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

In my practice as a physiotherapist in Toronto, I see a lot of people come through the clinic doors with various aches and pains.

Very few of them are acute injuries, while many of them are overuse or repetitive stress/strain in nature.

While undertaking a clinical history during the assessment, I’ve noticed that for a vast majority of people, the one dangerous (in)activity that they do on a regular basis for prolonged periods of time is sitting.

The Dangers of Sitting

And most people unknowingly considered this a fairly benign part of their daily life.

As I’ve stated before, this typically starts in the morning at the breakfast table (for those that even have breakfast!), then continues on with the commute to work or school, then the sitting continues until lunch where more of this dangerous sitting business will take place.

Then, after lunch, most people will return to their desks, chairs and various seating apparatus to carry on with the same form of sitting that they completed all morning. At the end of the workday, the seated and sedentary commute home is initiated.

And with the arrival at home, the television is switched on for some well deserved post-work relaxation before supper, which will take place while seated. Post-supper, the same posteriors are plunked back down in those plush couches for some more TV viewing.

Then the same process takes place the next day. And the day after that. And the day after that.

While the above may not apply to everyone, there are a significant number of people who would have no difficulty in seeing their daily routine played out as noted.

I know this happens because these are the same stories I hear in my clinical physiotherapy practice everyday.

Here’s the rub…

This pattern of inactivity which plays out in millions of lives every day has fairly serious health consequences.

I recently came across an editorial press release for the British Journal of Sports Medicine entitled: “Are we facing a new paradigm of inactivity physiology?” that nicely sums up some of these dangers.

In the editorial the authors discuss how recent studies have suggested that long periods of sitting and “whole-body” inactivity (what we term sedentary behaviour) are “strongly associated with obesity, abnormal glucose metabolism, diabetes, metabolic syndrome, cardiovascular disease (CVD) risk and cancer, as well as total mortality.”

I don’t know about you, but I definitely feel that those are some pretty serious consequences from the simple act of sitting for too long.

The authors propose their new paradigm which consists of the following four tenets:

1. Sitting and limiting non-exercise activity may independently increase disease risk

2. Sedentary behaviour is a distinct class of behaviour with specific determinants and effects on disease risk, separate from the behaviour of leisure-time exercise.

3. The molecular and physiological responses in the human body of too much sitting are not always the same as the responses that follow a bout of additional physical exercise.

4. People already insufficiently physically active will increase their risk even further by prolonged sitting time.

As the authors conclude, there are actually two behaviours (and their resulting effects) that we need to address:

1. The benefits of regular moderate to vigorous intensity physical exercise

2. The risks of too much sitting and limited non-exercise everyday life activity

So what can you do about it and how can you avoid these serious dangers of sitting for too long?

In the next few blog posts, I’ll work through the above two issues and give you some simple tips and strategies that you can immediately incorporate into your daily life to help stave off these deadly sitting related health issues.

Yours in movement.

Dev Chengkalath

Over the past couple of weeks a few articles have been published in the popular press that have seemingly undermined the usefulness of the physiotherapy profession, and by extension, given us physiotherapists a bad rap.

In my practice, there are three things I consider of utmost importance, my own golden triad if you will: my clients, my profession and my reputation. And I will endeavour to protect all three.

The following link will take you to one of the most prominent articles cutting down the physical therapy for injury rehabilitation.

“Treat me, but no tricks please”

After my first reading, I could feel my blood pressure bubble over and and those small hairs on the back of my neck rise in defensive posturing.

Within the first few lines of the article Gina Kolata wrote:

“But the letter the angry doctor had received from his insurer made me wonder whether physical therapy was different from the plasma treatment. Is there rigorous evidence showing it works?”

Here’s this journalist cutting up the profession which has given me so much and allowed me to help so many people.

Then it all made sense.

Therapeutic ultrasound

A few lines later, I realized that Ms. Kolata lumped all physiotherapists with what I refer to as “CHUM therapists” (Cold/Heat/Ultrasound/Massage):

“When I’ve gone to physical therapy, the treatments I’ve had — ice and heat, massage, ultrasound — always seemed like a waste of time. I usually went once or twice before stopping.”

