Pain in the back? Check the big toe!

Posted: December 30, 2011 in Uncategorized

Great big toe mobility

If one link breaks,what happens to the rest?


As many of you know, the times of treating the site of pain are behind us (with exceptions of course). Through a paradigm shift in the rehab/training world we have come to appreciate the body as an integrated unit, where all it’s part never function in isolation but as a unified whole. This means that when a patient presents with knee pain as an example, the knee is very rarely the cause of the pain. The knee pain is simply the consequence of an issue at a joint either above or below the knee. Now that we have that out of the way….on to the topic at hand!

Low back pain (LBP) is an epidemic. We all know the stat that 80% of us will have back pain at some point in our life…I know I have! The problem then becomes an issue of treatment. Let me just say that I am not dead set in my ways and I know there are many ways to skin a cat..i.e many different treatments can fix the same problem…that’s only if the right problems are addressed. In this blog I will explain how a restriction at the big toe can ultimately lead to back pain…just something else to think about.

Hallux Rigidus can occur for many reasons. This condition presents itself as limitations in big toe extension

Heel strike, to 5th toe, to 1st toe

(dorsiflexion). Why does that really matter? Oh…it matters! Every step you take the big toe is working to create power for push off. We start off with heel strike, the subtalor joint moves us into inversion where our weight is placed on our 5th met head and then we have subtalor joint unlocking which allows the midfoot to fall into functional pronation allowing the big toe to come into contact with the ground. At this point, the big toe digs into the ground to create the push off we need to move forwards. In order for the big toe to flex into the ground to create momentum, it must first go into 45-60 degrees of extension to create the proper length tension relationship to allow the push off phase to occur. This is where problems start to set in.

If the big toe can’t dorsiflex, the body is going to compensate for that lack of movement by trying to shift the body weight medially to get that big toe to hit the ground…the body is smart and will always find a way to do things to keep moving. When we don’t get the movement from the big toe, the knee must go into valgus collapse (knock kneed) to try and get as much weight on that big toe as possible for push off. When the knee goes into medial collapse, the hip moves into internal rotation and the lower back compensates by shifting towards the side of hip internal rotation. When the low back shifts, you can get muscle shortening, facet joint impaction, degenerative changes etc…leading to back pain that started from a lack of big toe extension.

So here is the BIG question…WHY can’t the big toe extend? Arthritis is one reason but I won’t discuss that as again, I believe arthritis is just a consequence of a biomechanical imbalance elsewhere. Here is a big reason that I see clinically. If the flexor hallicus longus muscle becomes restricted, the big toe will not have the mobility to extend due to the muscle keeping it in a plantarflexed position. We sleep in a plantarflexed position so this muscle often becomes tight in some people. If the flexor hallicus longus is fine and patient still can’t dorsiflex the first ray with ambulation then I check peronius longus. Why? The peronius longus has the task of transferring weight from the 5th met head to the big toe during the gait helps create that functional pronation I was talking about before. It also has a roll to play in plantar flexing the big toe to help with push off. So, if peronius longus is weak or tight it could be a cause of why the big toe can’t fully get the mobility it needs to create adequate push off power.

 In short, to treat this I mobilize/manipulate the first MTP using accessory and physiological glides. I do myofascial release of the flexor hallicus longus from the fibular origin to its insertion (probably getting a few other muscles at the same time…but that’s fine!). I stretch the foot into dorsiflexion, I work on peroneal strengthening (good one being heel lifts a with tennis ball squeezed between the ankles), and I of course work of glute strength…because everybody needs it! I also check the pelvis to see if there is an imbalance at the innonimate…that too can be one cause of big toe problems

Simple big toe self stretch:

Peroneal Exercise:

Are there other reasons for back pain? 100% yes without question. This article was just written to help therapists who have clients with nagging back pain to help think outside the box in terms of possible causes. I know I have been stuck with clients in my practice and have neglected to look at other factors…not so much because I didn’t want to, but more because I just didn’t know they could be issues in the first place. I guess the take away point is to be a detective with the body. Never think that a problem you see somewhere other than the site of pain is unrelated…it probably is. I’m the first to admit that I have been caught chasing symptoms to try and make the client happy. But I have found that if I take the time to explain why I’m wiggling their toe for their back pain, I gain credibility…because If I didn’t explain that, I’d be considered a voodoo therapist in their eyes hahaha

 Thanks for reading and happy new years!

