# Improvement of Myofascial Lower Back Pain During Standing and Forward Bending Through Manual Physiotherapy to Increase Ankle Dorsiflexion: A Case Report

## TL;DR

A high school athlete's lower back pain improved after physiotherapy focused on increasing ankle flexibility, suggesting a link between ankle mobility and back pain.

## Contribution

Manual physiotherapy targeting the flexor hallucis longus muscle improved ankle dorsiflexion and reduced myofascial lower back pain.

## Key findings

- Manual stretching of the flexor hallucis longus increased ankle dorsiflexion range of motion.
- Improved ankle mobility led to reduced lower back pain during forward bending in a standing position.
- The patient remained pain-free and returned to athletic performance seven months post-intervention.

## Abstract

Lower back pain substantially affects the quality of life of affected individuals, and effective treatment remains challenging. Here, we test the hypothesis that limitations in lower limb mobility, particularly at the ankle joint, contribute to compensatory movement patterns associated with lumbar pain. An 18-year-old male, high school javelin thrower, presented with right-sided lower back pain during forward bending in the standing position. Tenderness was noted in the right quadratus lumborum muscle, and the pain was relieved by manual anterior pelvic tilt during forward bending. Although temporary relief was achieved by improving hamstring flexibility and hip flexion range of motion (ROM), the effect was not sustained. Re-evaluation revealed posterior pelvic displacement during ankle plantarflexion, indicating a compensatory pattern because of restricted ankle dorsiflexion. Manual physiotherapy, including targeted stretching of the flexor hallucis longus (FHL) muscle, was administered to improve ankle dorsiflexion ROM. Following the intervention, the dorsiflexion ROM increased, and the patient reported a reduction in lower back pain during forward bending. At the seven-month follow-up, the patient remained pain-free and had returned to his previous level of athletic performance. Physiotherapy targeting the FHL muscle to improve ankle dorsiflexion ROM may be effective in reducing myofascial lower back pain during forward bending in the standing position.