Limited Hip Internal Rotation Is Associated with Low Back & Lower Limb Injury Risk
A major 2024 meta-analysis shows that alignment issues in the feet, ankles, knees and hips — often overlooked — are significantly associated with chronic low back pain (LBP). This adds strong evidence to our holistic, whole-body approach: pain rarely resides where it hurts.
What the research shows:
The study pooled data from multiple high-quality trials, collectively analyzing more than 100,000 individuals. ResearchGate+1
Key findings: people with flat feet or excessive foot pronation/ankle eversion were significantly more likely to suffer from low back pain than those with normal feet/arch structure. PLOS+1
Additional associations (with moderate to limited evidence) were found between increased hip internal rotation, knee internal rotation, and LBP — indicating that misalignment through the lower kinetic chain (ankle → knee → hip → pelvis/spine) correlates with back problems. ResearchGate+1
The paper also highlights that these issues are not just static posture problems — many of the included studies examined alignment during walking/stance, meaning dynamic alignment matters a lot. PLOS+1
Why this matters — and how it supports our method:
Many back-pain treatments focus on the spine alone. This research shows that the source of pain often lies downstream — in the feet, ankles, knees, or hips. That means treating the spine in isolation may miss the real root cause.
Because misalignments propagate up the kinetic chain, fixing foot posture, ankle alignment, gait & lower-limb mechanics can reduce pelvic/spinal stress, which is exactly what our posture & gait assessments are designed to catch.
This research supports a holistic, system-wide evaluation rather than isolated muscle work or spinal adjustments — aligning directly with our philosophy at Functional Patterns (or Burleigh Biomechanics).
For clients with chronic back, hip or knee pain — especially those with structural knock-ons from flat feet, pronation, knee valgus/rotations, or poor gait — this gives a science-backed rationale for movement-based correction rather than repeatedly chasing symptoms.
If you’ve been dealing with persistent lower-back pain, hip or knee discomfort — and want to address the root cause instead of masking symptoms — book a Posture & Gait Assessment or check out our Online Training for corrective movement and alignment work.
Research link:
Association between lower limb alignment and low back pain — Abbasi S, Mousavi SH & Khorramroo F (2024). PLOS ONE 19(10): e0311480. DOI: 10.1371/journal.pone.0311480 PLOS