 Jesse Awenus B.A (Hons) Kin, MSc.PT
Registered Physiotherapist

  1. Excellent article my friend. Nicely written. The big toe is a critical part of the movement puzzle. Liked the highlighted relationship to the peroneals. Gotta think globally. Thanks for posting. This will help someone and that is what it’s all about. I see this all the time in clinical practice.

  2. […] Pain in the back? Check the big toe! ( […]

  3. Thanks, well written, will pay more attention to my clients’ big toes now!

  4. Jesse A says:

    Thanks Vicky! Just something else to consider 🙂

    Glad you enjoyed it

  5. I had no idea that this could make a difference. I’m going to look into this as soon as I can. Thank you for sharing!

  6. jessephysio says:

    1st MTP extension is a big player in foot, knee and back pain…it’s a quick see if they have that 50-60 degrees of extension. Check contralateral side for east comparison.
    Thanks for reading the blog Amber!!

  7. jasssanhdu says:

    Aurora Group Atlanta explains the various causes of a burning sensation in your feet, including diagnosis and treatments.

  8. Thanks a lot for this interesting share about the relation of low back and the big toe. I am pleased to read this stuff and hope to get more.

  9. aching knees says:

    After I initially commented I seem to have clicked the -Notify me when new comments are added- checkbox and from now on every time a comment is added I recieve 4 emails with the exact same comment. There has to be a means you are able to remove me from that service? Thanks a lot!

  10. aching knees says:

    I’m amazed, I must say. Seldom do I encounter a blog that’s both educative and engaging, and let me tell you, you have hit the nail on the head. The issue is something which too few folks are speaking intelligently about. Now i’m very happy that I found this in my search for something relating to this.

  11. Increases power to discover new information and expertise

    Improves intelligenc
    best brain supplements reviews
    .1016PERj.eurpsy.2011.05.004. Zink lack listlessness, and is
    a reason that is typical for a lack of focus, understanding handicaps.

    ScienceDirect is likely to be phasing service for Web Browser 7 out.
    Permalinkparent[ ]smellybaconreader 0 points1 point2 factors 5 months before (1 youngster)[ ]smellybaconreader 10 items per day, 5 weeks
    0 points1 point2 things, agoAlso ==> 20 mg?!
    cognitive enhancers
    Cheers!!! Road, as previously mentioned above.
    Additional RAM. It manufactured my thinking sharper and did present energy to us.
    Psychopharmacology 93:87–93

  12. Hi there! Would you mind if I share your blog with my facebook group?
    There’s a lot of folks that I think would really enjoy
    your content. Please let me know. Thank you

  13. Soybeans are full of beneficial compounds that are perfect for anti-aging
    such as amino acids and anti-oxidants. The first thing you need to realize is that contrary to what many
    skin experts believe, the food that you eat has a lot to do with acne.
    Toothpaste to Remove Hair Dye From Skin – Wet the
    dye stained area of skin with warm water.

  14. Monica says:

    Simply desire to say your article is as surprising. The clarity in your post is simply cool and i can assume you
    are an expert on this subject. Well with your permission let me
    to grab your feed to keep up to date with forthcoming post.
    Thanks a million and please carry on the enjoyable work.

  15. Woah! I’m really loving the template/theme of this blog.
    It’s simple, yet effective. A lot of times it’s hard to get that “perfect balance”
    between user friendliness and appearance.
    I must say you’ve done a very good job with this.

    In addition, the blog loads super fast for me on Opera. Superb Blog!

  16. What’s up, just wanted to tell you, I liked this blog post.

    It was helpful. Keep on posting!

