Health matters

Back pain has many causes

Conway McLean, DPM, Journal columnist

The human body is a complex thing, making it prone to many pains and pathologies. Quite often these are due to our bipedal, upright status. Standing and walking on two legs, our entire body supported by just two feet, encourages all manner of painful conditions that develop slowly, over time. The major weight-bearing joints, especially lower spine, are susceptible to many degenerative changes, all resulting from alignment abnormalities.

The region of the body most commonly generating chronic pain is the low back, with an estimated 2.07 million cases of low back pain annually. A 2022 survey found that over a quarter of US adults experienced chronic low back at some point. Nearly half of these individuals reported a history of such pain for five years or more. As should be expected, sufferers will nearly always relate a diminished quality of life due to this recurrent discomfort.

Numerous causes are listed as being likely to lead to chronic low back pain, aka LBS (Low Back Syndrome). The three or four most often mentioned, like “arthritis” and disk disease, all can result from recurrent physical stress to the many components involved in weight bearing. Thus, it is reasonable to conclude that factors which increase these stresses will entail a higher likelihood of developing these complaints.

If you build a house on a crooked foundation, you will have a crooked house. Consequently, foot and ankle mechanics will affect pelvic alignment, the low back musculature, also potentially stressing spinal alignment. It’s only logical that the function of the structures involved in weight bearing will be affected by those parts below, upon which that structure is supported. But the “house-and-foundation” analogy will only take you so far: there was no mention of motion. In the human body, the mechanical function and the requirements for controlled joint motion colors every discussion on the topic.

A factor in the development of these problems is the foot bone that composes the bottom half of the ankle joint, the talus, moves with each and every step. Naturally, how much and in what specific direction varies greatly from person to person. When that bone turns to the inside excessively, the lower leg must rotate inward – it is locked onto the talus.

Anyone who pronates excessively, in which the arch rotates downward, will necessarily have this excessive rotation of the lower leg. Because the knee is a simple hinge joint and does not allow for rotation, only bending, the thigh rotates as well. Unfortunately, the result of this motion is to alter pelvic alignment relative to the spine. This will typically result in either hip joint stress, low back muscle strain, or problems with the bones composing the spine (bone spurs and pinched nerves!).

Too often the word “Arthritis” is bandied about carelessly, without any specific understanding of the pathology or the conditions leading to it. The term means only “inflammation of a joint,” which will apply to numerous situations and conditions. Joint damage obviously can result from some type of specific disease, popular candidates include osteoarthritis or rheumatoid arthritis. But more common is mechanical stress to a joint arising from abnormal motion of the foot during stance and gait. These complications will take years to develop when an individual has problems with their biomechanics.

The shape of the bones of the foot and leg are obviously a function of genetics, over which we have no control. But how the structures function can be altered in many ways, including various physical therapies, bracing, and foot supports. The latter is a common method, with many individuals who are using foot orthotics experiencing relief of their LBS. It certainly isn’t a rule, but it is an accurate generalization. Not all foot supports can do this, but when they effectively address the biomechanics of the foot, ankle, and lower leg, we generally see changes in the symptoms arising from these structures.

Many complications result from poor body mechanics, so treatment is important. When combined with its pain-relieving properties, along with the ability to prevent numerous problems that result from years of poor function, a well-fabricated foot orthotic is an excellent treatment option for a variety of biomechanical issues.

Obviously placing a specialized support inside your shoe and then simply putting your shoes on is a much easier method of treatment than undergoing an operation, with its potential for complications and side effects, pain, and downtime. Scarring can result from any surgical procedure, and this may alter joint function as well.

Many Americans are told they have pain because of arthritis. This may not be a specific and accurate diagnosis of the cause of your joint pain and inflammation. Too often, these problems are given this ill-defined label, and no definitive treatment rendered. It’s a fait accompli, and there’s nothing more to be done.

But the disc or bone problem may be a reflection of abnormal biomechanics of the structure supporting it. Without altering function, your foot and leg motion can result in chronic joint stress. These complex motions, over the course of 10,000 steps a day, 365 days a year, may be damaging critical parts of your musculoskeletal system. These forces cause cumulative stress. As a consequence, some parts just wear out faster (like the cartilage lining our joints).

Arthritis is not much of an explanation for the subtle biomechanical issues producing our nation’s epidemic of chronic back pain. A better understanding of these forces and motions is needed by the average healthcare provider, in the clinics and offices of middle America. Too many lost workdays, too much pain, continue to result from these commonplace but treatable complications of poor body mechanics.


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