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

In yesterday’s post, I discussed the subtle loss of stability in the lumbar spine when most people complete the sitting action.

Today, I’ll be giving you some quick physiotherapy tips on how you can fix your sitting. In the next post, I’ll give you tips on how to improve your standing from a sit.

As always, I’ll be using my trusted three part approach for relieving low back pain:

1. Knowledge

2. Motor Control

3. De-Conditioning

First, recognize that you are doing something to yourself multiple times a day (repeated sitting with loss of control) that is causing trauma to your tissues and that you must remove these injurious forces in order for healing to take place. If these forces aren’t removed or resolved, things just won’t get better.

You have take action to fix it.

This is the knowledge component.

Second, improve your motor control.

Recognize that motor control encompasses four major components including posture, movement patterns, mobility, and muscle balance. Each of these areas will have to be addressed for a long term solution.

This is the action phase where you apply your knowledge.

Start by fixing your posture as described previously (just click the link to be taken directly to the posture post).

Next, learn proper sitting mechanics. Sure, you’ve known how to sit since you were an infant, but when’s the last time you checked to see if you were doing it right? Are you sure you haven’t picked up any bad habits along the way?

You can work on mobility (loosening the hips and stabilizing the spine) and muscle balance (think about resolving any imbalances you may have because of compensations or specific movement habits) concurrently using simple drills such as the quadruped hip rocking movement in the following video clip.

Finally, and just as important as the other two areas, is fixing your fitness level. If you’re de-conditioned, you’ll let gravity do more work than it should, especially on the sit (remember the plop?).

Putting it all together…The sit breakdown:

From a standing position, control yourself down towards your seat while keeping your lower spine in neutral position (between rounded and arched). As your buttock descends towards the seat, push your hips backwards, making sure you keep your spine in that optimal, stable alignment.

Toronto Physiotherapist Demos Neutral Spine Sit To Stand

Some common errors include standing with your feet too close together, rounding your back as you sit down and of course, not controlling yourself down. Another often seen compensation is the use of the arms to lower yourself down.

Toronto Physiotherapist Demos Bad Sit: Posterior Pelvic Tilt and Rounded Spine

As your buttock touches down on the seating surface, this is where you need to be aware of the potential for loss of control through the lower back and pelvis. The plop tends to allow the lower back to round and the pelvis to fall into a posterior pelvic tilt (tailbone tucked under position).

For a proper sit, don’t allow the lower back to deviate from the neutral position throughout the WHOLE movement. Maintain that position right from the standing to the descent into the seat.

And that, my friends, is how you should be sitting. With control and purpose.

How many of you can honestly say that you pay attention to how you sit down every day?

If you’re experiencing low back pain, it’s probably time you started.

In the next post, I’ll work through the standing component to keep your back healthy and safe.

Yours in movement.

Dev Chengkalath

Now that you’re educated about your problem, it’s time to take control of the situation. 

In the case of solving your low back pain issues, this means getting your motor control back.

Motor control issues encompass a broad spectrum of items that relate to how we move and how we interact with gravity and our environment. These include daily postures, our muscle function, our mobility and our overall movement patterns.

Motor Control at its finest

I like to split motor control issues into four sub-sections and will explore each one separately. Do keep in mind that each of these items interact with each other and should not be considered independent of the others.

Motor Control Issues:

1. Posture
2. Muscle Imbalances
3. Mobility Issues
4. Movement Patterning

In this post, I’ll just briefly highlight each of the above.

Posture: Posture is the combination of all the positions of all the different joints of the body at any given time. Faulty posture may put you into positions of stress while ideal postures may alleviate them.

Muscle Imbalances: This simply means that your muscles aren’t working properly. In most cases this relates to how your muscles deal with forces. If an imbalance exists in muscle function the end results is that they aren’t dealing with either creating or resisting forces properly.

Mobility Issues: Mobility is your body’s ability to move a joint under control. With mobility, three states of being exist: optimal, hypermobility, hypomobility. Optimal mobility means your joints can be controlled through any required range of motion. Hypermobility is when a joint moves too much (too much range of motion) without being under control. Hypomobility then becomes the opposite-when the joint doesn’t move enough to allow the required range of motion.

Movement Patterning: As humans we tend to move through the same patterns every day. If we’ve picked up some bad habits, this can put various tissues at risk of injury. Take for example a sit-to-stand. This movement is probably one of the most frequently performed functional tasks we do each day: think toilets, chairs, cars etc. Now imagine that you have a faulty pattern and you repeat that pattern every time. Day after day. Week after week. Month after month. At some point, there will be a structure in your body that won’t be able to tolerate that stress and it will fail. This is where your back “goes out”.

Now if you can apply the appropriate knowledge and take control of the above four issues using physical therapy, you’ll be well on your way to relieving your low back pain.

In the next post, I’ll cover the final element of the top 3 steps to relieve your low back pain: Get Fit.

Yours in movement.

Dev Chengkalath

Mornings can be a tough time for people with low back pain. 

Often, this morning stiffness can make it challenging to start your day and get the ball rolling.  

So if you find your back pain acting up in the mornings when you wake up, try this quick physical therapist approved spinal mobilization movement to get things loosened up.

Just aim for 6-10 reps and always work in a pain free range of motion. 

For a written description of the Cat and Camel exercise, check out the Exercise Video section of the blog. 

Yours in movement, 

Dev Chengkalath