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

The physical assessment: observation

Physiotherapy Medical History

In the first part of this series I outlined the importance of a client medical history. This medical history will typically highlight some, if not all, of the potential root causes and contributing factors of your low back pain.

This medical history gives us the foundation upon which to structure the next component of our physiotherapy assessment: the physical exam. This is where we can test and observe how your body moves, works and functions both as isolated parts and in unity as a whole. This is where we can figure out if you have any mobility issues, postural dysfunctions or biomechanical faults. Using this information then helps us figure out how we can work collaboratively (that’s right, you have to be an active participant for this to work!) to resolve them.

The physical assessment can be broken down in to two components:

1. Observation
2. Physical Testing

In today’s blog post, we’ll be focusing on observation.

Observation of your movement and postures starts from the minute you step in to the clinic. While it’s listed under the physical exam, this component can actually take place before, during, and after the medical history. In fact, I’ve secretly followed clients out to their cars (and corrected how they get in and out of them!) to see how they move without knowing they’re being watched.

Here's looking at you.

We physiotherapists like to watch how you move, if you have any compensation patterns, how you hold your body, how you shift your weight, how you walk, how you remove your jacket, and a host of other seemingly ordinary activities.

All of these can give us clues as to the cause and/or the source of your low back pain (see my post on “cause vs source” for more information). All of these can give us clues as to how we can help you fix them!

For example, a client who winces or has difficulty bending forward to remove her shoes tells us that her body doesn’t like flexing forward, all without saying a word. In fact, even how she bends forward furnishes useful information on potential movement issues.

Slouched Sitting Postures: Over time can lead to injury.

The client who who resists twisting while removing his suit jacket let’s us know he isn’t a fan of rotation. This information will allow us to set up further tests during the physical testing. Again, without saying a word.

The client who sits on the examination table, slumped and slouched, with shoulders rounded forwarded and chin protruding gives us an idea of his body awareness and the types of postures he likely adopts for long periods of time during the day.

This is but a small sample of how these vital bits of information that can be garnered without a word spoken.

As you can see, observation is one of physiotherapy‘s most powerful tools. It directly impacts and influences what physical tests we’ll choose and ultimately what interventions we’ll apply to help you relieve you low back pain, get you back to function and performing optimally.

Stay tuned as next week I’ll break down the physical testing component of the physical exam.

Yours in movement.

Dev Chengkalath

Over the next couple weeks, I’ll take you through a general physiotherapy assessment to figure out what you’ve been doing to beat up your back for so long and what you can do about it.

• In part one, I’ll detail the often ignored importance of a basic medical history.
• In part two, which will be posted in a few days, I’ll delve into the first component of the physical assessment: observation
• In part three, to follow next week, I’ll discuss physical testing.
• In part four, I’ll outline some potential treatment options.
• And in part five, I’ll outline what you need to do to stay out of pain.

So stick around for the next couple weeks and stop beating up your back!

Part 1: Medical History

While this component of the assessment may seem a bit mundane, it’s probably one of the most important aspects of the whole process.

My clients come in thinking they’re going to get answers. The first thing they get are questions. Lots of them!

This is where my clients always wonder why I’m asking them so many open ended questions, or whether or not those questions have anything to do why they’ve come to my clinic to see me. This is also where they wonder, sometimes out loud, why they’re paying me to “chat” with them instead of treating them!

Believe it or not, your medical history will almost always give clues as to the cause and extent of any of your mobility problems. As I’ve stated numerous times before, without knowing the nature of the root cause of your physiotherapy issues, it’s almost impossible to resolve them.

This remains the case with relieving low back pain as well.

Not only does your medical history help with ruling out red flags or serious pathology that require medical intervention, it’ll also give me the clues that I need to figure out what you’ve done, how you’ve done it and potential methods on how we can fix it.

This could be something as simple as you telling me that you work 60 hours a week sitting at a computer or hunched over a drafting table.

It could be you describing what time of day the pain is better or worse.

It could be you just stating, in your own words, what types of activities are easy or challenging for you.

Or it could be you simply describing the type or quality of your pain and discomfort.

And these questions are just the first steps. Gathering all the pertinent information from the medical history sets the foundation for your physiotherapy assessment that follows.

What may seem simple or innocuous to you might actually be the clue that opens up another direction of questions and queries, all intent on helping you find your path to pain free living.

Yours in movement.

Dev Chengkalath