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How Your Feet and Ankles are Connected to Chronic Lower Back Pain

Do you suffer from chronic lower back pain? Tired of the constant merry-go-round? You know the scenario. You feel good so your workout is a go. You train the same as you always have — until one day, not knowing what you “did wrong,” the pain symptom flares up again, forcing you to stop working out, self-medicate and go back to rehab or therapies that target the pain. It works for a while and you find some temporary relief, only to have it flare up again the next time you work out or a few months down the road.

Today, millions of Americans suffer chronic lower back pain. At any given time it’s estimated that one million Americans experience it and that 80% of all Americans will suffer from at least one significant instance of acute back pain in his or her lifetime (1, 2).

Ever wondered what you’re doing wrong or why the pain keeps coming back? It’s an unfortunate scenario I see time after time as a Corrective Exercise Specialist (CES). In my experience, compensations and dysfunctions in muscle balance and joint positions result in limited range of motion, muscular discomfort and eventually cause repetitive stress on the body and chronic pain.

It’s Not the Activity That Hurts

Have you ever considered that the site of the pain isn’t the source of the problem? I can tell you that chronic muscle and joint pain has more to do with your position (your posture) and not your symptom (the pain you are experiencing).

Let’s look at the typical desk dweller. Your body adapts to the habit of sitting all day long. The human body is not designed to sit all day and when we do we’re susceptible to a myriad of muscle and joint imbalances, not to mention increased risks of obesity, organ damage, decreased oxygen flow to the brain and disc compression in the spine within the body from the habit of sitting (3).

Consider taking a body that is out of balance and asking it to perform athletic movements with ease. You may not have symptom-specific pain going into the activity but because the position of the body is off, you’ll go through compensations to get movements done. It isn’t much different than the alignment in a car. You can’t run a vehicle at top performance on an alignment that’s slightly off. If you have joint dysfunctions or muscle length tension imbalances, most often it is our failure to notice, address and correct these imbalances before exercise that leads to the chronic pain cycle repeating itself over and over.

It’s not the activity itself that causes the pain. Aside from acute trauma or an accident, it’s the body going into the activity that is the limiting factor.

How to Address Your Chronic Lower Back Pain

The first thing I do with a new client is a static postural analysis to assess where body alignment currently presents itself in relationship to anatomical design and function. Postural assessments are a structured and often missing component of fitness training program design. The information they provide is a powerful insight to help you avoid future muscle and joint imbalance injury and chronic pain.

Perhaps the biggest problem desk dwelling athletes have is low back pain. The majority of cases are idiopathic, meaning it is mechanical or non-organic in origin. The pain is not the result of a genetic condition or severe accident but simply muscle, joint and postural imbalances.

The customary practice of western medicine is to address the pain problem by treating the symptom. In addition to being told that you’re getting older and it’s a natural part of aging, you might receive a variety of different opinions on what to do or better said, not do. Stop the type of exercise, get a cortisone injection or physical therapy to work on your “core.”

While I agree that all these things can and do make symptoms of low back pain disappear for a time, I can guarantee that the pain will return at some point.


Because none of those things addresses the underlying cause of the pain, your joint alignment and muscle balance from the ground up! Corrective exercise looks at the bigger picture and seeks to address and resolve why the low back pain occurred in the first place.

One of the first things I assess with chronic low back pain clients is their feet and ankles. Did you know that foot position and foot/ankle mechanics are directly correlated to low back pain? Low back pain is very often the symptomatic result of joint dysfunction or muscle imbalance issues stemming from the feet and ankles.

Mechanical problems in the feet and ankles cause tension and friction in all of the structures that sit above them. The ankles, knees, hips, shoulders and spinal joints will eventually experience pain or result in injury if left unattended. How about plantar fasciitis? Burning sensations and heel pain caused by inflamed fascia in the bottom of the foot. But what causes the inflammation? Frequently we blame the inflammation on worn shoes. However, its cause is more often the result of improper loading of the foot and the body through foot strike. (Nutrition also plays a role in inflammation.)

If the ankle, knee, foot and hip are not aligned and functioning properly, then the plantar fascia is forced into a contracted state, screaming at you in pain.

Shoe inserts will change the way the weight is distributed and impacts the foot, therefore reducing pain momentarily. But they do not address the root of the problem. To permanently eradicate the pain, the source of the pain and dysfunction, AKA faulty mechanics, must be corrected. Otherwise, you may end up shifting the pain to other areas of the body, resulting in inner or outer knee pain or eventually hip pain.

If this is the first time you’ve considered the connection, stop reading right now and take a look at the position and condition of your feet and toes. Ask yourself the following questions.

The Foot and Ankle Connection to Chronic Lower Back Pain

  1. Do one or both of your feet point outward away from your mid-line? Do they align inward? Perhaps a combination of the two? If they point outward or inward or something between the two, there is a problem with your postural mechanics.
  2. How about your ankles? Do one or both of your arches sit high (roll away from the mid-line of the body) or fall flat on the ground? If so, this is a severe posture distortion right at your first connection to the earth.

Any disparity at the foot and ankle will throw off all the postural muscles throughout the rest of body. The feet are the foundation of human posture and they affect your ability to function adequately in movements of daily living and athletics.

You might be saying, “Yep, I know all that. That’s why I wear prescription orthotics or inserts in my shoes.” While I agree that orthotic supports provide support to the arches, in my experience, they do nothing to correct the stance (feet pointing in or out), ankle stabilization or the lack of full range of motion in the muscles and joints. They merely try to recreate what your foot musculature is designed to do on its own without addressing the underlying dysfunctional pattern at the foot and ankle.

If you think you have any of these issues, then a corrective exercise program is right for you. Programming is designed specifically to help retrain the imbalances in the foot and ankle position and how those imbalances affect the entire kinetic chain, which may be the underlying cause of chronic lower back pain.



  1. “Magnetic Resonance Imaging of the Lumbar Spine in People Without Back Pain.” M. Jensen, et al. 1994.
  2. “Acute, Subacute, and Chronic Low Back Pain: Clinical Symptoms, Absenteeism, and Working Environment.” B. Vallfors. 1985.
  3. “The Health Hazards of Sitting.” B. Berkowitz, P. Clark. 2014.