Ankle Pain and the Neck Part 2

Part 1 discussed why a patient’s sinus tarsi syndrome may have been due to cumulative trauma, driven by over pronation.  Then how the patient’s anteriorly rotated pelvis on the same side may have been causing this over pronation. This part will discuss how the upper cervical spine can influence the pelvis and thus the feet.

You will recall from part 1 that this patient had an anteriorly rotated left pelvis. The question then is why? Undoubtedly there was a muscle imbalance holding it in place as shown by his tighter muscles on the front of the left leg and low back. This was coupled with relatively longer hamstrings and bottom muscles on his left side.  Thus giving a fairly typical pattern of muscle imbalance. However what caused this muscles imbalance?

In this patient’s case his hips were shifted to the right. Try this now, STAND UP, actually it even works sat down, shift your hips right and feel what happens to your pelvis. You’ll find the left side tips forward and the right side tips up towards your chin. Again the patient’s flexibility assessment showed that the muscles pulling the hip to the right were tight and their antagonists (muscles that oppose their action) were looser. The next question is why are the hips shifted right?

One surprisingly common reason the hips will shift right is if the top vertebra (spinal bone) of the neck is misaligned to the right. This bone known as the atlas has your spinal cord running through it. Further it has important nerves that control functions such as heart rate and blood pressure (sympathetic) in close proximity as well as the vertebral artery, which along with the carotid provide the primary blood supply to the brain. Due to it’s proximity to so many important tissues misalignment of the atlas can have far reaching consequences. For example correcting the alignment of the atlas has been shown to dramatically improve posture, including pelvic tilt and alignment, and more shockingly reduce blood pressure more effectively than 2 drug therapy (Bakris et al 2007).

The reason the atlas causes a pelvic shift is very simple. If you experience a head trauma e.g. car accident, playing rugby or falling over whilst drunk and banging your head. Then the atlas is likely to be misaligned as it is the most unstable vertebrae in the column. If the head is shifted slightly right the eyes are no longer in the optimal position for ideal vision. Therefore the body will alter the position of the hips and shoulders below to bring the eyes level with the horizon. So if the head is out to the right it will bring the hips and shoulders underneath so the head is back in the middle. Thus creating this patient’s posture.

It should be remembered that the human body is a complex system of systems. Whilst the upper neck has a large influence on the ankles, so do many other areas and the questions then remains, why is the upper neck misaligned? For this there are many further causes; breathing, the jaw, vision, hearing, vestibular issues, organ issues, mental-emotional issues and other parts of the musculoskeletal system can all influence the jaw. This patient is also undergoing treatment to optimise function in some of these systems as well.

For brevity many details are omitted from this blog if you would like to discuss the topics in this blog please comment or email me at

Next week we’ll explore why so many people have flat upper abdominals but bloated lower abdominals. How are your lower abdominals?


Bakris, G. Dickholtz, M. Meyer, P.M. Kravitz, G. Avery, E. Miller, M. Brown, J. Woodfield, C. and Bell, B., 2007. Atlas vertebra realignment of arterial blood pressure goal in hypertensive patients: a pilot study. Journal of hypertension, 1-6, [E pub].

atlasatlas misalignmentbakris et al 2007CHEK assessmentsindividuals and the community.kieran macphailnutritional medicineover pronationpelvic shiftpersonal trainingphysiotherapyposturepronationsinus tarsi syndromesports massage and classes to companiesteamsvirtusvirtus