  17. I am regular visitor, how are you everybody?
    This piece of writing posted at this web page is in fact

  18. Kellie says:

    Thanks for sharing your thoughts on hair loss. Regards

  19. Quality articles is the secret to attract the visitors to go
    to see the web site, that’s what this site is providing.

  20. lycra suits says:

    What’s up, I read your new stuff regularly. Your story-telling
    style is witty, keep it up!

  21. Tangela says:

    I do accept as true with all the ideas you have offered
    to your post. They’re really convincing and will definitely work.
    Still, the posts are too brief for newbies. May just you please prolong them a
    bit from subsequent time? Thanks for the post.

  22. Titus says:

    I’ve been surfing online more than 2 hours today, yet
    I never found any interesting article like yours.
    It iss pretty worth enough for me. In my view, if all webmasters and bloggers made good content as you did,
    the wweb will bee much more useful thwn ever before.
    best way to buy instagram followers

  23. These v2 promo codes never ever expire to help you put your viewpoint easily before the anticipated time.

  24. Kathi Levin says:

    Thanks for sharing the article. If you are suffering from foot problems, contact our team of podiatrists in San Antonio for consultation. Visit us to know more about our services, location and many more.

  25. Nora Pratt says:

    Thanks for sharing the article. If you have any foot and ankle problems, consult a podiatrist at the earliest. Our team of podiatrists in San Antonio, TX provides consultation for foot problems.

  26. Rochell says:

    It is important to note that in order to sell your card it must not have been previously loaded
    onto your itunes account. Certain techniques have been proven over time to make him want to
    get back in touch with you – and even to want to restart your relationship.
    Getting birthday free e cards is also assured when you get your birthday greeting
    cards online.

  27. Hi, i believe that i saw you visited my blog thus i came to return the choose?.I am attempting to to find things to enhance my web site!I guess its ok to
    make use of some of your ideas!!

  28. Peter says:

    Hello admin, i found this post on 24 spot in google’s search results.
    I’m sure that your low rankings are caused by hi bounce rate.
    This is very important ranking factor. One of the biggest reason for high bounce
    rate is due to visitors hitting the back button. The higher your bounce rate the further down the
    search results your posts and pages will end up, so having reasonably low bounce
    rate is important for increasing your rankings naturally.

    There is very handy wp plugin which can help you. Just search in google for:

    Seyiny’s Bounce Plugin

  29. After creating the hosting consideration another undertaking
    would be to publish the internet site towards the server if you presently
    develop it within the local host.

  30. Before starting the first thing will be to make sure the customer has recently ordered an operating
    URL and hosting space.

  31. tea coffee says:

    Almost the same tea coffee caffeine purpose. They’re fairly cheap to operate, raising the bar from
    Shark competing with something likme the world’s largeest two wheeler rider must own.

  32. Jesse, I need you’re help.A bone spur developed on my left big toe joint about 6 years ago and I went to the FOOT DR right away. She said I had started developing Hallux Limitus. She didn’t recommend surgery at the time, so for the last 6 years, I played it safe, gave up high heels and got inserts made for my running shoes. For a few years, this worked! Over the past 2 years, I’ve developed ITBS, hip and lower back pain on the left side. I’ve read certain articles and they say that having Hallux Limitus or Rigidus can over time change your GAIT and cause pain in other areas because the BIG TOE push off when walking/running is very important. So I had my PT do a GAIT Analysis on me, he confirmed that i’m internally rotating my leg to avoid putting weight on the big toe. He said that I’m not suspanating and I’m doing a kind of swing motion where after toe off I my left heel points out, then swings my leg back to the front again. Its funny when I see it on a video.

