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

In the last blog post, mobility, stability and flexibility were defined in the context that I will be using them.

This is important to keep in mind as they have very different applications when it comes to relieving low back pain issues.

Quick Recap:

Mobility refers to the available motion at a joint, generally taking into consideration the amount of control exerted through that range.

Stability is on the same continuum as mobility but refers more specifically to the ability to resist excess motion and maintain joint integrity under neuromuscular control.

Flexibility (which falls under the broad expanse that is mobility) for our purpose will refer to the total range of motion available at a joint, whether or not it is under neuromuscular control

Mobility, stability and flexibility on low back pain:

As stated before, most people with mechanical low back pain have decreased mobility (are hypomobile) at their hips (think of the hours you spend sitting in a flexed hip position!) and have excessive movement through their lumbar spines (hypermobile or flexible lumbar spines; think of those poor, slouched postures you sit or stand in for long periods of time!).

This becomes a problem because the body will do what it needs to do to create the movements you want it to create.

In many of these low back pain cases, this means that the hips won’t extend far back enough. The body just can’t get enough movement through the hips.

The  body’s solution: find the next best place to achieve that extension in order to execute the desired movement pattern.

Unfortunately, this almost always means excessive movement through the flexible (hypermobile) lumbar spine.

Hypermobile Lumbar Spine

What does this mean for you?

Well, if you now have too much movement going through an area that is supposed to be stable, various tissues will get irritated and injured.

For most people, this won’t happen right away.

In fact, for most people, this happens over a longer period of time because they repeat those same injury-causing faulty movements over and over again, day in-day out, week after week, month after month, year after year.

Remember repeated flexion and extension through the lumbar spine is the primary stimulus for the creation of bulging or herniated discs.

Now imagine what happens to those poor lumbar discs if you repeatedly flex then extend through the lumbar spine to make up for your loss of hip mobility…Not a very pretty picture at all!

One day, the last straw is placed on the camel’s back, and it breaks.

So how do you save the camel’s back?

Well my friends, in the next post, I’ll go over some specific strategies that you can put in place to stabilize your spine and mobilize your hips.

Just remember this equation and many of your back troubles will disappear:

Stable Spine + Mobile Hips = Healthy Back

is to use poor technique when exercising.

How many of you have see someone doing an exercise at the gym or fitness centre that just made you cringe?

How many of you have wanted to go over and suggest a “safer” way of executing a certain movement?

Poor exercise technique (which includes poor exercise selection) is probably one of the most common exercise errors that causes or perpetuates low back pain. 

And it’s rampant!

Many people learn new exercises from books, magazines or on the internet. I know I’ve picked up a few that way. The problem with this type of “education” is that it isn’t always ideal. There is too much room for error. 

Three of the most common exercises prone to technique faults that put your low back at significant risk for injury include the squat, the dead lift and the common sit-up or crunch.

With the first two, most people are familiar with the risks as these have been embellished and extrapolated in gym lore, passed from generation to generation. Typically, excessive rounding of the lower back takes place, putting spinal structures at risk of failure. While the risks are real, the benefits from these exercises, for the properly qualified and instructed individual, far outweigh them. 

The last one, sit-ups or crunches (I’ll use the terms interchangeably) are a little more insidious. Many people are told by their physical therapists or trainers that they need to strengthen their core to relieve their low back pain. For many of these people, the first exercise that comes to mind are abdominal crunches. 

Unfortunately, this type of exercise is not only ineffective for core training, but it’s also potentially harmful. Having heard about the dangers of crunches, many people will then try another variation, under the assumption that this “different” version is somehow safer. It’s usually not. 

There are, however, many safe and efficient exercises out there for relieving low back pain. The key is to qualify yourself for the exercise while weighing the risk to the benefits. 

Yours in physical therapy,

Dev Chengkalath

As a physical therapist in Toronto who treats a lot of low back pain, a significant part of my job is to educate my clients on how they can become their own healers.

My goal is to not only enable them to get themselves out of pain, but to keep them that way.

Permanently.

As part of my client education, I always define three words:

Cause. Source. Symptoms.

By defining these, my clients should have a better understanding of what it really takes to relieve their low back pain and get back to enjoying life. 

Enjoy your life, pain free.

The Cause: The producer of an effect.

For low back pain, the end effect is a negative one. The “cause” is what leads to the direct, or more often, indirect, production of the pain, pathology and dysfunction.  For example, in some low back pain cases, repeated lumbar spine flexion and rotation movements put excess pressure on the discs. The discs wear out and bulge. This bulge in turn puts pressure on a nerve root, which then leads to pain to shooting down the leg.