It seems as though my profession had been boiled down to a few “modalities” of treatment that are typically used as quick time filler or that could or should otherwise be done at home.

Ice Pack: Not really physical therapy

It seemed as though the actual “physical” aspect had been forgotten.

Most importantly, the cerebral nature of our job description was completely omitted.

And this reminded me of something the esteemed Dr. Shirley Sahrmann, physiotherapist extraordinaire, spoke about at one of her movement impairment syndrome courses. I can’t recall her words verbatim, but in broad terms she lamented the fact that the way the industry is set up, we get paid for procedures, not to think.

Modalities are procedures. Actual physical therapy work such as progressive exercise programming requires thinking. And time.

As physiotherapists, we should be first and foremost educators. We should be teaching our clients what may be causing them pain. We should be teaching them what they can do to  get out of that pain. And we should certainly be teaching them how to stay out of that pain.

And we should be using movement as our medication of choice.

Yours in movement.

Dev Chengkalath

Toronto Physiotherapist

“Every man is the builder of a temple called his body”

Henry David Thoreau

I agree.

If you want to see what Mike had to say, check out his blog:

http://mboyle1959.wordpress.com/2010/01/14/most-people-are-dead-at-35/

Yours in movement.

Dev Chengkalath

In my practice as a physiotherapist in Toronto, I often come into contact with people who end up at the clinic seeking relief from their low back pain.

While many of their stories are unique, there are always certain similarities.

This holds true for not only back pain, but also shoulder pain, hip pain, knee pain or any other pain that you can imagine.

One of the most common questions I’m asked at the clinic is:

“How long will my low back pain last?”

And that, my friends, is a great question.

In some cases, my clients had low back issues resolved within days while others have taken months or longer.

But really, that just means I don’t know.

I wish I had a simple answer but since the actual mechanisms of low back pain are so varied and distinct for each sufferer, I wouldn’t honestly be able to answer that question with a blanket timeframe.

It just doesn’t exist.

There is no magic bullet, cure-all pill or results-guaranteed surgery. There is no exercise panacea.

Unfortunately.

However, in cases of mechanical low back pain, if you remove the root causes of the pain, the body has the incredible ability to heal itself.

While that task may appear simple, it’s not necessarily easy.

Fixing a bad back will take time and effort on your behalf. You will have to be consistent in working on improving your situation.

You’ll have to be willing to acquire the knowledge to learn what’s causing your pain or keeping you there.

You’ll have to be willing to break old habits, be aware of your postures and alter your positions.

You’ll have to be willing to do the work.

Basically,  you’ll have to give your body a chance to heal.

And that begs the question that has become the title of this blog post:

“How long will you let yourself suffer with lower back pain?”

What would you do to stop it?

What steps would you take?

What information would you need?

What price are you willing to pay?

What would you be willing to sacrifice?

These sound like hard questions to ask yourself, but they are absolutely necessary.

I’m looking forward to hearing your comments.

To your low back pain relief.

Dev Chengkalath

As the name implies, this isn’t for those people who are in the midst of an acute low back pain attack.

In fact, I would say this isn’t a physiotherapy core exercise for most people who are in any form of pain…

…Unless they can get out of the pain through abdominal bracing and using a neutral spine position. And they can hold that position without much difficulty.

That being said, in my Toronto physiotherapy practice, I use this exercise often when my client has progressed from the basic core re-training program to add a little variety to the exercise and rehabilitation program.

In this dynamic variation of the plank exericse, the key is to keep your body in that set “plank” position, without allowing your hips or your low back to sag or peak, while you raise and lower your body from your forearms to your hands.

This follows the idea of avoiding excessive flexion or extension based (forward or backward bending) positions through the low back (as discussed in the 3 Worst Core Exercises For People With Low Back Pain).

Yours in planking (dynamically or otherwise!)

Dev Chengkalath