Site of Pain Does NOT Equal Source of Pain

“The site of pain is not always the source of pain.” This is something I have to explain to my patients fairly often. I don’t blame them for this type of thinking, because it does seem rather common-sense to believe that the problem lies in the area that hurts. Unfortunately, that is not always the case, but fortunately, chiropractors are trained and skilled at finding the source and cause of their patients’ pain. Although we treat a variety of musculoskeletal conditions, most people think that  chiropractors only treat neck and back pain, and I think it is safe to say that most of our patients initially present with those complaints. However, there are several things that can lead to neck and back pain that aren’t directly related to the neck or back. Some of the most common contributors to back pain, especially in the low back, are issues in the lower extremities. All of our weight is displaced through our legs and feet, and if that weight distribution is not balanced, gait mechanics change. The hips, pelvis and lumbar spine absorb the effects of poor gait patterns, which eventually leads to spinal dysfunction and pain. Below are some ways to improve the biomechanics of your legs and feet, which can help prevent dysfunction and pain in your spine.

1. Short-foot Exercises: Aimed at strengthening the intrinsic foot muscles, short-foot exercises improve stability in the feet. These muscles help support the 3 arches of the foot, and also improve control of the toes. Simple exercises include: scrunching your foot so that the balls of the feet approximate the heel, spreading the toes and bringing them back together, raising the big toe while keeping the other 4 toes on the floor, and keeping the big toe on the floor while raising the other 4 toes. These may sound easy, but I assure you they are not, so don’t get frustrated when getting started.
2. Extremity Adjustments: Some chiropractors only adjust the spine, but a lot of chiropractors adjust the joints of the upper & lower extremities as well. There are a lot of small bones in the feet, which means there are many joints that may become restricted. It is important to get these joints moving properly to maintain full range-of-motion. The best way to accomplish this is with extremity adjustments, which all of our chiropractors offer at our office.
3. Stretching: Imbalances in the muscles and soft tissues of the lower extremity can also create problems with gait mechanics. Muscles that commonly need to be stretched are the calves, hamstrings, and hip flexors. Many people lack dorsiflexion of the feet, which means it is difficult for them to bring the top of the foot toward the shin, and this may also contribute to plantar fasciitis. Hamstrings and hip flexors get tight from prolonged periods of sitting and disuse, and this affects movement of the knees and hips.
4. Strengthening Exercises: One of the most common muscle weaknesses I find in my patients is of the gluteal muscles. This includes all 3 muscles in that group: gluteus minimus, gluteus medius, and gluteus maximus. Each of these muscles has a slightly different origin, insertion and action, but their primary role is extension of the hips and stabilization of the pelvis. Simple exercises to strengthen these muscles include: prone hip extensions, quadruped hip extensions (bird dog & donkey kicks), glute bridges, and squats. It is also important to strengthen balance with single-leg stance exercises.
5. Custom Orthotics: If you’ve tried all of the above and still feel like your feet are not supported, and your gait is not balanced, you may be a good candidate for custom orthotics. Sometimes it is not possible to train your natural arches into optimal condition, and that it is when orthotics may be warranted. At our office we analyze gait patterns, foot positioning (weight-bearing & non-weight-bearing), hind-foot and forefoot angulation, and then create a custom mold for each foot. We have helped a lot of patients with foot pain, knee pain, hip pain and low back pain by providing them with the best orthotics, customized to their exact specifications.
6. Massage Therapy: Muscles, tendons, and ligaments allow our joints to move, but can create pain and dysfunction if stress causes excessive tension in these soft tissues.  Massage therapy is an effective treatment, especially when integrated with chiropractic care. 

Having a hard time beating back pain? Try these simple methods to see if the source of your back pain is somewhere other than at the site of pain.