We’ve said it time and time again, gravity is our most consistent stressor, and we need to learn how to manage it first by doing the simple things well before we get too fancy with our exercise selection. The midline structures of our body (spine, skull, rib cage, pelvis) should function as an adaptable platform that can respond to the movement of our limbs. The load capacity of the tissues throughout our limbs is one of the most overlooked components of lower back rehabilitation. Everyone wants to get the back “strong”, but what we are oftentimes unknowingly encouraging is rigidity throughout the spine. That’s not what we want to encourage, because a rigid spine is not a spine that can adapt and dampen unexpected perturbations that we have to deal with on an everyday basis. The increased tension/tone and the expression of pain is typically an adaptive/protective response. But why does the nervous system feel that it needs to be protected? One reason that we often find clinically is due to poor movement strategies further down the chain, mainly at the foot & ankle complex.
What’s the first part of your body to hit the ground when you walk? Your foot. Specifically, the skin of the sole of the foot is the first tissue to become loaded when we engage with ground-based activity. One of the most important phases of walking is when you move from the heel to loading the entire foot as your whole center of mass shifts over the foot. This is a phase of gait when we want good quality cooperation between all the tissues throughout the lower limb. There’s also a huge BALANCE component to gait that is very often overlooked. When we are walking forward, during mid to late stance, we only have one foot on the ground. That, coupled with the forward momentum of my body and the downward force of gravity trying to pull me towards the ground REQUIRES cooperation & coordination between the lower limb tissues. This is not about strength. This is about how well those tissues dissipate stress, transfer forces, function reflexively, and it all starts at the foot/ankle complex. The more responsive the tissues around the foot and ankle are to load, the better the reflexive function throughout the entire lower limb. We call this Mechanoreceptor Responsiveness. With better responsiveness, comes better adaptability. This means that they can adapt much better, dissipate stress, and most importantly, help to control our balance during that single limb support phase of gait. This might refer to this as an “ankle strategy” throughout the research, which we can see from the image. This is what we want most of the time during specific phases of gait.
When you lose the ability to control gravity using ankle strategies during ground-based activity, it will certainly influence how forces are transmitted through your lower extremity. Your body mass (especially the head, arms, and trunk) during gait has to be decelerated by the reflexive properties of the lower limb, and when we lose an appropriate ankle strategy, we will typically use other strategies to control our mass. Typically, this will happen around the hip and lower back. Using a “hip strategy” to control your body mass during movement is normal when we are trying to adapt to larger perturbations, like getting pushed. However, if we begin using these strategies to control movement during repetitive movements like walking or even running, it can certainly influence the tone expressed in the tissues around the hip and lower back. Instead of using a distal-proximal (ankle to hip) control sequence, we start to adopt a proximal-distal (hip/lower back to ankle) strategy. This pattern of coordination is something we definitely want to identify and address in those with lower back pain. The solution does not often lie in “core stability” drills, but more so restoring the reflexive properties of the lower limb and appropriate ankle strategies.
Don’t get caught hyperfocusing on the lower back tissues in clients with lower back pain. Remember, we live in a gravity-driven world, and so the cooperation of all the tissues from the foot up to the lower back are key to identify.
If your clients suffer from low back pain, allow for more time to consider their injury history, especially past injuries around the foot & ankle complex. Past experiences of plantar fascia, ankle sprains, achilles problems and other related issues can guide what kind of strategies you want to use during treatment and rehab. Of course, there are many other layers we can look at, such as movement strategies to identify their ability to express an appropriate ankle strategy, but we focus on this in more detail on our IKN Approach courses.