Even a neck or upper-back issue can start at the feet if there are lower extremity issues
The roots of the chiropractic profession come from and focus on the spine. It is something we learn very early on in our training and we carry this proudly into practice.
The power the spine has in helping or hindering the nerve impulses coming from our spinal cord to innervate every part of the body is significant. We have all had the chance in practice to see how effective adjusting the spine is on bio-mechanical and symptomatic relief. In practice, we often find our patients presenting to us with specific pain.
Of course we want to address this pain and show the patient we are listening to them. However, let’s not chase the pain at the expense of finding and fixing the actual cause.
Whole-body and lower extremity wellness
Let’s take an average patient who presents to our clinic with lower-back pain. It is the most common reason a patient seeks chiropractic care. In fact, we are pigeonholed and stereotyped as “back doctors.” That means we are known for treating mostly that area, but that does not mean we treat “only” that.
Lower-back pain can be caused by or have a significant contributing factor from multiple areas of the lower extremity. Let’s take a look and break this down so it makes more sense.
Visualize a patient standing with their back toward you, barefoot and in anatomical position (Fig. 1).
You are an artist and the human body is your canvas. A patient can present with pain in the lower back, pelvis, hips, knees, ankles, feet — we never know how they will present. Will it be one area? Will it be all of them? It doesn’t matter how many parts are painful. It matters that you understand why they are all painful.
Because we tend to learn about the body in pieces as we go through school, we tend to treat the body in pieces in practice. But I want you to think of the body parts as they all relate to each other. That’s the key to whole-body wellness.
Start with the foundation
The feet are the foundation of our whole body. You know there is not just one arch under each foot, as the general population believes. There are three functional foot arches (medial longitudinal, lateral longitudinal, and transverse) and their main jobs are to maintain balance and proper weight-bearing properties of the feet. In up to 87% of the population, the three arches are falling, collapsing or over-pronating. This results in their feet flattening.
Now think about this: Approximately nine out of 10 people in the world have feet that are flat to some degree. The pronation ranges from mild to severe and usually involves both feet, with one being worse than the other. Flat feet have consequences bio-mechanically on the rest of the body. It’s impossible for them not to.
Look at the picture (Fig. 2) and notice this individual who has a left foot that is pronating worse than the right. Follow the pathway from the over-pronating left foot as it moves up the axial kinematic chain. Let me explain further.
Over-pronation of the foot
The three functional arches collapse and cause the foot to over-pronate. This process happens slowly and silently most of the time. Yes, we do get cases of plantar fasciitis, metatarsalgia, neuromas and heel pain, but many of our patients never have any pain in their feet. They have no idea this foot flattening is occurring. If they feel no pain, they pay it no mind. Once the feet flatten out enough, the force of the pronation begins to internally rotate the tibia bone.
The knee cap now feels an inward pull, so it starts to track medially within the patello-femoral groove. The inward rotation of the tibia continues to get stronger and stresses the femur bone right along with it. As the femur bone experiences medial rotational stress, the medial knee is now compromised. ACL, MCL, patello-femoral tracking, meniscus and arthritis conditions are often seen here.
The fun doesn’t stop there, folks! As the feet get flatter and worsen with time, the medial rotational force on the femur worsens. We now observe stress at the hip, sacroiliac joint and pelvis. Go back up and reference the picture I showed you earlier. Notice that the hips tilt inferior on the side of the flatter foot. You can even feel and observe slight to moderate lateral lumbar spine curvature that will be worse according to how over-pronated the foot is.
We began at the bottom of the feet and lower extremity and we have traveled up to the lumbar spine, following the wave of negative effects the excessively-pronated foot inflicts upon the body.
The axial kinematic chain
When you see this picture, realize that to some degree this represents 80-90% of the patients who walk through your clinic door. You can see the pattern of what the feet do to the rest of the body. You and your patients are living proof of this. You are likely an over-pronator yourself and are no different than your patients. If you take 10 chiropractors, 8-9 of us will be over-pronating.
To finish referencing the overall picture, note what is happening above the lumbar area. There is rotational stress on the spine (which happens to cause the misalignments and subluxations you keep finding). The shoulders become unlevel, then round forward, and the neck translates forward. Shoulder pain, neck pain and headaches are just a few of the symptoms we hear patients complain of.
Don’t forget that while this process of excessive foot pronation is happening and we see the effects on the entire axial kinematic chain, muscles throughout the body are reacting as well. Patients love telling us about tight muscles, muscle spasms and pulled muscles. You and I both know tight muscles are indicators of bones that are out of place. Biomechanical instability and stress beginning in the lower extremity will create muscle problems as well.
When you have a patient who has pain in different parts of the body, you should always check lower extremity issues. Once the feet, ankles, knees, hips and lower back are addressed, they have a positive effect on the thoracic and cervical spine and shoulders.
I know checking the feet and lower extremity is not the most obvious thing to do — especially if someone is presenting with only neck pain, headaches or shoulder pain. But take one last look at the picture of the pronating person and now see how much sense it makes. You really don’t have to memorize anything because you understand it.
Once you know how the lower extremity body parts are intimately related to the upper body parts, you see the patterns of subluxation and misalignment that emerge. Once you know the patterns it’s harder to miss the big picture of what is actually the cause of patients’ pain when they come in to you for care. Please remember: The lower extremities have a profound effect on the entire spine and on whole-body wellness.
KEVIN WONG, DC, is an expert on foot analysis, walking and standing postures, and orthotics. He discusses spinal and extremity adjusting at speaking engagements and writes for Foot Levelers. He can be contacted through orindachiropractic.com.