Can misaligned joints in your feet cause back pain

News

90% of back pain cases do not have a specific structural cause (Kjaer et al 2018). 

Back pain is complex and is influenced by many different factors.

Postural, misaligned joints and structural asymmetries like the picture below cannot predict back pain and are unlikely to be its cause.

Spinal curves, posture and imaging findings also relate poorly to pain (O'Sullivan et al 2016).

Viewing back pain purely as a structural problem may be unhelpful as it can reinforce negative thoughts and beliefs that back pain is difficult to manage. In turn, this can lead to an escalation in pain, fear of movement and negatively impacting quality of life.

There are no "magic bullet" treatments. 

Be mindful of therapies that attempt to realign your joints or change structure such as custom orthotics, over-the-counter orthotics, manipulation, mobilisations, soft tissue techniques, laser, needling and taping - to name a few. Research has shown that these therapies have small and at best short term benefits. 

Key messages

• Your back is made for movement
• Your back is strong
• The brain can turn pain up and down
• Think of pain as an alarm
• Pain does not necessarily mean harm
• Bad posture and deformations are common
• Exercise and movement inhibits pain
• Exercise strengthens the back
• Action comes before improvement 

The spine is capable of self-repair and is highly adaptable (Lederman, 2010). 

People with persistent or recurrent non-specific back pain need to be educated that back pain is a multidimensional disorder and that back pain can be managed and controlled through new ways of thinking, movement and active living.

It is important that you find an evidenced-based health professional who incorporates patient education, advice to remain active and at work and exercise as frontline treatment interventions (Kjear et al 2018). Do not waste your time or hard-earned money on fancy or expensive non-evidence based treatments.

Evidence-based health professionals will deliver a patient-centred approach that is individualised with the following goals:

• Help you make sense of your pain
• Provide you with strategies to control your pain and improve function 
• Provide validation and reassurance 
• Reinforce healthy lifestyle behaviours based on your preference
• Enhance self-efficacy and your ability to self-manage 

References

Lederman E. (2011). The fall of the postural-structural-biomechanical model in manual and physical therapies: exemplified by lower back pain. J Bodyw Mov Ther. 2011 Apr;15(2):131-8. doi: 10.1016/j.jbmt.2011.01.011.

O’Sullivan P, Caneiro JP, O’Keeffe M, O’Sullivan K. (2016). Unraveling the Complexity of Low Back Pain. J Orthop Sports Phys Ther. 2016 Nov;46(11):932-937.

Per Kjaer, Alice Kongsted, Inge Ris, Allan Abbott, Charlotte Diana Nørregaard Rasmussen, Ewa M. Roos, Søren T. Skou, Tonny Elmose Andersen, and Jan Hartvigsen. (2018). GLA:D® Back group-based patient education integrated with exercises to support self-management of back pain - development, theories and scientific evidence. BMC Musculoskelet Disord. 2018; 19: 418.
Published online 2018 Nov 29. doi: 10.1186/s12891-018-2334-x.