Jan 2016 16

Julie's story - dog walking, back ache and foot placement

By: Dave Wheeler

Julie is in her late 50's and has 3 dogs that she walks a couple of times a day. All in, she walks for maybe 2 - 2½ hrs a day.

She came to see me, complaining of lower back pain - especially on the left hand side -  which got worse the more she walked. It's something that she's suffered from for years: in her words "longer than I can remember."

It's worth saying before I go any further that Julie's story is a bit out of the ordinary. Most of the time, back ache is just that - back ache; in her case, though, something else was going on.


The causes of back ache - the usual suspects

Most of the time back ache is caused by something going on in the main muscles of the back, either:

  • Quadratus lumborum, QL, the small square muscle that sits at in the lower back back on either side that I've blogged about before, or
  • Erector spinae - the long muscles that run up the entire length of the back, either side of the spine, from your backside to your neck.

QL is the muscle that's most often to blame, often going into spasm and "locking" down for what seems like the most trivial of reasons.

I have no scientific proof of this next claim, only my own meandering experience, but I reckon that about ⅓ of all lower back ache isn't in fact related to the back muscle, but is rather to do with the glutes (the muscles of the bum). I've blogged about this before

In Julie's case, though, none of these seemed to be the problem.

People who have the flat back posture, which Julie did, often have one particular muscle, called psoas, which is tight.


Pic by BodyParts3D, © The Database Center for Life Science licensed under CC Attribution-Share Alike 2.1 Japan


Psoas attaches to the lower 3 lumber vertebrae - at the knobbly bits of the spine that stick out sideways like Frankenstein's bolts (these are called transverse processes). This happens to be the same place that the main muscle of the lower back, QL, attaches.

But then psoas runs from the spine inside the body, going through the pelvis and attaching to the inside of the leg bone at the hip.

Whilst we call this the psoas major muscle, on animals it's called the tenderloin. So if you like your fillet or sirloin steak, that's what you're eating.

Because the muscle attaches to the same lower 3 lumber vertebrae of the spine as QL, when psoas is tight, it can cause back ache.

So a tight psoas is, actually one of the usual suspects in back ache, especially for people with the flat back posture.

What was interesting in Julie's case how her psoas got tight in the first place - which was definitely NOT usual.


How the psoas got tight

Let me repeat - Julie's situation is very unusual. Interesting, but unusual. It is, though, a great demonstration of how everything in the body is linked.

So it turns out that Julie's left ankle doesn't have the same range of movement as the right hand side. In particular, she's not really able to do the movement known as dorsiflexion - that's the pulling up of the toes towards the ceiling,

Julie's left foot has less "sping her in step". This means that when she walks, there's less forward momentum being created by the bounce in her step on the left hand side. The momentum has to be created somewhere - Julie creates this momentum in her hip flexors.

Look again at the diagram of psoas - not only does it attach to the lower back, but also it attaches to the hip. It acts as a hip flexor.

So it turns out that because Julie can't dorsiflex her ankle, she's overusing her psoas her psoas to flex her hip in order to get the forward momentum in her walk.

That overuse translates into tightness in the psoas, which pulls on the lower 3 lumbar verterbrae, causing back ache. 

And the more she walks, the more she's overusing psoas to propel herself forward, so the more back ache she gets.


Sorting Julie's back ache

Apart from doing some trigger point work & deep tissue massage on her back, and some soft tissue release to stretch out psoas the main thing that will help Julie is a set of exercises to, quite literally, put the spring back in her step.

I gave Julie some stretches for her calf muscle so that she can start to dorsiflex her ankle, and some exercises to improve her proprioception (fine motor control). Providing she keeps up the stretching, she should notice an improvement in her back ache relatively quickly. 

As ever, if you think I can help, give me a call.