Heel Mobility and related back pain
This article describes how a lack of heel mobility can have a related effect on back pain as well as other common foot and heel problems.
Basic Foot biomechanics
As the heel strikes the ground there should a relatively small inward rotation or ‘pronation’ followed a similar but greater movement of the mid foot (the arch). The force and weight is then transferred to the metatarsals before push off by the big toe and others.
Causes of some common foot/heel problems
If the heel does not roll in then the mid foot has to roll further. This in turn increases the stresses through the connective tissue along the base of the foot called the plantar fascia. The lack of movement at the heel also causes greater stress through the Achilles tendon. These increased stresses over time can cause Plantar Fasciitis as well as heel spurs and tendonitis.
This extra roll of the mid-foot has been termed ‘over-pronation’ and it can lead to greater stress and force through the joint at the base of the big toe.
The body responds by laying down more bone in that area to cope with the extra force. The joint becomes larger and the toe is forced inwards forming what is commonly known as a bunion.
How can lack of movement in the heel create back pain and vice versa?
There are two perspectives to consider when looking for causes of heel and back pain.
Ground up forces. That’s to say the forces involved as the heel strikes the ground and the chain reaction of energy and movement as it passes up through the leg to the spine.
Top down forces. That’s to say how gravity acts on our spine and pelvis and how they adapt to cope with it and the effects on the biomechanics of the hip, knee and foot
The weight and therefore force of our torso, head and arms is distributed through our lumbar spine and evenly distributed through our pelvis via our sacrum into our legs. To help manage this we have large lumbar vertebrae, thicker discs, strong postural muscles and a matrix of interconnected pelvis and hip muscles such as gluteal muscles and hip flexors and core abdominal muscles.
However with our increasingly sedentary lifestyles our hip flexor muscles can become more contracted and shorter. This can lead to a slight forward tilt in our pelvis.
You can see from Fig 1 how it can increase an inward movement on the upper and lower leg and ultimately encourage increased pronation in the foot. This in turn can lead to foot and lower leg problems described earlier.
Also this can lead to tighter lower back muscles (see Fig 2) and increase the risk of lower back pain.
As the heel strikes the ground it is designed to roll inwards. This is called pronation and it is totally natural. The mid foot follows followed by flexion of the toes and especially the big toe.
This inwards roll of the heel bone initiates a subsequent inwards rotation of the lower leg then the upper leg and eventually the hip. It is the inner rotation of the upper femur and hip that gives the gluteal muscle the cue to contract and extend the hip, propelling the body forward to the next step.
So that first small inwards roll of the heel starts a chain of events culminating in the contraction of the most powerful muscle in the body. However if that inwards roll doesn’t happen then ultimately the gluteal muscle does not contract as efficiently and the lower back postural muscles become involved as they help out the hip to make the next step. That is on top of the job they already have providing stability and mobility to the lumbar vertebrae. A recipe for over work and fatigue of the lower back muscles and ultimately back pain.
Why does the heel become less mobile?
Tight calf muscles can be one cause of restriction of movement into the Achilles tendon which in turn attaches to the heel.
A reduced mobility of the calf muscle can be due to a number of reasons. Here are some.
Increased weight: As we get older increase in weight can go onto our tummies. This in turn can change our centre of gravity and bring it slightly forward. Our calf muscles get involved helping to pull us backwards and maintain our balance and CoG over our mid point.
Sports: such as cycling that put a greater load through the calf muscle and in one direction can lead to tight calf muscles
Shoes: that elevate our heels can cause a shortening of our calf muscles. Research has also shown that there is a correlation between high heeled shoes worn and Bunions. The foot is placed in extreme flexion and forces are compressed at the base of the big toes.
A lack of heel movement can also be due to previous ankle injuries: significant ligament strains and fractures can lead to a lack of movement between the joints in our ankles and the heel bone. This in turn can lead to increased load on the calf muscles and tendons.
Implications for effective treatment
In order to effectively treat foot pain and injuries from calf through to big toe Hugo assesses all aspects of the foot, leg, hips and lower back. Evaluation their mobility and ability to move as part of a chain reaction of events.
Likewise if back pain is the symptom Hugo will always assess foot and hip movement as part of the process and treat accordingly.
Hugo uses 3D Functional movement exercise as integral part of his treatment to help enhance the movement of joints and muscles and combines this with Osteopathy treatment to improve tissue health and return you back to pain free movement as quickly as possible.
Reducing Sciatic pain during pregnancy
If you are suffering from Sciatic pain during pregnancy then help is at hand. Often in the third trimester of pregnancy you can start to feel pain into the gluteal (buttock ) area and it can travel down the back of the leg and can go into the calf.
As the pregnancy progresses and the extra weight at the front continues to increase, the pain down the back of the leg can increase from occasionally uncomfortable to very painful.
Pain Killers are not recommended so what can you do?
You may think that there is no other option than to look up some stretches on Google and hope for the best!
Why does Sciatica occur?
The cause of sciatic pain in pregnancy is most often due to overworked muscles close by the sciatic nerve that runs from your lower back down through the buttock area and down each leg. As ligaments become increasingly relaxed, ready for the birth, your muscles have to work harder in your pelvis and hips to provide you with stability in that area. This often coincides with a slight rotation of the pelvis either to the right or the left. This could have been a pre existing rotation prior to the pregnancy or occurred during it as the body manages the extra weight. This causes one set of pelvic muscles to become slightly shorter and contracted on one side and on the other side they become slightly stretched and overworked. Over time this leads to inflammation of the overworked muscles and pressure on the sciatic nerve leading to the term Sciatica.
What can you do to calm it down?
As an osteopath my aim is to improve the health of the tissues, in this case, the muscles on the overworked side and to address the structural changes, the rotation. I improve the health of the tissues on the side of the sciatic symptoms by improving the circulation through soft tissue massage and sometimes Medical Acupuncture. The structural change, the rotation, on the opposite pain free side, I address through Therapeutic Functional exercise. I tailor the exercises to the patient but one of exercise that forms the basis is this exercise.
Patients normally report a reduction in symptoms with 3-4 days after the initial treatment. After one follow up session and patients continuing to do the exercises as prescribed for a further 7 days, and patients report that the symptoms significantly reduce to just an occasional ‘niggle’.
I had experienced Sciatica occasionally with my previous two pregnancies with my previous children and it normally went with rest. However this time it was just getting worse and worse. I couldn't stand, sit or walk for any length of time. Rest wasn't working!
I saw Hugo and he explained why it was happening. He gave me some specific exercises to do on the opposite side of the pain. He also gave me some acupuncture and massaged the muscles which was quite painful but it felt like it was helping. After 3 days I could feel the difference. One more treatment and doing the exercises religiously for approx 7 days and my Sciatica had all but gone. I can't recommend Hugo enough. If you are pregnant and experiencing sciatic pain don't suffer, go and see him.Libby, Mum of two soon to be three!