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

By now I hope you had a chance to try out the suitcase carry, either at your local gym with dumbbells in your hand or maybe even at home with your trusty Samsonite filled with your now obsolete hardcopy Encyclopedia Britannica collection.

If not, give it a try when you get a chance.

While I’m a huge fan of “functional training” I do believe the term is overused much like a “Paris Hilton and Lindsay Lohan Going Back to Jail” headline splashed across your favourite grocery store tabloid.

In my mind, all training should be functional. Otherwise, why are you doing it?

Hard core exercises are no different.

If the exercise doesn’t challenge your core in the manner in which it was designed, are you really getting all the benefit that you could be getting?

Resist movement and transfer energy: the ultimate core mantra.

With that in mind, this next simple exercise is a even easier to set up than the suitcase carry as it requires absolutely no equipment. However, I’m going to change the levels up a little bit.

Welcome to the Cross Over Plank.

The set up: get your body into a plank position. If you’re not strong enough to drop into the full plank, start on your knees and build up.

From this plank position, keep your body stable as you reach across with one hand and hover that hand over top of the other hand. Hold it there for 4-8 seconds, without letting your torso and hips rotate in any way. Return to the start position and switch hands.

And there you go, another episode of hard core exercises.

Yours in movement.

Dev Chengkalath

In a previous post, I covered some of the worst things you can do to your back, which included potentially harmful core exercises such as the abdominal crunch.

So if you had to take out crunches because the risk-to-benefit ratio wasn’t in your favour, what could you do instead?

If you aren’t already aware, the functions of the core are to resist movement and to transfer energy. Keeping this in mind, how could you set up your core exercises to target the appropriate muscles without putting you at undue risk?

Over the next few posts I’ll breakdown some of the exercises I consider to be indispensable when rehabbing a back injury, wanting a tight and toned midsection or improving athletic function.

The first exercise, which I’ll cover today is called the suitcase carry.

If the first thing that came to your mind was a picture of you walking around with a suitcase, you wouldn’t be far off the mark!

As the name implies, this exercise is simply walking around with a weight in one hand, mimicking the act of carrying a suitcase.

That’s it.

Don’t be misled by the simplicity of this movement, however!

While the set up and execution are rather straight-forward, the burn you will feel is intense.

How to set it up:

Pick a weight that you’ll find challenging for the distance or time you’ll be walking with it. This is the one of the most important parts of this exercise.

If you don’t have a dumbbell, you can improvise and actually use a suitcase filled with books or other items to give it some heft. In a pinch, cinder blocks or water-filled milk jugs will do. You’re only limited by your imagination!

Once you have a weight selected, stand up tall with a neutral spine. Keep your head and chest up and start walking slow and purposefully. Your posture is a key component and will let you know if the weight is too much, not enough or just right.

At first, you may not feel anything at all. Then suddenly, you may find yourself tilting your torso away from the side carrying the load, your unloaded arm held out to the side as a counterbalance. You need to fix this: stand up tall and bring your arm back down!

When done correctly, you’ll start to feel a fairly intense burning sensation along the obliques and lower back on the opposite side from the arm holding the weight. So if you are holding the weight in your right hand, you’ll feel the burn on the left side. This is normal. The muscles of the unloaded side are the one that have to do all the work to keep your body erect.

Walk the for the distance or the time you’ve selected and then switch sides.

Simple yet effective: this is a hard core exercise.

Give it a try and let me know how it felt.

Yours in movement.

Dev Chengkalath

Putting it all together: Treatment

You’ve now completed your medical history, you’ve been observed, you’ve been put through all the physical tests…

So what does it all mean?

The treatment component of the physiotherapy visit is where everything should come together and get you started back on the path to doing what you love to do, be it playing with your kids, gardening or high performance sport.

As discussed previously, the history and observation gave us the clues to set up the physical tests. The physical tests in turn gave us your baseline data; the “what you need to fix”.

The treatment is where all that information is put to good use. This is where it is processed, analyzed and converted in to a physical rehabilitation or performance program.

What exactly does this program entail?

Well, in my books, each program should cover three major aspects.

If any of these three are lacking, there is risk of perpetuating or exacerbating the injury or dysfunction.

Using a client with low back pain as the example, this is how I would potentially set up a treatment plan.

Knowledge is power

1. Knowledge: Does my client know what component(s) of his or her life is/are causing or contributing to the low back pain? Is he or she aware of how to remove some, if not most, of these or minimize their impact? Have I helped my client realize the impact of both internal and external factors (e.g. body structure as internal factor, work environment as external factor)? Basically, does my client understand what steps need to be taken consistently to resolve the issue(s)?

2. Motor Control: This is where I make sure that my client is clear on the impact of his or her daily postures and how he or she can improve/modify them. After treatment, my client should be comfortable understanding how any muscle imbalances play a role, how mobility (excessive or lack thereof) at various joints (e.g. immobile hips, hypermobile lumbar spine) may influence tissue damage and how specific movement patterns may determine repetitive stress or overuse (e.g. poor sit to stand mechanics). Not only should my clients understand these motor control areas, they should be able to teach me what they need to do to resolve them (e.g. stretches, exercises, proper movements/postures etc).

