by Mitch Hauschildt, MA, ATC, CSCS
I recently had an athlete that I evaluated with long standing plantar fasciitis on her left foot that has failed traditional physical therapy, multiple PRP injections and other conservative treatments. During my evaluation process, I found a lot of things that I won’t go into here (because I already discussed the patient on Instagram so feel free to read more there), but it did remind me of the importance of the connection between the shoulder and the foot. And, when I say that foot, I mean the ankle that is opposite that of the affected shoulder.
If you look at the human body as merely a bunch of joints and pieces, then this connection is hard to comprehend and you probably think that I’m a bit crazy by suggesting that this connection actually exists (and really matters). But, if you see the human body as a larger system, a big machine, if you will, then keep reading because you’re my kind of person.
I find that the shoulder and opposite foot/ankle are oftentimes related. When one shoulder hurts, the opposite ankle is restricted, or there is lower leg or foot pain somewhere. And the opposite is true as well. Many would say it is a coincidence. Some would say its because of the patterns that we use when we play sports or perform specific activities. I disagree with those because I see this among athletes and non athletes alike and athletes of all kinds of different sports.
The bigger question, in my opinion, should be, “how are they connected?” Don’t just take my word for it that they are connected. You need to understand that they are connected so that you can really own the information and then integrate it into whatever you do in your practice.
I see it as 2 different ways that we can connect the dots. Either may be right and both may actually be wrong, but based on what we know about anatomy, physiology and movement science, this is my take on it.
Spiral Line Approach:
Thomas Myers does a great job of explaining fascial anatomy in his book, Anatomy Trains. It gives us a very good understanding of how the body moves along traceable myofascial meridians. One of his fascial lines is the spiral line. I find that this line is extremely important to understand and train for the people that I work with. We as clinicians and trainers do not do a good job of training people with rotation. Because this fascial line wraps the entire body in a helical pattern, it affects a lot of joints and systems throughout the kinetic chain.
As it pertains to the shoulder and the foot, we can use the spiral line to help us see the connection. The spiral line starts on the back of the neck and crosses the upper spine and into the rhomboids and serratus anterior before crossing the torso on its way to the opposing hip. We know that the rhomboids and serratus are imperative to preventing shoulder dysfunction. Most people who struggle with shoulder impingement do so because their scapular stabilizers aren’t doing a great job of controlling the scapula and providing a firm foundation for the joint.
The spiral line then continues down the lateral hip before crossing over the lower leg and creating a stirrup under the foot (or a jump rope as Thomas Myers would put it) and then continuing up the back side of the body.
Dysfunction along this fascial line can easily cause foot and or shoulder pain because it provides a solid foundation for both areas of the body. And, because we know that fascia connects us both mechanically and neurologically, this one line can explain how one shoulder and the opposite hip are connected. It also explains why improving how people function in the transverse plane can help both areas as well.
Functional Line and Mechanical Approach:
This way of looking at the connection involves us using a couple of different concepts and bridging the gap between the two. First, we need to look at the upper extremity. We know through the back functional line that the lats and some of the scapular stabilizers are connected with the opposite glute through the thoracolumbar fascia. The back functional line explains how our body “cheats” through movements at times and efficiently transfers force from upper to lower and lower to upper, especially in the transverse plane. Thus, if one lat isn’t working well, the opposing glute likely isn’t working well and vice versa.
I also see a huge connection between ankle mobility and glute function. I do believe that there is a neurological connection between the two, but that is a little bit hard to visualize. I think an easier way of looking at the connection is more of a mechanical approach.
The mechanical approach to this connection states the our center of gravity has a lot to do with how these two areas function. If the glutes aren’t working well, we tend to go into an anterior pelvic tilted position. When we rotate our pelvis forward, our center of mass shifts posteriorly. In that position, we require less ankle dorsiflexion to stay upright, so if we stay in that position long enough, we will lose that mobility. And the same process can go from the foot up. Either way we look at it, if someone can’t dorsiflex, they likely don’t have great glute function.
So, to tie it back together, if the lat on one side doesn’t work well, the opposing glute doesn’t work well. If the glute doesn’t work well, the ankle on that side will often times be restricted. It can go both top down and bottom up. Either way, pain and dysfunction will take place.
I’m sure there are other ways and explanations for looking at the connection between the shoulder and the foot, but these are the two that I default to and make the most sense to me. The bigger picture here is to simply understand that we MUST evaluate and treat the human body as one large machine. We are a singular system. Treat it as such.