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

“As a physiotherapist, if I could boil down all the information that’s available to help people find low back pain relief and put them into 5 simple points, what would they be?”

1. The first step is always to figure out what’s the cause of your low back pain. And by cause, I don’t mean the irritations, the bulging discs, the inflamed tissues or any other item that may be considered the source of the pain (click here to read my post differentiating cause versus source). By cause, I mean truly find out what it is that you do everyday (e.g. repeated movements or prolonged postures) that puts your body at risk for injury or keeps it there.

2. Once you’ve figured out the first step. The second step is to remove or reduce that cause. Unfortunately, these are usually well-entrenched, well-engrained habits that you’ve probably been doing for years. For example, think of your daily postures.  Removing the cause of your low back pain will often require you to change your postures often (the best posture being the one you’re not currently in!) or necessitate that you decrease certain, repetitive motions (e.g. repeated forward and backward bending). Fighting to change these long-term habits is no easy task!

3. The third step is to re-train and re-educate your body. This is the motor control side of things. After the first two steps which fall into the realm of knowledge (the acts of learning and understanding what gets you into pain) the next few are designed to keep you out of it. Motor control encompasses postures, movement patterns, mobility concerns and muscle imbalances. By addressing each of these areas, you can work towards removing painful postures, correcting faulty movement patterns, improving mobility where needed (e.g. hips), increasing stability where required (e.g. lumbar spine) and creating an environment for optimal muscle balance and function.

Stable Spine + Mobile Hips = Healthy Spine

4. The fourth step is based on removing any ill effects from de-conditioning. When you’re de-conditioned, your body can’t tolerate the stresses placed upon it in the same manner as if you were in top form. Think of it this way, if you’ve been working yourself into the ground, putting in lots of overtime at work, eating poorly, sleeping just a few hours a night, your body more than likely feels drained and exhausted. You’re more prone to colds and other illnesses. In the same manner, if your body system is out of shape from lack of quality exercise, it won’t be able to deal with the various stresses that it faces everyday, from your morning commute to your prolonged postures. Eventually, something in that system will fail and lead to low back injury and pain.

Just move.

5. While I’ve listed this as the 5th step, it could just as easily have been placed as step 1. You don’t need to live with the pain. If you suffer from mechanical low back pain, there are solutions out there. Many of them are simple. None of them are easy. But there are options. Hopefully my blog gives you an idea of some of them.

Yours in movement.

Dev Chengkalath

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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

Hopefully after this series of posts, you’ll be a little less confused about what’s probably one of the most confusing aspects of low back pain:  the famous “slipped disc“.

This ubiquitous moniker is a fairly common one.

It’s flashed in eye-catching headlines in low back pain articles. It can be heard reverberating through the halls in hospitals and overheard being discussed in great detail in locker rooms. It’s unfortunately (mis)used all the time  by medical health professionals (physical therapists included) as either an umbrella category for a host of back pain issues or as a misnomer for the actual injury at hand.

In reality, there is no such thing as a slipped disc.

That’s right.

Slipped discs don’t actually exist.

So if the disc hasn’t slipped, what’s the problem?

In most cases, what’s happened is that the intervertebral disc has herniated to some degree and the ensuing tissue pathology has started to cause irritation on the local spinal nerve root.

So if you’re still with me after that last sentence, you get a gold star because that was the technical, mumbo-jumbo way of saying a part of your spine has bulged and is putting pressure on, or causing inflammation around, a nearby nerve. This then becomes the source of your pain, discomfort and dysfunction.

Over the next few blog posts, I’ll delve a little deeper into the “mysterious” world of disc bulges. In order to make this journey easier on you, here’s the agenda for the next few posts. As you’ll see, everything still follows the 3 key issues related to low back pain (which also happens to be the same 3 key issues related to most musculoskeletal issues!).

Part 1: Knowledge

In part one of this series we’ll spend some time on the function and anatomy of the spine. Having this knowledge is paramount in conquering this, or any other form, of low back pain. Knowing and understanding the structures that are involved will give you a better idea on how to protect them or help them do what they do best, heal.

Part 2: Motor Control

In part two of this series we’ll check out some of the motor control issues that lead to, or worsen disc bulges and their painful effects. This includes postures, positions, habits, muscle imbalances, mobility issues or movement patterns that all play a role in disc bulges, whether good or bad.

Part 3: De-conditioning

In the final part, we’ll talk de-conditioning and how you can reverse this process. And, as always, we’ll do all this while keeping your back happy and healthy, using the right kind of exercises, in the right way. Safely and efficiently.

So in the next post, we’ll get the knowledge base laid and then build up on it.

After everything is said and done, you should be better able to understand the true causes and potential cures for your disc herniation (formerly known as “slipped discs“).

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