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Many of you seem to realise that I have a foot fetish but not for the reasons that come instantly into your imagination 🙂
You know with me it all comes back to the interconnections between all our different body parts and how they influence each other.
The one joint and area we are going to focus on in this months blog is our big toe or ‘great hallux’ and how it can with the CAUSE of LOW BACK PAIN!
So there it is sitting at the front of the foot and is made up of the proximal and distal phalange bones. If you are like me I am sure you have stubbed that little fella on more than one occasion.
It seems to be even more prevalent these days as people walk along with there heads engrossed in their smartphones and oblivious to whats around them and boom….straight into a raised curb. Some people would call that karma!
Toe extension and low back pain
Our big toe should be capable of getting 60 degrees of toe extension (raising the toe). If we can’t then we are setting up compensations in the rest of our bodies and potentially an episode of low back pain. In essence, when we have limited toe extension our feet tend to live in a pronated or flat position. This adaptation in our foot leads to a strong pattern forming in which muscles like our glutes and hamstring get lengthened and what I call ‘locked long’ creating a sustained tension in those muscles. Ultimately too much tension or compression in the system is not ideal. It always come back to finding that balance and its my job with some work from you to find these imbalances and go to work in restoring some equilibrium in our bodies.
I had a client in last month and she had a 2 year history of low back pain. It had responded pretty well to some of the conventional Osteopathy techniques out there, but after a couple of weeks the pain would soon return. So she was recommended to come and see me due to my foot fetish and see if I could make a link between her low back pain and the way she moved. We found a link!
During the assessment I got her standing and it was noticeable that she has a distinct lack of toe extension on the right hand side. This was also the side that she carried her little toddler on. She soon pointed out that she had a right sided bad ankle trauma about 3 years beforehand which involved a dance floor, some Jimmy Choos and a fair few G&Ts.
This added information really helped paint a picture of what might be going, as there is always a strong correlation between an old injury and how the body compensates and moves during the healing process. These compensatory patterns become the norm and she would find herself moving around the problem. When on joint fails, many joints fail = NOT GOOD
Now I won’t try to bore you with the detail of biomechanics that limited toe extension has on our movement patterns, but I’ll try and help you see the connection it has with potential low back pain
Two phases of our walking (gait) that you need optimal toe extension is ‘strike’ (contact) and ‘propulsion’. I’ll focus on propulsion.
As you can see from the image that toe extension is super important. Ignore that contact phase showing toe extension as that is shocking toe extension. I pretty much guarantee if someone had that toe extension at contact, they would have issues.
So what was the result of her having less than 60 degrees?
- A foot that lives in pronation (flat foot)
- A foot that therefore cant access supinate (arched foot)
- A knee that wont access full extension
- Her hip lived in a flexed position so couldn’t access hip extension
- Her pelvis stayed hiked on the right relative to the left side (compressed right lumbar spine facet joint)
- She adapts her propulsion by actively having to contract her hip flexor to bring the leg through. Not efficient at all!!
She ultimately was living in the right side of her body due to this pattern occurring and with every breath and step she took, the right side was getting the brunt of the ground reaction forces travelling up her system…a great reason why her low back pain wasn’t really ever resolving.
We went to work with this information and I got stuck into mobilising the foot. With 33 joints in one foot alone, we needed to get that toe to learn extension while the foot was supinating.
The next phase was to get her back on her feet and integrate this back into movement and get her body to experience:
- Toe extension and supination of the foot
- Knee extension
- Hip extension
- Posterior tilt of the pelvis
- lumbar spine flexion
A month later with her homework set out, we touch based on e mail a few days back and she has been as good as gold and has had no low back pain since the treatment.
She might not be out of the woods yet but she is a long way into getting her body and centre of mass into a much more balance position and the results have so far have proved this.
So next time you look at your feet you might just start to get a fetish for them too 😉
If your struggling with an ongoing problem thats not resolving the give me a call on: 01494 870815
See you next time out
All the best
Mario Ciccone B.Ost, FAFS