All posts in Back Pain

Radial Shockwave Therapy on Trigger Point to Improve Back Pain

Radial Shockwave Therapy on Trigger Point to Improve Back Pain
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How a Lack of Sunshine in the Winter Can Impact Your Bone Health

How a Lack of Sunshine in the Winter Can Impact Your Bone Health
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Vitamin D, often known as the sunshine vitamin, plays an important role in your bone health.1 It is mostly made by the body through exposure to sunlight. This is unique to vitamin D since most vitamins come from the foods you eat.1 Having too much or too little vitamin D in your body can affect the amount of calcium in your bones and can take a toll on your overall bone health:

  • Low levels of vitamin D can lead to decreased bone mass (osteoporosis) which can increase your risk of fractures.1
  • Too much vitamin D can lead to calcium deposits in the kidneys (kidney stones), or calcium build-up in other soft tissues like the heart, lungs, and blood vessels.2

More than 90% of a person’s vitamin D requirement tends to come from casual exposure to sunlight.3This poses some unique challenges for those whose environments limit their exposure to the sun.2 For example, in Canada and other countries in the northern hemisphere during the winter months, people are exposed to less ultraviolet light. This means in the winter in Canada our bodies produce little to no vitamin D.1 Statistics Canada reported that, in the winter months, 40% of Canadians had vitamin D levels that were below the recommended range.1 In the summer, that number is much smaller, but still a whopping 25%.1 This means that as a northern country, we often lack the exposure to ultraviolet light that is needed for enough vitamin D to be made in the body year-round.

You can get vitamin D naturally from a few foods, including egg yolks or fatty fish such as salmon or mackerel.1 In Canada, some foods are fortified with vitamin D by law to prevent the risk of vitamin D deficiency in the general population, including milk, soy milk, rice beverages, and margarine.4

This winter, increase your vitamin D intake and keep your bones strong by reading nutritional labels and seeking out products during your regular grocery shop that are fortified with vitamin D. It also never hurts to add a little bit more sunlight to your day!

For questions about keeping your bones (and the rest of your spine, muscle, and nervous system) in good health this winter (and throughout the year), you can ask Dr. Luciano Di  Loreto & Associates.

 

References

  1. Vitamin D blood levels of Canadians. Statcangcca. 2015. Available at: http://www.statcan.gc.ca/pub/82-624-x/2013001/article/11727-eng.htm. Accessed October 17, 2016.
  1. Vitamin d and calcium: updated dietary reference intakes – nutrition and healthy eating – health Canada. Hc-scgcca. 2016. Available at: http://www.hc-sc.gc.ca/fn-an/nutrition/vitamin/vita-d-eng.php. Accessed October 17, 2016.
  1. Holick M. Vitamin D: important for prevention of osteoporosis, cardiovascular heart disease, type 1 diabetes, autoimmune diseases, and some cancers. Southern Medical Journal. 2005;98(10):1024-1026. doi:10.1097/01.smj.0000140865.32054.db.
  1. Food sources of vitamin D. Dietitians of Canada. 2014. Available at: http://www.dietitians.ca/Your-Health/Nutrition-A-Z/Vitamins/Food-Sources-of-Vitamin-D.aspx. Accessed October 17, 2016.
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3 Easy Core Exercises to Support Your Low Back

3 Easy Core Exercises to Support Your Low Back
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Your core muscles are essential for supporting your back, stabilizing nearby joints, and reducing the risk  of injury.1 A stable core helps to maintain the integrity of the spinal column and if it isn’t stable, you may experience low back pain.2 The good news is that there are a few exercises you can do to help reduce or even prevent low back pain.3,4

Below are three core exercises developed by Dr. Stuart McGill designed to increase your endurance, support your core, and, ultimately, protect your back5:

  1. Modified Curl-up: Lie on your back with one knee bent and the other straight. Place your hands under the arch of the low back and maintain the arch during the modified curl-up. Start by bracing your abdomen by bearing down through your belly and focus your gaze at one point in the ceiling. Lift your shoulder blades off the ground about 30° while keeping your neck and spine in line. Make sure your chin remains tucked, rather than pointing at the ceiling during the movement. Complete 3 sets of 10 to 12 curl-ups.5 

