Why Your Ankles Might Be the Root Cause of Your Knee or Back Pain

If you’ve been dealing with nagging knee pain or persistent lower back issues, you’ve probably spent time foam rolling your quads, stretching your hamstrings, or blaming your posture. But what if the real problem isn’t in your knees or back at all—what if it starts way lower?

Your ankles might be the hidden culprit.
It sounds counterintuitive, but restricted ankle mobility and poor foot control can create a chain reaction of dysfunction that affects everything upstream. In fact, many physical therapists, strength coaches, and movement experts agree: the ankle is one of the most underrated players in joint health and total-body alignment.

This isn’t just a theory—it’s backed by clinical research, athletic performance data, and real-world results.

The Body Works in Chains—Not Isolated Parts

The human body is a kinetic chain. That means every joint affects the movement and stability of the joints above and below it. If one link in the chain is off, compensation occurs. And often, that compensation shows up as pain elsewhere.

Take the ankle: if it lacks proper dorsiflexion (the ability to bring your toes toward your shin), the body has to find a workaround when squatting, walking, or running. That might mean collapsing inward at the knee (valgus collapse), tilting the pelvis forward, or shifting the hips unevenly—all of which can lead to discomfort or long-term wear and tear.

A 2014 study published in the Journal of Orthopaedic & Sports Physical Therapy found that limited ankle dorsiflexion was significantly associated with dynamic knee valgus during single-leg movements—one of the major risk factors for ACL injuries and patellofemoral pain.

How Ankle Mobility Affects the Knees

Your knees are hinge joints. They’re designed to move in one primary direction—forward and backward. But when your ankles are stiff or restricted, your body may force the knees to rotate or collapse inward to make up for that loss of motion. This puts added stress on the ligaments and connective tissue around the knee.

That’s why athletes who improve their ankle mobility often see immediate relief in knee tension. The movement pattern becomes more natural, aligned, and force is distributed properly through the lower chain.

Using a simple slant board can help target that limited range of dorsiflexion, allowing for better joint loading during squats, lunges, and step-downs.

How It Impacts the Lower Back

Now let’s move up the chain to the lower back. The spine sits above the pelvis, which is heavily influenced by hip mechanics. But guess what determines hip mechanics? Foot placement and ankle mobility.

When your ankle can’t move freely, your foot position often compensates by turning out, and your hips may shift or tilt to accommodate. This often results in lumbar extension (arching the low back), anterior pelvic tilt, and overactivation of the spinal erectors—leading to chronic low back tension.

Dr. Kelly Starrett, a renowned physical therapist and founder of The Ready State, frequently emphasizes that low back pain often stems from mobility issues below the waist. In multiple interviews, he points to ankle and foot function as overlooked sources of mechanical dysfunction in both everyday movers and elite athletes.

Test It Yourself: Ankle Mobility Check

Here’s a simple test to evaluate your ankle mobility:

1. Stand facing a wall, barefoot or in flat shoes.

2. Place one foot about 4 inches from the wall and try to bend your knee forward to touch the wall without lifting your heel.

3. If you can’t reach the wall without your heel popping up, your dorsiflexion is limited.

If you fail this test, your body is likely making up for it somewhere else—possibly your knees or back.

Using a mobility wedge kit for calf stretches and ankle mobilizations can make a huge difference in just a few weeks.

Common Symptoms Linked to Poor Ankle Mobility

• Tight hip flexors

• IT band pain

• Flat feet or collapsed arches

• Low back tightness during or after walking/running

• Uneven squat depth or valgus knees

• Knee clicking or grinding during movement

These are all red flags that your body might be compensating for a lack of control or mobility further down the chain.

Solutions: Improving Ankle Function for Pain-Free Movement

Improving ankle function isn’t complicated, but it requires consistency and attention to detail. Here’s what a solid ankle-focused routine might include:

1. Soft Tissue Work:
Use a lacrosse ball or foot roller on the bottom of your feet and calves to release tight fascia and trigger points.

2. Dorsiflexion Drills:
Perform knee-to-wall drills, loaded ankle rockers, or use resistance bands to encourage more motion at the joint.

3. Strengthening the Foot Intrinsics:
Weak foot muscles contribute to poor arch support and ankle collapse. Toe curls, arch lifts, and short foot drills can reawaken these muscles. Tools like toe spacers can also help realign the foot structure over time.

4. Walking Barefoot (or in Minimal Shoes):
Footwear with narrow toe boxes and elevated heels restrict natural foot movement. Gradually introducing barefoot walking (at home or on safe surfaces) can improve proprioception and control. For a transitional option, consider minimalist training shoes.

5. Ankle-Loaded Movements:
Try front-foot elevated split squats or heel-elevated goblet squats to load the ankle through greater ranges of motion with control.

Functional Benefits of Better Ankle Mechanics

Correcting ankle mobility doesn’t just reduce pain—it improves performance. Enhanced dorsiflexion allows for:

• Deeper, more stable squats

• Efficient walking and running mechanics

• Improved agility and balance

• Better force transfer through the legs

• Less compensation from the knees and back

In one study by The International Journal of Sports Physical Therapy, collegiate athletes with poor ankle dorsiflexion showed significantly reduced vertical jump height, sprint times, and agility scores compared to peers with adequate mobility. That’s not just a rehab issue—it’s a performance limiter.

Real Talk: Most People Ignore Their Ankles

Why? Because ankle work isn’t sexy. Foam rolling your calves or doing toe curls doesn’t look impressive on Instagram. But if you want to move better, lift safer, and stop bouncing from injury to injury, ankle mobility has to be part of the plan.

Try incorporating a stretch strap into your daily warm-up or cooldown to reinforce mobility and control without needing complex routines.

Final Take

When it comes to pain and dysfunction, the body rarely points to the exact cause. Your knees might hurt, your back might ache—but the source may be your ankles. Poor mobility, collapsed arches, or limited dorsiflexion can throw off your entire movement chain, forcing your body to adapt in ways that eventually lead to pain.

But there’s good news: ankles are extremely trainable. With a bit of attention, consistency, and smart tools, you can restore mobility, improve alignment, and dramatically reduce discomfort higher up the chain. The next time your back flares up or your knees feel tight after squatting, don’t just stretch your quads—check your feet and ankles first. They might be quietly asking for help.