A client of mine had spent months working with a physio, treating his low back pain as a back problem. Stretches, strengthening, the usual advice, and it helped a little before returning within a few weeks, every time. By the time he came to me, what actually changed things wasn't anything done to his back at all. It was his ankle.
This isn't unusual. The low back sits in the middle of a long chain that runs from the feet up through the hips and spine, and when one link further down that chain stops moving the way it should, something else usually ends up covering for it. The back, being both central and constantly loaded, is a common place for that cover-up to show up.
What the Research Actually Shows
A blinded comparison of 100 adults with chronic mechanical low back pain against 104 adults without it found the low back pain group had significantly reduced ankle dorsiflexion range of motion, the ability to bring the shin forward over a planted foot, along with a smaller navicular drop and higher arches.1 The study is a cross-sectional comparison, not a before-and-after trial, and the authors are explicit that it needs replication before anyone draws firm conclusions from it. But the association lines up with something coaches see constantly: when a joint lower in the chain stops moving through its full range, load has to go somewhere, and the low back is very often where it lands.
A back that keeps hurting isn't necessarily a back that needs to get stronger. It's often a system covering for a joint that isn't doing its job somewhere else.
Why This Changes What Gets Checked First
When a joint's mobility is restricted at the ankle, the foot can't load properly during walking, standing, or a squat. Something has to make up the difference, usually the knee, hip, or low back, absorbing motion that was supposed to happen lower down. Treating the pain at the site it shows up, rather than checking whether a joint above or below it is doing its job, is one reason back pain that "resolves" keeps coming back a few months later.
This is also why I start further out than most people expect, checking how someone breathes and how their joints move through the range they actually have, before ever loading the area that hurts. The back isn't wrong for hurting. It's usually just reporting on a problem that started somewhere else.
If your back pain keeps returning no matter what you do to your back specifically, it might be worth checking what's happening further down the chain. That's exactly the kind of thing one-to-one coaching is built to find.
- Brantingham JW, Lee Gilbert J, Shaik J, Globe G. Sagittal plane blockage of the foot, ankle and hallux and foot alignment-prevalence and association with low back pain. J Chiropr Med. 2006;5(4):123-127. doi:10.1016/S0899-3467(07)60144-X. A cross-sectional, non-randomized comparison; the authors state further research and replication are necessary before firm conclusions or recommendations can be made. ↩