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  1. Side Bridge: Lie on your side and prop yourself up on your elbow, which should be placed directly under your shoulder. Keep your legs straight, and put your top foot on the ground in front of your bottom foot. Place your top hand on your bottom shoulder. Maintain the natural curve of your spine, brace your abdomen, squeeze your gluteal muscles, and lift your hips off the ground. Hold for 8 to 10 seconds and repeat 3 times on each side. If that’s too easy, increase the number of repetitions rather than the length of time.5 

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  1. Bird Dog: Begin on your hands and knees with your hands directly under your shoulders and your knees directly under your hips. Brace your abdomen and squeeze your gluteal muscles. Lift your right arm straight in front of you until it is level with your shoulder and squeeze your muscles between your shoulder blades. At the same time, straighten your left leg straight back until it is level with your hips, keeping your hips square to the floor. Return to the starting position in a slow and controlled manner and switch sides. That is one repetition. Do 3 sets of 8 to 10 repetitions.5 

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Core exercises are just one of many ways to support your back and to help with back pain. Dr. Luciano Di Loreto & Associates at Fit for Life Wellness & Rehabilitation Centre are is trained to offer a range of treatments which includes guidance on strengthening exercises.

 

References

  1. Abdelraouf OR, Abdel-aziem AA. The relationship between core endurance and back dysfunction in collegiate male athletes with and without nonspecific low back pain. Int J Sports Phys Ther. 2016; 11(3): 337-44.
  2. Gordon R, Bloxham S. A systematic review of the effects of exercise and physical activity on non-specific chronic low back pain. Healthcare. 2016; 4(2): 22.
  3. Willson JD, Dougherty CP, Ireland ML, Davis IM. Core stability and its relationship to lower extremity function and injury. J Am Acad Orthop Surg. 2005; 13(5): 316-25.
  4. Chang WD, Lin HY, Lai PT. Core strength training for patients with chronic low back pain. J Phys Ther Sci. 2015; 27(3): 619-22. doi: 10.1589/jpts.27.619.
  5. Callaghan J. ‘THE BIG 3’ EXERCISES FOR YOUR CORE – RunWaterloo [Internet]. RunWaterloo. 2014 [cited 8 September 2016]. Available from: http://runwaterloo.com/the-big-3-exercises-for-your-core/. Accessed November 18, 2016.

Sourced from the CCA Blog

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How Sitting is the New Smoking

How Sitting is the New Smoking
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There’s no sugar-coating it: North Americans sit a lot. Two-thirds of the North American workforce sits for all or part of their workday.1 When you don’t adjust your posture frequently enough, you’re more likely to experience discomfort while sitting—and you’re inviting a whole host of other musculoskeletal problems along with it.1

Today, on average, sitting takes up more than half of an adult’s waking hours.What’s worse is that, according to Mayo Clinic cardiologist Martha Grogan, “for people who sit most of the day, their risk of heart attack is about the same as smoking.”3 Based on current trends, researchers predict the number of hours we spend sedentary will likely increase.2

There are other health risks that come from being more sedentary: prolonged time spent while sitting or reclining can tamper with your glucose levels and your metabolism.4 It’s also a risk factor for type 2 diabetes.4 The good news is that if you break up those long periods of sitting, you can reduce your risk of having diabetes, heart disease, or stroke.4

The Heart and Stroke Foundation of Canada5 recommends at least thirty minutes of moderate-intensity aerobic activity—such as brisk walking or bike riding—at least five days out of the week. If you work Monday to Friday, consider adding a few steps to your commute, or taking two 15 minute walk breaks each workday.

Here are some more helpful tips to help break up your sitting time6,7:

  • Create a schedule to remind you to stand up and move. Programming your day can help you stick to something you may otherwise forget to do. A good goal is 5–10 minutes of activity per hour. For example, if you have a job that involves sitting most of the day, plan to spend five minutes every hour up from your chair and moving around the office (like getting coffee, walking around the building, or taking a restroom break) and spend the other five minutes doing stretches.
  • Walk around on your lunch break. Invite coworkers from your office to go for a walk with you at lunch. You can check out a nearby park or take a new route around the neighbourhood.
  • Park further away and walk. Whether you’re running errands or parking at work, you can choose to park further away and walk those extra few steps to your destination.
  • Walk around the house while talking on the phone or during commercial breaks of your favourite show. You might find other opportunities throughout the day too!

