Ankle assessment being performed by a physiotherapist for low back pain

Why did the physiotherapist assess my ankle when I have low back pain?

How often have you wondered why your physiotherapist is insistent on checking more than just your localized pain points?

For example, you called and specifically requested treatment for low back pain. When you arrive at the clinic, you are asked about your knee and ankle, your physiotherapist explains the reasoning behind the whole-body assessment, but then you are in pain, and it probably didn’t make sense to you at that point.  

“You want me to move my ankle when I’m here for back pain?”. You’re confused and left wondering if you mentioned your very specific concerns at all or if your physiotherapist is was just not a competent professional? Gulp. 

Your concerns are valid, and we hear you. You chose the best physiotherapy services with us at Revere Physiotherapy, and we have your back- literally and metaphorically. This blog post is written to clarify all your doubts on this topic. 

In order to truly manage your dilemma, it is essential to understand the physiotherapy concept of regional interdependence.  

What is regional interdependence? 

  • Imagine your stationary body to be tower of Jenga blocks. The goal is to keep all the bricks on the pile without letting any one slip. However, if you have played the game, you know how it works.  
  • When any one brick is removed, likened to a localized injury, the other two bricks in that row take on additional weight and the alignment of the tower above and below that point is quite precarious. You can see the entire tower is shaky. Weight is not distributed evenly through the pile, and it is prone to collapse.  
  • When it comes to our body, it is hardly stationary, it is a moving tower of Jenga blocks. All these forces on the body are always changing depending on the physical activity and posture. It is not just moving up and down, the body moves sideways, front to back with a certain degree of rotation. If any of the structures are locally injured, the ones above and below take up more than they are designed to do ideally. 
  • In other words, all parts are interdependent on each other to keep the entire tower from collapsing. That is regional interdependence. 

Why is regional interdependence relevant for you? 

  • The first step in the physiotherapy process is the assessment. 
  • The Selective Functional Movement Assessment (SFMA) is the framework used by physiotherapists to carry out a thorough assessment to inform decisions for treatment plan and exercises. Regional interdependence is one of the core concepts based on which the SFMA was designed. 
  • Regional interdependence refers to the concept that seemingly unrelated impairments in a remote anatomical region may contribute to or be associated with the patient’s primary complaint.
  • Traditional medical training given to a physiotherapist ensures that the physio therapist can perform a standard orthopaedic assessment which would include assessing the area of primary complaint and considering it in isolation. Unless, the patient had a diagnosis of a neurological disorder, the traditional medical model did not necessitate a whole-body assessment.
  • However, recent advances in physiotherapy insist on viewing the body, especially the motor system, in its entirety, even in the absence of a neurological condition.
  • By broadening the clinical focus, your physiotherapist will be able to detect unrelated limitations unrelated to the medical diagnosis given by the doctor, but vital to ensuring you are able to perform all the activities of your choice after treatment.
  • In the absence of this whole-body perspective, there are increased chances for recurrence of pain and discomfort and further complications. This is like cutting off the weeds just enough so they’re not visible above the ground level. If you’re a gardener, you can tell, that’s not very helpful.
  • Regional interdependence requires the physiotherapist to pull out the weeds altogether to ensure thorough recovery. 

Core principles of regional interdependence. 

1. Source versus cause:
  • The first point of contact for a patient with pain is usually the physician, in this case your physician will give you a medical diagnosis. 
  • While this medical diagnosis serves as an explanation of the origin location (source) of your pain, it does little to explain what caused is the cause of your pain 
  • This is best understood as source versus cause. The SFMA guides the rehabilitation profession or physiotherapist to the most dysfunctional part of the body that is affecting your movement pattern adversely. 
  • Regional interdependence provides the theoretical framework to assess and treat seemingly unaffected parts of your body.
2. Mobility/Stability alternating pattern:
  • Researchers have described the body to be working in alternating patterns of mobility and stability.
  • “The body works in an alternating pattern of stable segments connected by mobile joints. If this pattern is altered, dysfunction and compensation will occur.” 
  • If you have noticed in your body, as per a normal pattern, some joints are more mobile than others; hip is more mobile than the knee and the ankle is more mobile than the foot, your thoracic spine moves more than your lumbar spine etc.
  • This wonderfully complex design ensures safe and effective movement, but it also helps describe injuries. 

Clinical application of regional interdependence. 

Let’s go back all the way to your initial question, why is your ankle being assessed when you have low back pain?

  • The position of your ankle while engaging in activities like lifting objects, running or walking influences the hip musculature which in turn directly determines the extent to which your lumbar spine will stabilize or move to keep you from falling over.  
  • If your ankle isn’t mobile enough, then your lumbar spine will have to move to compensate. Your lumbar spine is not meant to be a mobile joint. This can result in injuries in the back. Understandably, fixing your ankle mobility will correct the movement altogether and relieve your lumbar spine of unnecessary movement.  
  • Similarly, researchers have found shoulder stabilization exercises to be just as effective as elbow exercises for tennis elbow 
  • There are numerous applications for regional interdependence within the field of rehabilitation science.  
  • As you can probably tell by now, it is imperative to see your body as a kinetic chain and identify weak links to fix your chronic pain and improve overall movement.  

At Revere, we understand how all this can sometimes be intimidating. We have the best expert physiotherapists who are committed to ensuring a complete and thorough recovery. Patient education is something we take seriously and we will do our best to alleviate all your concerns and set you up for successful and pain free movement patterns. 

Reach out to us at We are offering a FREE 10-minute consultation call with our expert physiotherapists. Call us at (604) 566-5108    

If you feel ready, book an appointment with our expert physiotherapists. Share this article with friends and family who could benefit from the best physiotherapy services at Revere Physiotherapy.


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