My left hip hurts, why are you treating my right ankle?

This is something I quite often find myself explaining to my clients. Quite often, pain in one location (unless as a result of a direct trauma) is not always a problem with that location, but the result of altered movement patterns and mechanics throughout the entire chain.

For example, lets say that as a teen you rolled your ankle and limped around for a week or so, then headed straight back into all of your school sports with no rehabilitation. Now 10, 15, 20 years later, you are experiencing low back pain. Many people would slough the ankle sprain off as unrelated and fail to mention it in their history to their physical therapist for the their back pain. The ankle sprain however, is extremely important because it gives an understanding of how your mechanics of walking may have changed during that time.

Think of it this way:

1. You sprain your ankle

2. You put more weight on the opposite leg for a number of days or weeks to offload the injured foot.

3. Your pelvis becomes rotated to compensate for the weight shift

4. You spine counter rotates to compensate for the pelvic rotation.

5. Your brain now becomes hard wired after an extended period of time to maintain these walking mechanics to prevent pain in the ankle.

Eventually you will begin to bear more weight back on the injured foot and the pain will disappear, however in some cases, you may not come back to complete 50/50 weight bearing on both feet. You may then maintain a very slight imbalance in weight distribution and possibly some rotation in the spine and pelvis. Over time, this change in mechanics will be hard wired in your brain and may eventually become painful in other locations than the ankle.

This can be true of any old injury to any part of the body. The brain takes the path of least resistance, meaning that if something can be done without pain or with less energy the body will do take that option. That option isn’t always ideal and can lead to compensations and poor movement patterns down the road. This is where a good history by your physical therapist or other health practitioner is of utmost importance. A thorough assessment is the most important part of getting a good treatment. Finding a physio who will look at the whole picture and assess on a global scale will be paramount in treating your injuries and correcting faulty movement patterns.

Just don’t be suprised if they wind up treating something that seems unrelated, because it may just be the cause.