Little changes can go a long way to improve your posture and decrease a number of health risks. Whatever method you choose, you can also use the Straighten Up Canada app and Fit-in 15 program to find small exercises you can do during the day.

 

References

  1. Fenety A, Walker JM. Short-term effects of workstation exercises on musculoskeletal discomfort and postural changes in seated video display unit workers. J Am Phys Ther Assoc. 2002; 82(6): 578-89.
  1. Healy GN, Eakin EG, Owen N, et al. A cluster randomized controlled trial to reduce office workers’ sitting time. Med Sci Sports Exerc. 2016; 48(9): 1787-97. doi:10.1249/mss.0000000000000972.
  1. Winslow, R. The guide to beating a heart attack: first line defense is lowering risk, even when genetics isn’t on your side. The Wall Street Journal. April 16, 2012. http://www.wsj.com/articles/SB10001424052702304818404577347982400815676. Accessed November 25, 2016.
  1. Benatti FB, Ried-Larsen M. The effects of breaking up prolonged sitting time. Med Sci Sports Exerc. 2015; 47(10): 2053-61. doi:10.1249/mss.0000000000000654.
  1. Stay active. Heart and Stroke Foundation of Canada. 2016. Available at: http://www.heartandstroke.ca/get-healthy/stay-active#How-much-activity-do-I-need. Accessed November 22, 2016.
  1. Storrs C. Stand up, sit less and move more, researchers say; here’s how to do it. CNN. August 6, 2015. Available at: http://www.cnn.com/2015/08/06/health/how-to-move-more/. Accessed October 14, 2016.
  1. Sit less. The Heart Foundation. Available at: https://heartfoundation.org.au/active-living/sit-less. Accessed October 14, 2016.

Sourced from CCA Blog.

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8 Ways to Get Children Up and Moving

8 Ways to Get Children Up and Moving
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Children have another month before they’re back to school and summertime is a great season to get kids outdoors and active. It can sometimes be a struggle to get children away from technology to spend more time outdoors practicing activities and sports, however it is so important to keep them physically active and set themselves up for success in the future, including good MSK health.

Children aged 5–11 should participate in at least one hour of physical activity each day to help build strong bones and muscles. But sometimes getting children interested and motivated to go out and play is easier said than done.

Here are some tips to help get children up and moving:

  • Encourage frequent walks or even biking adventures around the neighbourhood
  • Get active as a family
  • Ask them to help you carry the groceries
  • Have them help with garden work
  • Play some tunes and host a dance party outdoors
  • Join community, recreational sports team(s)
  • Take kids to the playground or to the park to play

There are numerous benefits to active living for the young and old: it improves self-esteem, the health of the cardiovascular system, bones and muscles, as well as posture; it also encourages healthy growth and development. Outdoor activities are also a great way to get children to socialize and meet new friends.

To meet the suggested daily requirements, children aged 5–11 years should minimize the time they spend being sedentary each day. This may be achieved by limiting recreational screen time to no more than two hours per day; being less sedentary is associated with additional health benefits. Also, consider limiting sedentary (motorized) transport, extended sitting, and time spent indoors throughout the day.

Consider signing children up for summer programs that involve physical activity and get them involved in summer team sports. Another great way to teach children the importance of physical activity is to do something active as a family as often as possible—whether you go for a bike ride or play a game of soccer together. Setting an example is the best way to show children to the importance of physical activity.

You can also download the Straighten Up Canada app for easy-to-follow videos that demonstrate simple activities and exercises that can be done anywhere.

 

References

1Public Health Agency of Canada. Physical Activity Tips for Children (5–11 Years)L Tips to Get Active. Modified April 25, 2012. Accessed May 30, 2016. http://www.phac-aspc.gc.ca/hp-ps/hl-mvs/pa-ap/05paap-eng.php
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7 Camping Tips That Will Save Your Back This Summer

7 Camping Tips That Will Save Your Back This Summer
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Summer weather is here! This means there are more opportunities to go outdoors and have fun. One activity that many of us look forward to in the summer months is camping. The fresh air, a well-lit campfire and a dip in the lake are difficult to resist. But preparing for camping is just as important as enjoying it. Be ready for the unexpected.

