Relieve Low Back Pain | Reduce Low Back Pain | Canada's Leading Authority in Human Movement | Dev Chengkalath

Over the last couple of blog posts I’ve explored the basic concept of sitting.

Surprisingly, when broken down, it’s not as simple as it seems. It’s not all about just plunking yourself down into your seat. There are rules and regulations to be followed for optimal spine health.

This holds true for the simple art of standing as well.

The Art of Standing

Standing is probably the first movement pattern that we lose over time. Sadly, in many cases, the loss of this ability will ultimately lead to the loss of personal independence.

So what can you do to hold on to your youth?

Practice proper standing.

Or more specifically, fix your sit to stand. This is what I spend countless hours helping my clients understand at my Toronto physiotherapy practice.

Since I’ve covered the optimal sit in the previous couple posts, I won’t belabor the point other than to reiterate how important that initial component of the sit to stand really is. It sets you up for success in the latter half, the stand.

The stand:

Let’s start off with the final position of the sit with your spine in neutral. Make sure your feet are wide enough apart. This will give you an appropriate base of support from which to initiate the standing motion. For most people, a hip to shoulder width distance tends to work well.

Now that your feet are set and you have a good foundation to start from, it’s time to switch focus to the hips.

As you start that standing movement, lean forward through your torso. By leaning forward, I don’t mean you should be flexing through your spine! This is a very important point to keep in mind.

Your back still maintains that neutral position with the motion taking place through your hips.

As you lift yourself up into a standing position, you should be bringing your hips forward by thrusting through your buttock. Think of this as hinging through your hips. The following video clip demonstrates the hip hinge pattern with movement through the hips while the spine remains in neutral.

A common movement pattern mistake here is using the muscles of the low back to ratchet or “pull” yourself up. This will put all sorts of potentially harmful forces through your low back.

Putting it all together:

Now that you’ve got the sit from before and you’re aware of how to initiate the stand, it’s time to integrate all those bits of information together and complete the sit to stand as demonstrated in the following video.

While this may not seem like a lot, if those of you with low back pain paid attention to how you executed this movement, over time you’d save your spine from some significant trauma.

Think of it this way, how many times do you sit and stand in a day? In a week? In a month?

Now if you could remove those unnecessary forces, how would your back feel?

Yours in movement.

Dev Chengkalath

In yesterday’s post, I discussed the subtle loss of stability in the lumbar spine when most people complete the sitting action.

Today, I’ll be giving you some quick physiotherapy tips on how you can fix your sitting. In the next post, I’ll give you tips on how to improve your standing from a sit.

As always, I’ll be using my trusted three part approach for relieving low back pain:

1. Knowledge

2. Motor Control

3. De-Conditioning

First, recognize that you are doing something to yourself multiple times a day (repeated sitting with loss of control) that is causing trauma to your tissues and that you must remove these injurious forces in order for healing to take place. If these forces aren’t removed or resolved, things just won’t get better.

You have take action to fix it.

This is the knowledge component.

Second, improve your motor control.

Recognize that motor control encompasses four major components including posture, movement patterns, mobility, and muscle balance. Each of these areas will have to be addressed for a long term solution.

This is the action phase where you apply your knowledge.

Start by fixing your posture as described previously (just click the link to be taken directly to the posture post).

Next, learn proper sitting mechanics. Sure, you’ve known how to sit since you were an infant, but when’s the last time you checked to see if you were doing it right? Are you sure you haven’t picked up any bad habits along the way?

You can work on mobility (loosening the hips and stabilizing the spine) and muscle balance (think about resolving any imbalances you may have because of compensations or specific movement habits) concurrently using simple drills such as the quadruped hip rocking movement in the following video clip.

Finally, and just as important as the other two areas, is fixing your fitness level. If you’re de-conditioned, you’ll let gravity do more work than it should, especially on the sit (remember the plop?).

Putting it all together…The sit breakdown:

From a standing position, control yourself down towards your seat while keeping your lower spine in neutral position (between rounded and arched). As your buttock descends towards the seat, push your hips backwards, making sure you keep your spine in that optimal, stable alignment.

Toronto Physiotherapist Demos Neutral Spine Sit To Stand

Some common errors include standing with your feet too close together, rounding your back as you sit down and of course, not controlling yourself down. Another often seen compensation is the use of the arms to lower yourself down.

