Just wanted to mix things up a bit and try out a new method (at least for me!) of getting the information out there.
I put together this short clip discussing the major causes of lower back pain.
Let me know what you think!
Yours in movement,
Dev Chengkalath
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
During my time as a physical therapist, I’ve come across a fairly significant number of individuals suffering from chronic pain.
These people have experienced pain for far longer than what would be expected from their form of injury or they had pain with no known cause that seemingly appeared out of nowhere.
No trauma, no falls, no apparent reason for their debilitating pain and discomfort.
Over the last few weeks, I’ve seemed to have had an influx of clients come in with long-standing complaints of chronic pain similar to the above.
While completing the assessments and taking the histories, I found myself asking some of the same questions over and over again.
Mostly to myself, I would hear my deep masculine voice in my head (I swear that’s what my voice sounds like!) asking:
Why were these individuals still in pain, over such a long period of time, when there wasn’t any significant physical or organic cause for the pain?
Many had been tested using all the latest in technology from MRIs to CT scans to doppler imaging. Scopes, probes, blood and tissue samples etcetera etcetera.
It would seem as though no medical stone was left unturned.
Multiple medications had been prescribed and ingested. Referrals had been conducted. Second, third and fourth opinions had been sought. Specialists consulted. Therapies rendered. The list goes on.
But still no solutions.
And often, even no hope of salvation from the unyielding shackles of pain were given…Typical responses included “you’ll have to learn to live with it.”
With the exponential growth of medical science, why were these people still suffering?
Why were they still at the mercy of the relentless battering placed upon their bodies, minds and spirits by this crushing beast we call chronic pain?
As my cognitive wheels were turning, I kept coming back to a single question. It kept repeating over and over again in my head:
Where had modern medicine failed them?
In my next blog post I’ll discuss in greater detail HOW modern medicine missed out. And what you can do to fill in those gaps to protect yourself or your loved ones.
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