Camp grounds and parks allow us to enjoy a large variety of recreational activities, which is what makes it a summer favorite. Preparing and organizing packing ahead of time can help you manage the unexpected and tackle challenges as they arise. We want to help out all our campers this summer with some useful tips to follow before you load up the tent and strap your canoe on the roof of the car1: 

  1. Test your gear to ensure it works. Before packing materials in your vehicle, test your equipment to ensure it works and do so safely.
  2. Plan for activities. Plan your activities in advance to ensure that you have the right equipment and are physically ready for the challenge.
  3. Familiarize yourself with your upcoming campsite. Learning about the facility and what is available to you helps you prepare in advance for what to bring.
  4. Make a list and check it twice. Preparation is key! Make a list of the items that you may need, but consider what is truly essential. Packing extra weight can put a strain on your body, so be discerning and keep things light.

Like many other events in your life, camping can pose a number of risks to your MSK health. Preparing for the challenges ahead can also help prevent potential injuries. If you plan on doing any activities during your camping trip such as hiking, biking, or running, it is a good idea to see your chiropractor in advance for tips and advice on how to physically prepare yourself when outdoors. Here are some tips to consider:

  1. Support your back. From packing to pitching the tent or while on a hike, keep neutral curves in your spine while keeping your core engaged and active. (See our blog on how to maintain good posture.)
  2. Mind the lift. Remember to bend from the hips and knees while using your legs to lift. Keep a neutral spine and use your entire body to turn. Pivot from your feet to move your body.
  3. Pack light. Carry only what you need, and avoid excess. This can help prevent fatigue and strain from packing, hiking, or even canoeing. Being a minimalist can help prevent injuries.

References 1Woodbury, Shari. “How to prepare for a family camping trip.” Family Share. https://familyshare.com/1926/family/how-to-prepare-for-a-family-camping-trip

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Five Tips for Reducing Chronic Inflammation

Five Tips for Reducing Chronic Inflammation
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The human body is pretty amazing. It can convert food into energy and sunshine into vitamins. And, when everything is working as it should, the human body also has the ability to heal itself. When you get injured, a protective response is triggered that dilates blood vessels to improve blood flow to the injured area. You might experience immobility, heat, pain, redness and swelling, and this is normal. Acute inflammation is the body’s natural response to a threat. White blood cells move in and are then replaced by anti-inflammatory compounds to begin the healing process. Common examples of the normal process of acute inflammation include a sore throat, a sun burn or sinusitis.

Chronic Inflammation

Sometimes, however, when the negative stimulus continues, the inflammation “on” switch gets stuck and there is a persistent activation of inflammatory molecules. This is referred to as chronic inflammation, and can last for days, months, or even years, often with no visible signs. Chronic inflammation can result from a viral or microbial infection or environmental factors, including common allergens such as pollen. The condition can cause damage to the body’s tissues, replacing healthy cells with fibrous tissue. Chronic inflammation is abnormal and does not benefit the body – it signals a failure to eliminate whatever caused the initial acute inflammation. If your medical practitioner suspects that you may be suffering chronic inflammation, he or she can test for biomarkers that indicate inflammation, such as white blood cell count or albumin levels.

Inflammation and MSK Conditions

Chronic inflammation can lead to or complicate a number of diseases and conditions, such as asthma, Crohn’s disease and arthritis. Some cells in the body, such as neurons, cardiac cells and skeletal muscle cells are especially vulnerable to the effects of inflammation. Particularly, some systemic inflammatory MSK conditions including rheumatoid arthritis and ankylosing spondylitis can leave individuals susceptible to chronic pain and even signs of inflammation.

In some cases, biomechanical issues, trauma or injury can also lead to chronic inflammation and pain if left untreated. For example, an injury to the knee may cause additional weight loading on the joint and alter the gait. With time, the knee is more and more susceptible to injury and inflammation, and if left untreated, that condition can become chronic or recurrent.

Tips for Reducing Chronic Inflammation

1. Diet

Avoid foods that are high in saturated fats and trans fats, as well as foods with a high glycemic index. A Mediterranean-style diet that incorporates olive oil, fruits and vegetables, nuts, beans and whole grains is thought to act as a natural anti-inflammatory. A good diet also helps to maintain a healthy body weight. Also, it is recommended to avoid or limit alcohol, tobacco, sugar and refined carbs among others.1

2. Exercise

Regular exercise keeps your body moving and joints lubricated, your muscles toned and your energy level high. Those who exercise regularly are more likely to heal faster from injuries and less likely to develop chronic inflammation.