Toronto Physiotherapist Demos Bad Sit: Posterior Pelvic Tilt and Rounded Spine

As your buttock touches down on the seating surface, this is where you need to be aware of the potential for loss of control through the lower back and pelvis. The plop tends to allow the lower back to round and the pelvis to fall into a posterior pelvic tilt (tailbone tucked under position).

For a proper sit, don’t allow the lower back to deviate from the neutral position throughout the WHOLE movement. Maintain that position right from the standing to the descent into the seat.

And that, my friends, is how you should be sitting. With control and purpose.

How many of you can honestly say that you pay attention to how you sit down every day?

If you’re experiencing low back pain, it’s probably time you started.

In the next post, I’ll work through the standing component to keep your back healthy and safe.

Yours in movement.

Dev Chengkalath

While sitting and standing (think squatting) may seem like the most rudimentary task, it’s by far the most improperly executed activity that most of us do everyday.

Don’t believe me?

Take a look at the next person beside you, or within eyesight, to sit down (I’ll go over the standing part in tomorrow’s post).

Slouched Sitting Postures: Over time can lead to injury.

I’m not just saying have a cursory look.

Rather, I’m asking you to actually observe them going through the full cycle of this basic human movement.

What do you see?

If you look carefully, you’ll see some very interesting applications of physics at work.

Gravity in all its glory will accelerate those gluteals at 9.81 meters per second squared until the firm (or plush) surface of whatever seating receptacle becomes a barrier to any further downward gravity-assisted movement of the buttocks.

And this is usually where it gets really interesting.

For those of you out there who don’t spend your days observing people and how they move, you might not notice or even care. But for the rest of us physical therapy types, this is fascinating.

This is where imprecise compensatory repetitive motions come into play.

As soon as those glutes start their heavily gravity-assisted travel towards the seat, the “plop” is almost inevitable. You know the plop I’m talking about. It’s that free-fall into the chair when muscles are turned off and gravity does all the work.

Now as soon as those glutes hit the seat and no further downward motion takes place, for most people (and especially those with low back pain) there is a subtle loss of  lumbar spine stability.

What does that loss of stability look like?

Well, this loss of motor control can be seen with the posterior tilt of the pelvis (think of this as tucking your tailbone underneath yourself) coupled with the rounding of the lower back and the forward carriage of the head (see above photo for slouched spine postures and forward head/neck position).

This wouldn’t be so bad if it were corrected right away. In fact, this correction is imperative to relieve low back pain!

Ideal Sitting Posture: Easy to find, hard to hold.

However, the major issue is that once this slouched posture has been achieved, it tends to be maintained thus becoming a prolonged posture (which coincidentally  is one of two components of overuse tissue trauma, the other being repetitive motions).

So how do you fix it?

In tomorrow’s post, I’ll go through a detailed breakdown of the sit  (and then the return to standing) and how you can fix it using the three part approach outlined in my previous post re-capping the causes of low back pain.

Yours in movement.

Dev Chengkalath

I’ve received some feedback the last little while and it seems that people like lists. They’re quick to read and easy to understand.

You ask and you shall receive…

From my experiences as a physiotherapist in Toronto, these are the top 5 things you do to your back that you should not do:

1. Abuse it: This is probably the most simple item on the list. Almost every one of my physical therapy clients, with a little bit of prodding, can tell me exactly what activity causes them back pain.

Yet they keep doing it.

If something hurts, stop doing it.

This likely leads to low back pain...

This includes exercises. Or body contortions as pictured above.

In most cases, pain is a signal from your body that something isn’t right. Usually it means that some sort of tissue is being damaged.

2. Prolonged Postures: The big culprit here is sitting. How many of you spend more than 15 minutes in the exact same position? How many of you spend an hour in the exact same position?

I’m willing to bet that there are quite a few of you who spend your days driving in a car, commuting, riding in airplanes, and more specifically sitting at a desk in front of a computer (usually for HOURS on end!).

Slouched Sitting Postures: Over time can lead to injury.

Then you get home and crash on the couch in front of the TV, or worse, lie down in bed in awkward postures, twisting your body to get a good view of the screen while “relaxing”.

By maintaining these postures for longer periods of time, you don’t let the tissues recover from the stresses that they face.