    He suggests that I have the bone spur removed even though he said that my range of motion of my left Big Toe isn’t that bad when I dorseflexes it. But the fact that I’ve changed my gait is a concern to him. He had me do some Big toe joint exercises and tests. I had a very hard time doing, and when I did do them my toe joint started hurting so I would allow my leg to collapse in. Or when I stood on my tippy toes my ankle would stick out to support the weight. PT said I also do this collapse of the left leg when I’m squatting or doing one legged leg lifts, my left leg goes in to compensate. So now I’ve been having hip and groin pain and lower back pain and some doctors are saying I have a hip impingement but say I don’t show all the symptoms of a classic hip impingement. My PT said that even if I have a FAI and I had surgery, it still would fix my gait or that fix that i’m not pushing off my big toe properly, and thats why he suggests I get the bone spur out.

    I went back to my Foot Dr and she agreed to do a “cheilectomy” on my left toe. She’s not a runner and so when I talk to her about gait and anything else she just doesn’t get it. But she is one of the BEST Orth Surgeon’s in the area.

    What are you thoughts and advice?

  33. Thanksgiving is a time to give thanks for everything important to us.
    Download Page: Trees and Text Winter Background for
    Word. Once it has downloaded, open it and print as many copies as you need.

  34. "windows 7" says:

    Have you ever thought about including a little bit more than just your articles?
    I mean, what you say is valuable and everything. Nevertheless think about if you added some great photos or videos to
    give your posts more, “pop”! Your content is excellent but with images and video clips, this
    website could certainly be one of the very best in its niche.
    Amazing blog!

  35. Cary brief says:

    Hello, thanks for your article. I am trying to find a dr to deal with my big toe problem. I have a fused lumbar l4l5s1. (1999). Still have low back pain, bad leg pain, foot pain. Thing is my big toe has no strength for push off, it bends all the way back and hurts like it is broken sometimes. Went to foot dr and he blamed fusion and gave me narcotic topical (didn’t take). My pain dr says nothing. Since I do. Don’t know what the toe problem is called it makes it hard to get it taken care of, any suggestions? Thanks again. Cary in miami

  36. Caitlyn says:

    Since summer has arrived, some of the most popular organic items on the site
    are the organic and natural sunscreens and after burn skin care.
    The inlay skills were first applied in plane surface and then applied in curved surface.
    This gives it the quality of being able to breath – the
    air will flow through it naturally which
    means your skin will feel comfortable and free.

  37. Edith says:

    the Wii was first named the “Nintendo Revolution” then later
    changed to Wii prior to release. The Blue Ray disc drive greatly enhances the quality of video the users
    watch. Read the latest video game reviews at our video
    game blog.

  38. I am regular visitor, how are you everybody? This paragraph posted at this web page is
    in fact pleasant.

  39. Waylon says:

    This is, without a doubt, one of the first essential steps in training your puppy and
    an exercise our puppy needs to master in their early days. It is simple by hearing a clicking
    sound on the floor it indicates that their nails are long and need
    to be trimmed. Use the suitcase’s built-in pockets for
    pens and markers.

  40. Great article, and yet another example of just how impacting lower back pain can be on your overall health, great article!

  41. Very descriptive blog, I loved that a lot.

  42. Nice Post. I Learned a Nice Idea from your Post. Thank you very much for sharing.

  43. It is pertinent to note that Victor Ikpeba was an integral part of
    the Super Eagles squad from 1993- 2000. Given that you are
    at level 0 right now, you don’t have much of a choice in what you’re able to
    enter into for your first GT5 race. One such pistol that I know of is made by Kimber
    (I’ve previously written glowing reports about their products in the past) and is meets both of your requirements.

  44. […] Pain in the back? Check the big toe! […]

  45. Electrically passive adapters permit a smaller card to suit
    and function in a device constructed for a bigger card.

  46. After some dialogue, I was designated to speak on products
    legal responsibility on the panel, Blanton ‘Neal handled the attitude
    from building litigation, and Trey Suggs dealt with medical malpractice.

  47. I will be spending the following month on foot looking for a brand new
    place, and should you decide to come back to Columbia, this will probably be you
    very soon. In addition to specialty web sites, it’s also possible to search
    for room rentals on normal categorized sites reminiscent of

  48. James John says:

    Thanks for sharing the article. If you have any foot and ankle problems, consult a podiatrist at the earliest. Our team of podiatrists in San Antonio Tx provide consultation for foot problems.