3. Rest

Several studies have shown that sleep deprivation can have an impact on inflammation and even increase it. For example, a 2006 study concluded that sleep loss alters molecular processes that drive cellular immune activation and induce inflammatory cytokines,2 which in turn can increase pain.3

4. Drink water

Water is an essential element to maintaining the body’s proper function. In fact, there are many benefits associated with drinking water aside from the basic need to stay hydrated. Water can help optimize energy throughout the day by nourishing your cells, keep the discs of the spine hydrated and even help modulate your calorie intake. It is also thought to help reduce chronic inflammation by reducing acidosis and keeping the body’s PH level in balance.

5. Quit smoking

We have already discussed the negative impacts of smoking on the musculoskeletal system, and it is well known that the toxic minerals contained in cigarette smoke are associated with premature death. Smoking triggers an immunologic response and can increase the level of inflammatory markers.

Sourced from the Canadian Chiropractic Association

 


1. Leo Galland, MD. Diet and Inflammation. Nutr Clin Pract December 2010 vol. 25no. 6.
2. Irwin MR, Wang M, Campomayor CO, Collado-Hidalgo A, Cole S. Sleep deprivation and activation of morning levels of cellular and genomic markers of inflammation. Arch Intern Med. 2006 Sep 18;166(16):1756-62.
3. Jun-Ming Zhang, MSc, MD1 and Jianxiong An, MSc, MD. Cytokines, Inflammation and Pain. Int Anesthesiol Clin. 2007 Spring; 45(2): 27–37.
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The Top 3 Common Myths about Chiropractic Treatment

The Top 3 Common Myths about Chiropractic Treatment
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Many Canadians continue to have questions about the role that chiropractors play in the healthcare team, and what benefit care may have to their health. To find out what chiropractic can do for you, find a chiropractor in your community. However, there are commonly shared myths that can be easily explained by your chiropractor.

We took three of the most common myths around chiropractic treatment and explained them:

1. Once you see a chiropractor you have to keep going back

This is false. When seeking care from a chiropractor, the chiropractor will perform an assessment including a history and physical examination to determine the cause of the pain or dysfunction. From these observations, a diagnosis will be made and the treatment plan developed in collaboration with the patient – according to their needs and goals. The treatment plan will recommend a number of initial visits to see if the patient responds to care and scheduled re-evaluations. Depending on the patient and the condition, the recommended course of care may vary. Ultimately, the decision to continue care is yours. As a patient, if you have questions or concerns about care, you should feel comfortable to ask the chiropractor for more information on the recommendations made and address any concerns. The care plan should be part of a shared decision-making between the patient and practitioner.

CHIROPRACTIC-1 2. Chiropractors are not ‘real’ doctors

Chiropractors are regulated in all 10 Canadian provinces, and are designated to use the title “doctor” similar to physicians, optometrists and dentists after completing the extensive Doctor of Chiropractic degree program. Those professions who are recognized to use the “doctor” title have extensive training in their area of expertise that allows them to be diagnosticians – to provide a diagnosis.

 3. Adjustments are painful

In general, adjustments or joint manipulations do not hurt. In fact, many patients report immediate pain relief. Patients may be nervous about the ‘cracking’ or popping sound that may occur during an adjustment. The sound is believed to result from the release of gas bubbles from the joint.

Learning more about chiropractic care can help you access and determine if chiropractic care is right for you. To learn more, contact your chiropractor and ask questions about how chiropractic care could work for you.  To learn more about what to expect at your first chiropractic treatment, you can take a look at our online videos.

Sourced from the Canadian Chiropractic Association

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Tips for New Mothers: Pre- and Postnatal Care

Tips for New Mothers: Pre- and Postnatal Care
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Expecting a baby is very exciting, but it takes a lot of effort and attention to ensure both the mother and baby are healthy. In this blog post we will outline some helpful tips for pre- and postnatal care. The information shared may help enhance or maintain your health during your pregnancy and delivery, and after the birth of the baby.

During the Prenatal Period1

Prenatal care is extremely important to ensure good health for you and your baby and decrease potential health risks during pregnancy. Being judicious about monitoring your health can help identify problems early, and allow opportunities for prevention. According to the Patient Education Institute, babies who are born to mothers who lack prenatal care have three times the chance of being born at a low birth weight, along with several other complications1.

