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Dem Bones

You may be familiar with the song which describes how the “toe bone is connected to the foot bone, the foot bone is connected to the ankle bone, the ankle bone is connected to the shin bone”. A beautifully simple and clear lesson in skeletal anatomy, but there is so much more going on!

We are born into gravity and for the rest of our lives we are in a constant relationship with it. It is sometimes a battle, and gravity very often wins! But our bodies are very specifically designed to engage in this relationship – we have bones that are shaped and placed to bear weight and/or transmit the forces associated with gravity. In theory, if we used our bodies as they are designed, we shouldn’t have a problem with gravity. And I’m not just talking about losing your balance and falling down, I’m talking about the slow deterioration of joints, the “falling” of the arch of your foot, the downward sloping of the shoulders. Of course, there is the natural ageing process, but most of us spend a lifetime developing postures and movement patterns that will potentially speed up that process. How do these dysfunctional patterns develop? Through compensations. These are the acquired patterns that we adopt to keep us moving upright through gravity when we’ve been injured – and it’s not always a traumatic injury. Sometimes the injury is the slow onset of dysfunction related to how we spend our lives – sitting 8hrs a day, for example!

How does this relate to the song? Well, as I said, there’s much more to it than one bone connected to the next – the position and function of one joint can affect joints all the way along the chain. Let’s consider a common area of injury which may result in compensations down the line. “The hip bone is connected to the back bone” – in anatomical terms this is the iliac bone connecting to the sacrum. Perhaps you’ve experienced some low back or hip/buttock pain and been told it is your “SI joint (sacroiliac joint)”? This is the joint between the “hip bone” and the “back bone”, and as such it is very important in translating forces between your lower body and your upper body. The sacrum is a wedge shaped bone at the base of your spine and is specifically designed to translate forces (not weight bear) from above, across the wide base at the top of the bone through to the hips. If, through trauma (a fall on the ice), or habitual positioning (seated with legs crossed), your sacrum is knocked (trauma) or pulled (muscles from habit) out of position, it will no longer transmit those gravitational forces evenly through the pelvis. Now, with a sacrum in a dysfunctional position, there is more weight being born on one side. Sacral dysfunction often does illicit local discomfort, and may prompt you to seek treatment. But in some cases, it isn’t treated and a compensatory gait has already developed, altering the positioning of the hip, the knee, the ankle, and the bones of the foot, allowing them to bear that extra little bit of weight that is coming down the line, keeping you upright in gravity. And thank goodness those joints did compensate, otherwise a lifetime of sitting with your legs crossed would mean you would fall over every time you tried to stand up! But it also means that now these joints are doing more than their share, and here we have the accelerated ageing mentioned earlier. (And don’t even get me started on how altered movement of the sacrum can affect the contents of your pelvis (bladder, uterus, prostate, colon), and even the spine and head!)

And to be clear, it can work in both directions – maybe that old ankle injury has altered weight bearing at the foot, and years later your knee and hip are giving out. So don’t be surprised if after a thorough assessment your manual therapist tells you that even though your pain is always in your left hip, the problem is originating at your right ankle!

Now that you see how your body is a functional unit (not a bunch of pieces operating independently), what advice do I have? Treat it that way! Move! In every possible direction – let your muscles do all of the things they were designed for (how often do you use the full range of your shoulder?) When you move, move the whole thing! When you seek treatment for a specific pain, don’t forget to mention that you repeatedly sprained your ankle when you were younger. Don’t leave out that you have frequent headaches, or digestive issues. Your manual therapist may ask you a lot of questions that don’t seem to be related to your complaint, now you know why!

Maybe the song should be “the foot bone is connected to… everything!”