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

As always, in the realm of physical therapy and injury rehabilitation, there are often more questions than hard answers.

One of the most often debated areas relates to the notions of mobility, stability, flexibility and how these impact low back pain.

Because the language used can change from person to person or physical therapist to physical therapist, I want to start off by defining some terms in the context I’ll be using them.

That way, we’re all on the same page. Or at least on different pages of the same book.

Mobility: Ability of a joint to go through a specific range of motion under neuromuscular motor control. To confuse things even more, mobility can be further categorized as hypomobility (not enough movement) or hypermobility (too much movement). So as you can see, mobility can encompass components of both stability and flexibility).

Stability: This term falls under the continuum of mobility, but for our purposes will be used to denote the ability to of a joint to resist excess motion and maintain joint integrity under neuromuscular control.

Flexibility: The total range through which a joint can move through without necessarily taking into consideration the level of neuromuscular control that is exercised (e.g. when you’re lying on your back and someone is pushing your leg into a hamstring stretch).

One of the most common statements I hear  in my physical therapy practice from my low back pain clients is that they believe they need more flexibility in their lumbar spines or in their hamstrings, that these areas just don’t move enough.

In most cases, this couldn’t be further from the truth.

As I’ve stated previously, what is needed is more hip mobility and increased lumbar spine stability.

In the next post, I’ll dig a little deeper into the impact of mobility, stability and flexibility on low back pain and how mobilizing your hips and stabilizing your low back could spare your spine and save you pain.

Yours in movement.

Dev Chengkalath

Over the last couple of blog posts I’ve explored the basic concept of sitting.

Surprisingly, when broken down, it’s not as simple as it seems. It’s not all about just plunking yourself down into your seat. There are rules and regulations to be followed for optimal spine health.

This holds true for the simple art of standing as well.

The Art of Standing

Standing is probably the first movement pattern that we lose over time. Sadly, in many cases, the loss of this ability will ultimately lead to the loss of personal independence.

So what can you do to hold on to your youth?

Practice proper standing.

Or more specifically, fix your sit to stand. This is what I spend countless hours helping my clients understand at my Toronto physiotherapy practice.

Since I’ve covered the optimal sit in the previous couple posts, I won’t belabor the point other than to reiterate how important that initial component of the sit to stand really is. It sets you up for success in the latter half, the stand.

The stand:

Let’s start off with the final position of the sit with your spine in neutral. Make sure your feet are wide enough apart. This will give you an appropriate base of support from which to initiate the standing motion. For most people, a hip to shoulder width distance tends to work well.

Now that your feet are set and you have a good foundation to start from, it’s time to switch focus to the hips.

As you start that standing movement, lean forward through your torso. By leaning forward, I don’t mean you should be flexing through your spine! This is a very important point to keep in mind.

Your back still maintains that neutral position with the motion taking place through your hips.

As you lift yourself up into a standing position, you should be bringing your hips forward by thrusting through your buttock. Think of this as hinging through your hips. The following video clip demonstrates the hip hinge pattern with movement through the hips while the spine remains in neutral.

A common movement pattern mistake here is using the muscles of the low back to ratchet or “pull” yourself up. This will put all sorts of potentially harmful forces through your low back.

Putting it all together:

Now that you’ve got the sit from before and you’re aware of how to initiate the stand, it’s time to integrate all those bits of information together and complete the sit to stand as demonstrated in the following video.

While this may not seem like a lot, if those of you with low back pain paid attention to how you executed this movement, over time you’d save your spine from some significant trauma.

Think of it this way, how many times do you sit and stand in a day? In a week? In a month?

Now if you could remove those unnecessary forces, how would your back feel?

Yours in movement.

Dev Chengkalath

I’ve received some feedback the last little while and it seems that people like lists. They’re quick to read and easy to understand.

You ask and you shall receive…

From my experiences as a physiotherapist in Toronto, these are the top 5 things you do to your back that you should not do:

1. Abuse it: This is probably the most simple item on the list. Almost every one of my physical therapy clients, with a little bit of prodding, can tell me exactly what activity causes them back pain.

Yet they keep doing it.

If something hurts, stop doing it.

This likely leads to low back pain...

This includes exercises. Or body contortions as pictured above.

In most cases, pain is a signal from your body that something isn’t right. Usually it means that some sort of tissue is being damaged.

2. Prolonged Postures: The big culprit here is sitting. How many of you spend more than 15 minutes in the exact same position? How many of you spend an hour in the exact same position?

I’m willing to bet that there are quite a few of you who spend your days driving in a car, commuting, riding in airplanes, and more specifically sitting at a desk in front of a computer (usually for HOURS on end!).