Many of the following well-known preventative strategies are good to keep in mind to ensure mother and baby are healthy:

  • Stop smoking and limit your intake of alcohol
  • Talk to your doctor about any pre-existing medical conditions, dietary supplements (including folic acid), and any over-the-counter medications or prescription drugs you may be taking
  • Keep moving (consistent light exercise is important) and focus on healthy food choices

 

During the Postpartum Period2

Postpartum care starts after the baby is born and lasts about 6–8 weeks. During this time, the mother will focus on getting adequate rest, proper nutrition and other self-care measures as instructed by your family physician. Here are some helpful postpartum care tips:

Diet and Activities: After giving birth, it is recommended that a new mother continue to eat a balanced diet, drink plenty of fluids and slowly get back to normal activities and routines. For the first 2–6 weeks after a C-section, for example, she should refrain from physical exertion such as lifting, pushing and pulling of heavy objects. Ask your family physician or other healthcare providers if in doubt.

Postpartum Checkup: Normally, a healthcare provider will want to see the mother 6 weeks after delivery for a checkup. If there are complications, a visit may be scheduled sooner.

These are just a few things to consider, however, consulting with a healthcare provider such as a chiropractor is the best way to get proper information and care tips for your pre and postnatal healthcare.

Provided by Canadian Chiropractic Association

References:

1 Robin Madell, “Pregnancy Care.” Healthline. December 15, 2015. http://www.healthline.com/health/pregnancy-care#Overview1
2 X-Plain: Patient Education, “Postpartum Care.” The Patient Education Institute, Inc. Last reviewed August 23, 2012. https://www.kaahe.org/en/ArabicSampleModules/modules/obgyn/ogff01a1/ogff0101/ogff0101.pdf.
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From Head to Toe: How your feet may be affecting your back health

From Head to Toe: How your feet may be affecting your back health
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When you think about your back pain, do you consider the health of your feet? Maybe not.  We read this blog on the Canadian Chiropractic Association and thought we would share it with you!

Your feet serve as the foundation for your entire body as it moves. Dysfunction in your feet can manifest as pain in other areas of your body like your back. Did you know that studies have linked flat feet, excessive pronation, ankle instability, and ankle joint dysfunction to low back pain? Faulty foot biomechanics, like the ones we just pointed out, can have a negative impact on all supporting joints above the foot/ankle complex, including the low-back region.

For some people, even those with faulty foot biomechanics, they may not experience symptoms like others do. But for those at risk, read about how your feet may be linked to the pain in your back:

Flat Feet: Flat feet can increase risk of back pain due to flattening and rigidity of the arch. For people who have flatter arches, the feet may not adequately correct how the forces disperse on landing. This can result in forces being translated up to other structures, like the back, causing pain and discomfort1. Foot orthotics can help correct flat feet (pes planus).

Leg Length discrepancy:  This is literally a difference in leg length between one and the other. Leg length discrepancy can be structural or functional. To accommodate the difference, the body will adapt and in some cases may result in a functional scoliosis. Also, to compensate, muscles and other soft tissues may be affected which can cause pain and discomfort1.

Excessive Pronation: Over-pronation occurs when the foot and ankle joint collapse in the centre from bearing weight. The foot absorbs axial rotation of the leg during gait and then prepares the body to react against contact with the floor2.  Foot orthotics can help improve pronation.

Ankle Instability: Ankle instability can be due to an injury, or due to irregular neuromuscular control of the ankle. Studies have shown a correlation between moderate to severe ankle instability and the risk of low back pain3.

So if you are experiencing back pain, consider the role that other structures may play. How your feet function as you move, work, and participate in activities you love can impact the rest of your body. Talk to a chiropractor to find out more about how to prevent or manage such issues.

 

References

1O'Leary C, Cahill C, Robinson A, Barnes M, Hong J. A systematic review: The effects of podiatrical deviations on nonspecific chronic low back pain. Journal Of Back & Musculoskeletal Rehabilitation [serial online]. April 2013;26(2):117-123 7p

2Rothbart B, Estabrook L. Excessive pronation: A major biomechanical determinant in the development of chondromalacia and pelvic lists. J Man Phys Ther. 1988; 11(5): 373-379.

3Marshall PW, McKee AD, Murphy BA. Impaired trunk and ankle stability in subjects with functional ankle instability. Med Sci Sports Exer. 2009; 41(8): 1549-57.
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