  49. She mailed me a letter saying that if I did not pay by the twenty fifth
    she’d refer me to a lawyer.

  50. Still the agitation is determinate to come forth to as the
    microsecond you’re arrested inside Shelby county jail in Memphis Tennessee
    among hoodlums from unsteady levels parallel to massacrers, gang members, defilers,
    infant molesters, lifters, den of thieves and others, you need
    to get realization of the correctness and unimaginable codes of conduct.
    Search engine marketing experts provide marketing tools that boost the
    success of your website, making it a lucrative and successful enterprise.

    After hearing all the latest optimizing news, link building techniques (be it local or optimized search), there is a hot topic that is making everybody eager to know more information.

  51. Nothing’s ever gonna keep you down.) Thanks for following us and giving props to
    the 1000’s of nice, tremendous A+ TEDx events all over the world.

  52. So whether you are a minimalist or a know-how junkie, you may
    want to try all the brand new gear, clothing and accessories our staffers have put to the test.
    These are the Tuis, Out of doors Tech’s tremendous-premium headphones.

  53. Disney can not handle extra visitors for peak intervals.

  54. That will not happen with our Dead Trigger 2 hack, as a
    rssult of everything is completed fully on-line.

  55. Alex says:

    The description of symptoms of leg pain is greatly explained by web health network. It’s a must read.

  56. HEENA says:

    Can A Strong Core Reduce… Even Eliminate Your Joint Pain?
    You may have heard that a strong core is important for physical fitness.
    Unfortunately, what you’ve heard probably starts and stops with your abs, so you get a “sexy,” ripped” six-pack. That practically guarantees joint pain.
    If your core is weak, your joints compensate by bearing weight that your muscles can’t. Then target one muscle in particular and all the other weak muscles compensate, stressing your joints even more.
    Sooner, rather than later, that stress leads to joint pain in a vicious, downward spiral.
    What you probably haven’t heard is how a strong core can protect your joints, even end joint pain at the source.
    Because your core is a system of 29 pairs of muscles.
    But until now, this knowledge has been the exclusive professional secret of the very best sports doctors and physical therapists working for professional sports teams.
    Most of us just don’t have access to doctors and physical therapists who know how to teach you to engage, activate and above all, balance your core muscles.
    Quickly, without expensive equipment, complicated protocols, or spending several hours a day in physical therapy.
    Until now, thanks to former NBA pro and chronic joint pain relief expert Jonathan Bender. Who has a gift for making the complicated. Simple and easy.
    If you don’t want to suffer from joint pain any longer… or you want to escape it altogether, click to read “5 Ways Your Core Protects Your Joints.”
    It’s already improving my life. I think it can do the same for you.

  57. Tom McJury says:

    A question…I severed the tendon at the top of my big toe. Had surgery but never regained any control of the most distal segment of the big toe. Fast forward 7 months or so post surgery, I began to experience low back pain on the same side as the toe injury. This has gone on for well over a year. Do you think the two are related?

  58. Hello,
    Thanks for sharing the useful information.It is really a great blog.Also you can know more about onBest back of knee pain ayurvedic treatment nagpur

  59. This was a excellent informative post you have shared on this page about the pain of backbone but ,If the big toe can’t dorsiflex, the body is going to compensate for that lack of movement by trying to shift the body weight medially to get that big toe to hit the ground…the body is smart and will always find a way to do things to keep moving. When we don’t get the movement from the big toe, the knee must go into valgus collapse (knock kneed) to try and get as much weight on that big toe as possible for push off. When the knee goes into medial collapse, the hip moves into internal rotation and the lower back compensates by shifting towards the side of hip internal rotation. When the low back shifts, you can get muscle shortening, facet joint impaction, degenerative changes etc…leading to back pain that started from a lack of big toe extension.

  60. DemoskAce says:

    who is liam payne dating best time of year to start dating

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s