Think of this like an elastic band that you stretch and hold. Eventually, when you let go, it won’t spring back to the original length. The same thing happens to your body tissues.

As stated previously, the best postures are the ones that keep changing.

3. Repetitive Motions: Similar to prolonged postures, numerous repetitive motions have been shown to be the major factor in disc herniations with full lumbar flexion (rounding of the low back) being the major player.

What exactly are repetitive motions?

Think about bending a paperclip back and forth over and over again. Eventually, the paperclip will break.

To get an idea of some of the repetitive motions that we use regularly, just have a look at the previous post where I discussed the 3 worst core exercises for people with low back pain. Each of those exercises puts the lumbar spine through those exact repeating movements (flexion, extension or rotation) that can potentially lead to intervertebral disc injuries such as bulges.

4. Neglect it: According to Dr. Stuart McGill, and the study he cites by Luoto et al (1995), low back muscular endurance appears to have a greater protective effect against low back injury than does low back strength.

Ergo, make sure you work on your muscular endurance using exercises such as the Birddog and plank variations.

McGill also suggests that lower back exercises seem to have their greatest positive effect when executed daily, and not 2 or 3 times as week as most exercise sessions are set up.

So don’t neglect your back!

5. Ignore it: This is the most surprising item on the list, but the longer I’m in clinical practice the more often I see this.

People will live with their back pain for years without doing anything about it.

Or worse yet, they will ignore it and work through it. Sometimes they will even wait patiently for the latest excruciating episode to clear up. There are people out there who can help you.

Find them and let them help you fix yourself.

Yours in movement.

Dev Chengkalath

The power of the internet can’t be doubted.

It has the ability to spread knowledge across the globe in real time. You have a problem, google it, and more than likely you’ll find a solution.

So what’s wrong with that?

As a physiotherapist in Toronto, these are the questions I ask myself: How good is the information you’re getting? Is it valid? Reliable? Can it be trusted? Will it help you? Or will it hurt you?

This holds even more weight when dealing with physical issues such as injuries or illness. Plug in your signs and symptoms and within seconds, hundreds, if not thousands of webpages will be returned for your perusal.

It’s no different with relieving low back pain. Plug in those search terms and instantly you’ll have at your disposal more information than you could possibly even use.

When looking at low back pain, a good portion of the information that’s returned discusses strengthening your abs to fix your back problems. At times, this is similar to the information many people are given by their medical and fitness professionals: “Build a strong core to protect your back”.

Unfortunately, abdominal training is typically considered the foundation of core training. In reality, abdominal training is only a small part of the bigger picture. And in some cases, poorly designed or applied abdominal training can actually be what’s keeping you in pain.

As I’ve already talked about six pack abs and low back pain, I’ll just stick to giving you some ideas on how to keep your back strong, safe and healthy. Without further ado, here’s my list of the 3 worst core exercises for people with low back pain:

The abdominal crunch or sit-up: These staples of most back rehab programs should be eliminated because of the tremendous compressive loading forces that they create through the discs of the spine. There are better ways to train the core!

Dr. Stuart McGill, one of the foremost spine researchers in the world, has measured compressive forces of approximately 3300N (730 lbs) in the spine with these types of exercises.

This is equal to the amount of force noted by some government health agencies as the amount of force needed to cause injury!

Abdominal machines (crunch and twist machines): So if crunches or sit-ups can cause as much damage to your spine, imagine what happens when you take the same exercise, restrict movement at certain joints, isolate movement at others (in this case the lumbar spine) and then add a load.

Doesn’t sound very good, does it?

Now take that same flexion movement add a loaded rotation component on the twisting abdominal machines and you’re well on your way to getting yourself sent off to the disabled list.

In fact, we’ve  dubbed these types of exercises “disc herniators” and inform our clients on continuing to do these only if they wish to help us finance our latest exotic car purchase.

www.madwhips.com

Take home message: save your spine and stop flexing and/or twisting through your low back!

Back Extension Machines: As described by Dr. McGill, the repeated spine flexion/extension movements used by these devices create the same conditions that were necessary in his lab to produce disc herniations.

Enough said.

Why would you want to do the same to your back at home?

So there you have it…The 3 worst core exercises for people with low back pain. If you love your back, stop doing them.

Let me know your thoughts. Do you agree? Disagree? Or just not care?

Yours in movement.

Dev Chengkalath