In other cases, the cause may be repeated poor postures (think slouching in front of a computer or TV) for hours on end. This then leads to stretching or trauma over time to certain tissues such as the ligaments. These tissues will then become injured and painful. 

Notice how the cause was the repeated movements or postures which then in turn injured the discs or ligaments.

The Source: The tissue that is irritated, injured or involved that directly leads to the production of pain.

In many low back cases this can be the facet joints, the vertebral discs, nerve roots or ligaments, to name a few.

Disc Bulge: Why did it happen?

Notice how if you were to only look at the source of the pain, you wouldn’t take into consideration the reason that the disc is bulged in the first place or the reason the ligament was stretched excessively.

The Symptom(s): This is what you feel as a low back pain sufferer.

remember him?

Keeping with the same examples, in the first case you would feel the shooting pain down your leg (aka sciatica). Maybe some numbness, tingling or muscle weakness as well. In the ligament sprain case, you may feel some tightness or protective muscle spasm in the area around the injured site with localized aches and pains.

Now if you were only dealing with the symptoms, you’d deal with less than if you were just looking for the source tissue and even less than if you were looking for the cause!

Basically, you’d deal exclusively with stopping that immediate pain.

You might use hot packs, cold packs, pain medication, muscle relaxants or other modalities such as interferential current. You may avoid painful movements and take plenty of rest. 

The easy stuff. 

Notice how if you were only to deal with the symptoms, you’d just mask the deeper underlying issues.

To recap, as a physical therapist who treats a lot of low back pain, my first priority is to educate my client, to empower them to become their own healer.

To do that, they must learn a very important lesson:

Separate the cause, the source and the symptoms so you don’t miss out on identifying and removing the real reasons that you are suffering from low back pain.   

Dev Chengkalath

“O bed! O bed! delicious bed!
That heaven upon earth to the weary head.”

Thomas Hood, Miss Kilmansegg – Her Dream

 

Truer words were never spoken. 

How many times have you crawled into bed thinking that this was your escape from the wear and tear, the hustle and bustle, the rigours of your never-ending day?

How many times have you risen in the morning only to feel the exact same way you did when you laid your weary head down onto your pillow?

Foggy. Un-refreshed. Exhausted.

How about those times when you’ve gone to bed feeling great, but then wake up the next morning all stiff, sore and achy?

Sleep should be your salvation from pain. Your bed, your sanctuary. 

If you suffer through the night, your mattress may be the problem.

In fact, it could be one of those hidden causes of your low back pain. Or at the very least, it could be exacerbating your current problems. 

As a physical therapist who works at relieving low back pain, I see this all the time. 

why can't everyone sleep like her?

I have clients who come in and tell me about their 10-15 year old mattresses, or that they sleep on the same side all the time, in the same “groove” that they’ve worn in. 

Based on my experiences, this is the one piece of furniture that everyone should invest in.

Think about it. 

When’s the last time you flipped your mattress?

When’s the last time you rotated your mattress?

Heck, when’s the last time you bought a new mattress?

Seriously, think about the number of hours you spend sleeping in your life. 

Shouldn’t those hours be spent in comfort? Shouldn’t those hours be spent actually restoring your body? Shouldn’t those hours be spent sleeping instead of tossing and turning?

If you only do one thing (after fixing your posture), it should be investing in a solid bed. 

To your sleep-full nights.

Dev Chengkalath

 

 

 

In my clinical practice as a physical therapist, I’ve come across some complicated backs. Very complicated. 

Some a few days or weeks young. Some a few months young. Some a few years young. Some with twenty, thirty, forty or more year histories. Those ones, not so young!

The other day, I had a few minutes between clients so I was discussing how to relieve low back pain with a colleague. In those brief moments, we ended up chatting about all the different ways out there to help resolve this fairly significant issue. 

We concluded, after debating back and forth a bit, that with all the advances in science and technology, the best outcomes to relieve low back pain still came down to two things:

Education. And Movement. 

So where am I going with all this?

Well my friends, with both young and old low back pain, the solution is still the same. If you just developed the problem, or if you’ve had it for years, you need to:

Educate Yourself. And Move Correctly. 

So to let you in on one of the most simple, yet effective movement strategies I use to help my clients relieve their low back pain here’s the hip hinge. 

As a throwback to the 1920’s this one is almost a silent film. For those of you needing further clarification, the clip description will elaborate a bit more. As always, feel free to comment or email me with your queries.

To your clean hinging. 

Dev Chengkalath