What do you mean my ankle is causing my low back pain?

That’s not always the case, but it might be! The source of your pain is not always the same as the cause. Most patients will come to physiotherapists with a very specific complaint. “My back hurts when I tie my shoes”, or “My shoulder hurts when I do my hair”, and as therapists it’s easy to directly treat the source of pain. This helps you feel better by the end of our session, however, during our next visit the narrative is often the same. “I felt great for awhile but the pain came back”. To provide a more long term solution to your pain we often have to step back from the painful joint and look at the body as a whole.

One way that we look at the body as a whole is by using the Selective Functional Movement Assessment (SFMA). This assessment uses a concept called regional interdependence to determine the cause of pain rather than the source. It’s essentially a fancy way of saying that all the joints in our body need to work together, and if certain areas aren’t doing their job the others have to pick up the slack. An easy way to illustrate this concept is to imagine that you and a friend are carrying lumber to build a house. After a few minutes your friend’s shoulder starts to hurt and they stop helping. You’re not happy about it but the rest of the lumber needs to be moved so you pick up their share as well. At the end of the day who do you think will be more sore? You? Or your friend?

The same logic applies to the body. Our bodies are divided into an alternating pattern of stable and mobile joints. If a joint becomes stiff or less mobile, the pattern becomes altered causing dysfunction and compensation. This will often lead to pain! For example, many patients experiencing knee pain will have a stiff ankle on the same side as their pain. The ankle may not be painful but it may be contributing to the knee pain. The decreased movement in the ankle can lead to an altered movement pattern and an unhappy knee.

So what does this mean for you as a patient? A good rule of thumb when you’re feeling pain that you can’t pin on a specific incident or injury is to take a look at the joints above and below the painful area. Going back to our knee example; try stretching out your hips and ankles prior to your painful activity to see if you can find any stiffness. Go back to your painful activity and see if the pain has lessened. If the pain is the same or has increased, it’s a good indication that you may not be ready for that activity at that time. If you’re unsure if you’re on the right track, book an assessment with your favorite clinician! We’ll put you through a full movement screen and make sure that you’re headed in the right direction to self-manage your pain and stay active.