Head forward
of optimal alignment
collarbone, the head is too far forward for
optimal alignment and may be contributing
to their lower back problems (Chek 2001;
Price 2018).
2
Lower back
overarches
Figure 1: Excessive curve in the lower
back as a result of a forward head position
Evaluating the position of the head
The following assessment can help you
evaluate whether a client’s head position
may be contributing to their lower back
soreness.
Ask the client to sit on a gym ball or on
the edge of a chair with the feet and head
facing forward. Stand to one side of the
client and locate the part of their cheekbone
that protrudes outward the most, just below
the eye. Place one of your index fingers on
this part of the client’s cheekbone and your
other index finger directly below it on the
client’s collarbone. With your index fingers
positioned in this way, stand directly over
your fingers and look down to assess the
position of your index fingers in relation
to each other (see Figure 2). Ideally, they
should be vertically aligned, that is, with the
tip of one finger directly below the tip of the
other (Chek 2001; Price and Bratcher 2010).
If the end of the index finger on the client’s
cheekbone is forward of the one on their
Overpronation
Overpronation, or collapsing of the feet
and ankles, can cause musculoskeletal
imbalances and myofascial restrictions
to the structures of the lower back (Price
2018). Overpronation causes the feet and
ankles to roll toward the midline of the
body which, in turn, rotates the lower legs,
knees and upper legs inward. This change
in the position of the legs causes the hip
sockets to shift backward, the pelvis to
drop down and forward, and the lower
back to overarch (see Figure 3) (Price and
Bratcher 2010). Over time, this can cause
excessive stress and strain to structures of
the lower back and be a major underlying
cause of pain and dysfunction in this area
of the body.
Evaluating for overpronation
The following assessment can help you
evaluate whether overpronation may be
contributing to a client’s lower back pain.
Ask the client to stand in bare feet facing
you in their normal standing position. Now
take a look at their feet, ankles and toes for
visual indications of habitual overpronation.
Since overpronation results in excessive
pressure being transferred over the inside of
the foot and ankle, the following issues may
be present (see Figure 4):
• inflammation and/or swelling at the ankle
• inflammation of the first joint of the big
toe (i.e. bunions)
• calluses on the skin of the big toe
• a big toe that has shifted toward the
lesser toes (i.e. hallux valgus)
• lesser toes that are scrunched up and/or
appear bent and crooked.
Overpronation also rotates the knee toward
the midline of the body. To compensate
for this position of the knee, a person will
unconsciously turn their foot/feet noticeably
outward to help externally rotate the lower
leg and align the kneecap forward again.
Therefore, a person who overpronates will
typically have an abducted foot position (see
Figure 4).
Lower back
overarches
Hip scoket
shifts backward
Pelvis
anteriorily
rotates
Upper leg
rotates inward
Figure 2: Assessing for forward head position
Lower leg
rotates inward
When the head is forward of its optimal alignment,
the lower back arches more than normal to help
support the weight of the head
Foot
overpronates
Figure 3: Overpronation affecting
the position of the pelvis and lower back
24 | NETWORK SUMMER 2018