Slouched Sitting Postures: Over time can lead to injury.

Then you get home and crash on the couch in front of the TV, or worse, lie down in bed in awkward postures, twisting your body to get a good view of the screen while “relaxing”.

By maintaining these postures for longer periods of time, you don’t let the tissues recover from the stresses that they face.

Think of this like an elastic band that you stretch and hold. Eventually, when you let go, it won’t spring back to the original length. The same thing happens to your body tissues.

As stated previously, the best postures are the ones that keep changing.

3. Repetitive Motions: Similar to prolonged postures, numerous repetitive motions have been shown to be the major factor in disc herniations with full lumbar flexion (rounding of the low back) being the major player.

What exactly are repetitive motions?

Think about bending a paperclip back and forth over and over again. Eventually, the paperclip will break.

To get an idea of some of the repetitive motions that we use regularly, just have a look at the previous post where I discussed the 3 worst core exercises for people with low back pain. Each of those exercises puts the lumbar spine through those exact repeating movements (flexion, extension or rotation) that can potentially lead to intervertebral disc injuries such as bulges.

4. Neglect it: According to Dr. Stuart McGill, and the study he cites by Luoto et al (1995), low back muscular endurance appears to have a greater protective effect against low back injury than does low back strength.

Ergo, make sure you work on your muscular endurance using exercises such as the Birddog and plank variations.

McGill also suggests that lower back exercises seem to have their greatest positive effect when executed daily, and not 2 or 3 times as week as most exercise sessions are set up.

So don’t neglect your back!

5. Ignore it: This is the most surprising item on the list, but the longer I’m in clinical practice the more often I see this.

People will live with their back pain for years without doing anything about it.

Or worse yet, they will ignore it and work through it. Sometimes they will even wait patiently for the latest excruciating episode to clear up. There are people out there who can help you.

Find them and let them help you fix yourself.

Yours in movement.

Dev Chengkalath

The power of the internet can’t be doubted.

It has the ability to spread knowledge across the globe in real time. You have a problem, google it, and more than likely you’ll find a solution.

So what’s wrong with that?

As a physiotherapist in Toronto, these are the questions I ask myself: How good is the information you’re getting? Is it valid? Reliable? Can it be trusted? Will it help you? Or will it hurt you?

This holds even more weight when dealing with physical issues such as injuries or illness. Plug in your signs and symptoms and within seconds, hundreds, if not thousands of webpages will be returned for your perusal.

It’s no different with relieving low back pain. Plug in those search terms and instantly you’ll have at your disposal more information than you could possibly even use.

When looking at low back pain, a good portion of the information that’s returned discusses strengthening your abs to fix your back problems. At times, this is similar to the information many people are given by their medical and fitness professionals: “Build a strong core to protect your back”.

Unfortunately, abdominal training is typically considered the foundation of core training. In reality, abdominal training is only a small part of the bigger picture. And in some cases, poorly designed or applied abdominal training can actually be what’s keeping you in pain.

As I’ve already talked about six pack abs and low back pain, I’ll just stick to giving you some ideas on how to keep your back strong, safe and healthy. Without further ado, here’s my list of the 3 worst core exercises for people with low back pain:

The abdominal crunch or sit-up: These staples of most back rehab programs should be eliminated because of the tremendous compressive loading forces that they create through the discs of the spine. There are better ways to train the core!

Dr. Stuart McGill, one of the foremost spine researchers in the world, has measured compressive forces of approximately 3300N (730 lbs) in the spine with these types of exercises.

This is equal to the amount of force noted by some government health agencies as the amount of force needed to cause injury!

Abdominal machines (crunch and twist machines): So if crunches or sit-ups can cause as much damage to your spine, imagine what happens when you take the same exercise, restrict movement at certain joints, isolate movement at others (in this case the lumbar spine) and then add a load.

Doesn’t sound very good, does it?

Now take that same flexion movement add a loaded rotation component on the twisting abdominal machines and you’re well on your way to getting yourself sent off to the disabled list.

In fact, we’ve  dubbed these types of exercises “disc herniators” and inform our clients on continuing to do these only if they wish to help us finance our latest exotic car purchase.

www.madwhips.com

Take home message: save your spine and stop flexing and/or twisting through your low back!

Back Extension Machines: As described by Dr. McGill, the repeated spine flexion/extension movements used by these devices create the same conditions that were necessary in his lab to produce disc herniations.

Enough said.

Why would you want to do the same to your back at home?

So there you have it…The 3 worst core exercises for people with low back pain. If you love your back, stop doing them.

Let me know your thoughts. Do you agree? Disagree? Or just not care?

Yours in movement.

Dev Chengkalath