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Sunday January 20, 2013
By Dr MARK REYNEKER
Lower limb alignment is not the only thing that can cause back pain, but it is certainly the most commonly overlooked diagnosis.
WHAT is the first thing that comes to mind when someone says the word podiatrist?
If you’re familiar with the term, most will answer “foot specialist”, or “foot doctor”.
If you’re not familiar with the term, the responses you get can range from “the doctor who deals with children” to “it’s some kind of diet”.
Yes, I’ve heard it all, but after 12 years of practice, I can assure you that nobody has ever said: “The doctor who treats back pain.”
However, that is exactly what we’ve done over the past 20 years, since more and more research has shown that if the lower limbs (your legs and feet) malfunction, it will most likely lead to chronic back pain.
If you’re unfortunate enough to fall into the large percentage of the population experiencing lower back pain (LBP), then you will know that it can oftentimes make your thigh, calf or foot feel numb or tingle.
Many patients experience a tugging, or pulling sensation in the leg while back pain is more subdued.
Others may just experience discomfort in the back of the thigh, or a distinct pain in the lower back on certain movements.
Your doctor may take a MRI or an x-ray, and diagnose you as having a problem with your disc, which lies between the vertebrae, or perhaps a nerve compression.
There are a few diagnoses that can be made, and just as many treatments can be offered.
Often, this leads to what we call revolving-door practice. The patient comes in for treatment and leaves feeling better, only to show up again to repeat the whole process. This happens both with surgical and non-surgical treatments.
The answer to this lies in the research that has been conducted over recent years on the link between the lower limbs and your spine.
For treatments to be effective, we need to find the root cause of the problem. Just knowing what’s wrong is not enough. We have to answer why the problem occurred. We say this because the diagnosis you are given is oftentimes the manifestation of the root cause.
What’s the root cause?
Let’s consider Angela’s (name has been changed) case study. She goes to work Monday to Friday where she spends an average of three hours standing and walking. The rest of the time, she is seated.
For two years now, she has had this dull lower back pain, and she goes for a massage to relieve the pain and the tight leg muscles on her left side once a week. She noticed that the pain was always worse after a day of shopping or having walked long hours.
One day, she decided to finally mention this to her general practitioner, who gave her an anti-inflammatory drug. It felt good, but as soon as she stopped the drugs, the irritating pain returned.
She then turned to a chiropractic, which helped. An orthopaedic surgeon referred her to their physiotherapy department, and that helped too, but the discomfort returned as soon as she stopped treatment.
One day, her aunt jokingly said to her: “Why do you walk with your feet turned like that?” Her aunt later insisted that she should see her podiatrist.
It was on this visit that we discovered not just the diagnosis, but more importantly, the root of the problem.
Angela had a limb length discrepancy, which is to say, one leg was shorter than the other by eight millimetres.
This made Angela’s pelvis tilt, causing the spine to curve. Biomechanical data shows that any difference greater than three millimetres can wreak havoc with your alignment and cause persistent lower back pain.
After addressing the difference, the lower back pain and its associated leg discomfort resolved within three weeks.
There are many other biomechanical anomalies, such as flat feet, incorrect leg bone rotational alignment, knee position, pelvis rotation, and weakened buttock muscles that can be the underlying cause. It can be discovered by having a biomechanical evaluation of your lower limbs by a podiatrist.
A typcial biomechanical examination can last 10-20 minutes, and may include x-rays and video gait analysis, depending on the problem.
Expect to have your walking and alignment scrutinised.
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