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

Let’s face it.

Back Pain Sucks.

And it really does get in the way of life.

But it doesn’t have to!

Over the past few years in my physiotherapy practice I’ve had the pleasure of working with some wise and insightful clients on their journey towards a back pain free life.

For some of these individuals, the constant irritating pain has been a loyal companion over long stretches. At times abating to a dull nagging “friend” that tags along for the ride. And at other times rushing to the forefront of their awareness in crushing, life-altering waves of excruciating spasms.

Through their pain, suffering and journey towards salvation, each of these clients has taught me something new about living life with back pain.

Without further ado, here are the top 5 things that my clients have taught me about back pain:

1. You can do something about it: You don’t need to live with the pain. There are solutions out there. You may just need to dig a little deeper and search a littler harder. Ask around. Find out what others you know who have had back pain have done. This doesn’t mean their solutions will work for you, but at least it’ll give you someplace to start.

2. Keep moving: Exercise almost always helps. In most cases of low back pain, appropriate movement will help. It will keep joints lubricated, muscles working and mental outlook up. If you’re carrying a few extra pounds, losing those will ease the load on your spine and other joints. Even dropping 10 lbs will significantly decrease the wear and tear on your body. Getting in shape will dramatically improve your capacity to tolerate various stresses, mental and physical.

3. Empower yourself: Be your own best advocate. Only you truly know how your back pain impacts you. Only you are the “expert” on your own life. It’s easy for someone else to sit across a desk from you and say “stop doing ____.” They aren’t the ones living your life. It’s much better if the people who are supposed to help you, work with you, to generate workable solutions that can be implemented in your “real world” and not in some imaginary or unattainable “ideal world”.

4. Consistency is key: Stay on track and keep at it. Don’t give up. Be relentless. There will be peaks and valleys on your journey towards relieving low back pain but in the end, you will find a solution that works for you, a solution that will let you get back to the business of enjoying life.

5.  Know and respect your body’s limits. The body is capable of some pretty amazing feats. It can heal and repair itself from some pretty incredible situations if given the opportunity. This does not mean you can’t push the limits or even reset them. By all means, this should be the goal when looking at reaching new heights of human movement and performance. Just do so safely within the tolerances of your body structures.

If you have any insights on relieving low back pain, I’d be interested in hearing about them. Drop me a comment and let me know.

Yours in movement.

Dev Chengkalath

It seems to me that people like lists.

They’re short. Concise. And should be to the point.

And if created correctly, they’re pretty easy for most people to remember.

So here goes…

This is my list of the five worst things you’ve done to you low back today:

1. You’ve flexed through your lumbar spine on fully hydrated intervertebral discs (yup, these are the same discs involved in those famous disc herniations or “slipped discs”). In fact, this was probably the first thing you did this morning upon awakening from your more than likely short and insufficient sleep.

• Sitting bent forward on the edge of your bed in that sleep induced haze right after you wake up.
• Sitting in that same bent forward and flexed position on the toilet.
• Brushing your teeth, washing your face, and maybe even standing slouched in the shower.
• Hunched over the breakfast table (you SHOULD be eating breakfast!).

2. You’ve spent more than 30 minutes (this being a fairly conservative guess) in a static and continuous slouched posture.

• Collapsed on yourself with your ribs resting on your pelvis during your commute to work (this includes planes, trains and various forms of automobiles).
• In your standard computer posture in front of that technological wonder that was designed to make your life easier and more manageable. This position likely has you with your head protruding and your shoulders rounded forward for extended periods of time.
• On the couch watching your favourite television programming (typically for a few hours) after a long, grueling and tiring day at the office.

Slouched Sitting Postures: Over time can lead to injury.

3. You sit. And sit. And sit. Enough said. Follow the link if you need more info on the dangers of sitting.

4. You wear high heels. This one is mostly for the women out there, although, who am I to judge? This piece of fashion will confer the wearer with an instant and noticeable alteration of lower limb appearance. But at what cost?

• Centre of gravity shifts with resultant changes in weight bearing
• Increase in lumbar spine curvature (increased lordosis, possibly excessive)
• Altered muscle recruitment patterns, biomechanics and gait patterns

5. You decided that you were too tired to exercise today. This follows along with number 2. And number 3. I think everyone is aware that exercise is good for you so there’s no need to belabor that point. It’s just a matter of prioritizing it to get it done.

Yours in movement.

Dev Chengkalath

It seems as though my  Toronto physiotherapy practice doors act as some sort of magical entrance to the land of body awareness.

For the brief period of time that they’re with me, my clients allow themselves to be aware of what’s going on with their bodies.

For those brief moments, they reconnect with how their bodies function.

For that period of time, they are in control of their pain.

It’s true.

The number of times I have seen my clients turn their pain on and off in my treatment room is astounding.

While I don’t believe in physiotherapy miracles, I would even go so far as to say it’s almost magical.

And what’s more amazing about this pain control is that it’s done without powerful drugs, fancy high tech machinery, or, in most cases, any equipment at all.

There are almost no adverse reactions.

Contraindications are almost non-existent.

And the time investment, surprisingly, is just a few seconds at a time.

So at this point, you’re probably wondering what this panacea for pain relief really is.

It’s movement.

Don’t be confused.

It’s not just any movement, but movement with a purpose.

The simple act of moving your body in a precise fashion to retrain your tissues to respond in a specific way.

It’s movement designed to unload certain irritated joints and tissues, while activating inhibited ones.

It’s movement designed to improve your motor control and put you back in the driver’s seat of your body.

The Movements:

Over the last couple weeks I’ve had great success addressing a variety of aches, pains and dysfunctions with the following two motor control movements.

The first one, a forward wall slide, is fantastic for dealing with tight, painful shoulders and upper backs.

And the following video clip of quadruped rocking is extremely helpful in addressing hip and low back issues.

So if you’ve got some of those aches and pains, give these movements a try.

But remember, it’s not just about doing the movement for the sake of doing it, it’s about doing them with purpose. It’s about feeling what your body is doing. It’s about breathing. It’s about taking control of your body back.

Yours in movement.

Dev Chengkalath