... what, exactly, is a sprain?

LET’S DIVE IN TO SOME ANATOMY CONTEXT 

The medical definition of a sprain is an injury to a ligament, often in the form of an overstretched ligament or a tear.  This can come from an acute injury like a fall or a sports tackle or it can occur from repetitive overuse as well.

When you look at anatomy diagrams in a text book, the muscles are depicted in red or pink and your connective tissues (ligaments and tendons) are shown in white.
The reason why your muscles appear red, not only in illustrations but also in real life, is because your muscle tissues benefit from a tremendous amount of blood perfusion, so they’re red.

Your ligaments and tendons don’t get much blood flow, that’s part of the reason why they appear white.

This also means that your muscles will heal much faster than your ligaments while your ligaments are likely to heal faster than your tendons - all because of the quantity and rate of lymph and blood flow through those respective tissues.

So….when you sprain an ankle or a knee ligament, it may never go back like it used to be.

Those ligaments, which provide structure and stability to complex joint mechanics, may be compromised and this often results in an increase in instability in that joint.

HOW DOES THIS RELATE TO YOUR BACK?

When thinking about the human body, some of your joints crave stability while others are designed to function with more mobility. See the diagram at top.

Your knee doesn't circumduct or laterally flex or rotate; it is a stable joint that only moves through flexion and extension. Plus some tibial torsion.

When you lose ligamentous stability in your knee, that joint becomes inherently less stable.

Think about it like this: Every time you walk, jog, hike, jump, pivot, that ground force reaction that you’re creating, which is normally contained within the prescribed movements of your knee, those forces are now leaking/transferring/moving farther up your skeleton, often to your hips, pelvis or spine, which are then forced to receive these  new forces and movements which normally should've/would've been handled at the knee. 

Think of ground force reactions like an energy wave - that wobbly motion may no longer be absorbed by an injured lower joint, so the energy reverberates higher up the chain.

It can often be felt in whichever joint is your next weakest link.

For women of childbearing age, especially, our next weakest link is often our pelvis, sacroiliac joint and/or lumbar spine.

WHAT ABOUT POSTURE?

Although social media is full of self-proclaimed pros insisting that posture doesn’t affect back pain, that just doesn’t make any sense. 

Many back pain sufferers are dealing with injuries relating to compressive forces and your posture and daily movement habits have a profound effect on how you’re using your body, how your joints are stacking and how much spinal joint compression you’re experiencing throughout your day.

The way you sit, stand, sleep, work, lift, carry and move contributes plenty to where, when and how much pain you’re dealing with on an ongoing basis.

Wearing athletic shoes with a narrow toe box and heel lift or wearing high heels can squish your toes, reduce your body's natural shock absorption. Fashionable, unpractical footwear may retard your gait and/or distort your center of gravity.  
Less-than-ideal footwear and an altered gait can certainly exacerbate pain to radiate up through your knees to your back.

WHAT TO DO?

Old injuries require ongoing care and management. It’s a good idea to develop a self-care maintenance routine so that everyday you’re spending a couple of minutes doing something nice for those old injuries.

It's also a good idea to take a good look at all of the holistic and interdisciplinary ways that you can start to make incremental changes. This may include making changes to your  footwear, nutrition, daily postural habits, breathing and/or your walking gait. All of these things can improve how you're moving through the world so that your back isn't taking the brunt of your unknowing bad habits.

If this sounds interesting but insurmountable, then we would be a good match for creating an individualized coaching program so that you can proactively tend to all of your interconnected health concerns and injuries at the same time so that your body starts to feel and move as a healthy whole again.

Tune in to the next article where we get in to ACL injuries!