From Ankles to Shin Splints to Low Back Pain

...they're all connected

Recently, I have been having the same conversation over and over again. It seems to go hand in hand with cooling weather and people wanting to get out and run more. It focuses around ankle pain, knee pain, and low back pain. They are all related and lead to the same conversation. Let's have that conversation now.

Humans didn't evolve to walk around on asphalt. The hard un giving surface takes its toll over the years, and the ligaments in the arches of our feet stretch out.

Also, just as we tend to be either left handed or right handed, we also tend to be either left footed or right footed. That means that we favor one side over the other for supporting our weight. In the short term this doesn't matter much, but over the years one of your feet will support significantly more weight than the other.

The combination of hard ground and one-sidedness usually results in the ligaments of the arch of one foot stretching out more than those on the other side.

When your arch "drops" it begins a chain of events, each of which may lead to a different pain syndrome. Initially, the soft tissues of the foot try and maintain your arch, and the overuse leads to the buildup of scar tissue. This often results in plantar fascitis. After the soft tissues in the foot fail to maintain the arch, the muscles in your shins (Tibialis Anterior and Posterior) are the next line of defense. The will prevail for a while, but the overuse again leads to inflammation and the build up of scar tissue. This is the origin of everyone's favorite running injury, shin splints.

A "dropped arch" also changes the dynamics of your gait and causes your leg to rotate externally. This puts more strain on the inside of your knee and can lead to knee pain. An externally rotated hip also puts more stress on your IT band and Piriformis. An irritated IT Band will cause both knee and hip pain while a piriformis in spasm can cause sciatica.

An altered gait also puts more stress on your SI joints. These joint function mainly in walking and bending at the waist. They also bare much of the stress of sitting. Irritated SI joints make it hard to walk, almost impossible to bend at the waist, and make sitting for long periods of time unbearable.

I think I've just named about 95% of the injuries most common to runners, and they all start in the foot.

The treatment for each of these syndromes begins the same way. First, you have to put support under the arch which both gives relief to the supporting structures and evens out your gait. By this I am referring to a decent orthotic.

Next, you need to work out the scar tissue built up in the soft tissues from overwork. This will be different in each individual, but pretty much tends to be where it hurts. It involves deep tissue types of massage and myofascial work.

Finally, some adjusting to get the inflammation out of the joints and improve flexibility is a good measure and some minor strengthening of arch-supporting structures tends to finish out the treatment rather nicely.

A problem that has been ongoing and seemingly elusive can be treated in short order when you address it at the source.

 

-Morgan Smith, DC

September 2, 2007