How Your Ankles Could Be the Hidden Cause of Your Back Pain
Most conversations about back pain focus on the spine, hips, or core strength. But research increasingly points to an overlooked contributor: the ankles.
Ankle instability and foot imbalances—often the result of repeated sprains, overpronation, or structural misalignment—can send ripple effects up the body, subtly altering posture and movement patterns. These changes may place excess strain on the lumbar spine and contribute to chronic low back pain (LBP).
1. Chronic Ankle Instability and Low Back Pain
A 2024 case series published on PubMed followed three patients with chronic low back pain who also showed signs of chronic ankle instability (CAI). Despite normal spinal imaging, each patient reported significant relief from back pain after interventions targeting the ankle. The study suggests that CAI may be an underrecognized driver of lower back symptoms, even when spinal imaging appears normal.
2. Foot Posture and Lumbar Curvature
Research in the International Journal of Physiotherapy found a strong association between foot posture and lumbar lordosis. Specifically, individuals with pronated foot posture (collapsed arches) exhibited increased curvature in the lower spine—a biomechanical shift that can amplify lumbar strain over time.
3. Ankle Instability Impacts Back Pain Outcomes
A study in the Bulletin of Faculty of Physical Therapy revealed that individuals with chronic low back pain experienced greater improvements in pain and mobility when their rehabilitation program addressed ankle instability. This points to a biomechanical link between foot control and spinal function.
4. Functional Ankle Imbalances Disrupt the Kinetic Chain
A study published on ResearchGate examined the relationship between functional ankle instability, limited ankle dorsiflexion, and back pain. The researchers found that even mild asymmetries at the ankle level were associated with altered hip and spine mechanics—further reinforcing the interconnectedness of the lower extremities and the spine.
Final Thought
Back pain rarely exists in isolation. It’s often the downstream effect of mechanical imbalances elsewhere in the body—sometimes beginning as far down as the feet and ankles. The research is clear: instability at the base can compromise the structure above.