3. Conditioning: Have you ever been injured only to use that injury as your reason to stop all physical activity? Or have you had your healthcare provider tell you to “take rest” for extended periods of time? This break from exercise has the potential to lead to significant de-conditioning and further prolong healing time. Often, it is quite possible to work “around” an injury by choosing the appropriate exercises or activities to maintain or even improve overall conditioning levels while allowing injured tissues to heal!

And there you have it.

A treatment plan outline for a client suffering from low back pain. Using this outline, the details would be specific to the individual coming in for treatment. It would represent what that individual would likely have to do to work towards relieving low back pain.

Yours in movement.

Dev Chengkalath

Range of Motion (ROM)

The range of motion of a joint is typically tested in 3 ways.

I’ll be restricting my post to the first two, which are active and passive ranges of motion.

The final range testing is done through what’s termed joint play. This is done by the physiotherapist using very specific movements of joints when they’re held in specific test positions and will give information on the integrity of the joints’ ability to glide on each other properly.

Active ROM is tested by asking you to move through as much range of motion that you can.

For example, if I were to test your shoulder’s active ROM, I’d simply ask you to lift your arm straight overhead as far as you can. I could further differentiate between shoulder flexion (straight overhead from in front of you), shoulder abduction (lifting your arm overhead from the side) and shoulder extension (moving your arm backwards and up).

While fairly easy to test, I don’t find active ROM appropriate for all areas of the body and very seldom test the lower back for active ROM. I prefer to teach a majority of my clients (especially those looking to relieve low back pain) to minimize lumbar spine movements.

Passive ROM is tested typically at the end of active ROM, and usually only if there are deficits in the available range when completed actively. This gives us a baseline level of knowledge on how far your joints are actually able to move (total range) and how far you’re able to move within that range (available range).

Strength Testing

As with ROM testing, strength testing can take o many forms but I’ll just highlight a few here today. These are: manual muscle tests (MMTs), resisted isometric movements (RIMs) and functional movement tests/screens.

MMTs can be used to test specific muscle groups by placing those muscles in specific test positions and then challenging them. This gives the physiotherapist key information on how well a certain muscle or muscle group may be functioning.

Overhead Squat Test

RIMs are tests designed to compare the function of contractile tissues (e.g. muscle) with the function of inert or non-contractile tissue (e.g. ligaments). In the proper RIM test position, contractile elements (along with nerves) are challenged. Inert tissue, should not. This allows the the physiotherapist to distinguish between damage to inert tissue (ligament sprains) or damage to contractile tissue (strains of the muscle).

Functional movement tests/screens are based on taking you through specific movements to see how you do. These can include many different positions or exercises such as squats, lunges, push ups, or planks. The results of these tests give information on qualities such as balance, control, body awareness, strength, coordination, injury risk and many others.

In fact, a failed functional test could very well become your treatment exercise!

Special Tests

The last of the tests are called special tests. These are designed to test very specific outcomes and in the hands of a skilled clinician can yield important information that may help elucidate a physiotherapy diagnosis. Some examples of these tests include ligament stability tests (e.g. Lachman’s  test for the ACL), nerve or vascular tests (e.g. Roos stress test for thoracic outlet syndrome) and specific injury tests (e.g. Neer’s test for shoulder impingement).

So there you have it, a brief outline of the information gathering process.

While these tests are important in their own right, it’s just as important to look at the whole clinical picture which includes the medical history, the observation and the results of the physical examination. By the end of this week, I’ll put it all together and show you how all this information forms the basis of a treatment plan.

Yours in movement.

Dev Chengkalath

Part 3: The Physical Testing

Note: When i originally wrote part 3, it ended up quite a bit longer than I was expecting, so I’ve actually split it into 2 parts, the first of which you’re reading here and the second, which will be posted tomorrow.

Da Vinci's Vitruvian Man

Now that your physiotherapist has completed the medical history and has been observing you non-stop, it’s time to move on to the physical testing.

This is where the massive amounts of information from the the former two components are digested, analyzed and tested more rigorously. This is where those theories ruminating in our minds about what may be ailing you or what may be stopping you from your optimal level of performance are challenged, supported or rejected.

The physical testing will form the active part of your rehab or performance treatment. Unfortunately, this may also be the part of your visit that could cause discomfort or recreate your pain. This should be short lived and in the interest of gaining as much information about your situation as possible which will be used to create your treatment plan to get you out of pain and back to function.

There is typically a structured order by which we take our clients through the process so that we may gather the most pertinent information in a logical sequence. That being said, there is no one ideal method of running through a physical examination and you may find that various practitioners will have different approaches to testing for the same information.

In the end, it’s not so much how the information is gathered that matters most.

What matters most is what’s done with it.

That will ultimately make the positive or negative impact on your health or performance status.

Before I break down the physical testing, here’s my caveat: this is by no means an exhaustive or comprehensive discussion on the subject. This is merely a VERY brief overview to give you a basic understanding of why we do what we do and what we hope to achieve by doing it.

For the sake of brevity, I’ll be focusing tomorrow’s blog post on 3 areas:

1. Rage of Motion (ROM) (active, passive, joint play)

2. Strength (RIM, MMT, movements: squats, lunges, etc)

3. Special tests

Yours in movement.

Dev Chengkalath