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

In my practice as a physiotherapist in Toronto, I see a lot of people come through the clinic doors with various aches and pains.

Very few of them are acute injuries, while many of them are overuse or repetitive stress/strain in nature.

While undertaking a clinical history during the assessment, I’ve noticed that for a vast majority of people, the one dangerous (in)activity that they do on a regular basis for prolonged periods of time is sitting.

The Dangers of Sitting

And most people unknowingly considered this a fairly benign part of their daily life.

As I’ve stated before, this typically starts in the morning at the breakfast table (for those that even have breakfast!), then continues on with the commute to work or school, then the sitting continues until lunch where more of this dangerous sitting business will take place.

Then, after lunch, most people will return to their desks, chairs and various seating apparatus to carry on with the same form of sitting that they completed all morning. At the end of the workday, the seated and sedentary commute home is initiated.

And with the arrival at home, the television is switched on for some well deserved post-work relaxation before supper, which will take place while seated. Post-supper, the same posteriors are plunked back down in those plush couches for some more TV viewing.

Then the same process takes place the next day. And the day after that. And the day after that.

While the above may not apply to everyone, there are a significant number of people who would have no difficulty in seeing their daily routine played out as noted.

I know this happens because these are the same stories I hear in my clinical physiotherapy practice everyday.

Here’s the rub…

This pattern of inactivity which plays out in millions of lives every day has fairly serious health consequences.

I recently came across an editorial press release for the British Journal of Sports Medicine entitled: “Are we facing a new paradigm of inactivity physiology?” that nicely sums up some of these dangers.

In the editorial the authors discuss how recent studies have suggested that long periods of sitting and “whole-body” inactivity (what we term sedentary behaviour) are “strongly associated with obesity, abnormal glucose metabolism, diabetes, metabolic syndrome, cardiovascular disease (CVD) risk and cancer, as well as total mortality.”

I don’t know about you, but I definitely feel that those are some pretty serious consequences from the simple act of sitting for too long.

The authors propose their new paradigm which consists of the following four tenets:

1. Sitting and limiting non-exercise activity may independently increase disease risk

2. Sedentary behaviour is a distinct class of behaviour with specific determinants and effects on disease risk, separate from the behaviour of leisure-time exercise.

3. The molecular and physiological responses in the human body of too much sitting are not always the same as the responses that follow a bout of additional physical exercise.

4. People already insufficiently physically active will increase their risk even further by prolonged sitting time.

As the authors conclude, there are actually two behaviours (and their resulting effects) that we need to address:

1. The benefits of regular moderate to vigorous intensity physical exercise

2. The risks of too much sitting and limited non-exercise everyday life activity

So what can you do about it and how can you avoid these serious dangers of sitting for too long?

In the next few blog posts, I’ll work through the above two issues and give you some simple tips and strategies that you can immediately incorporate into your daily life to help stave off these deadly sitting related health issues.

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

We are all students of life. Or so we should be.

Here’s a list of 10 things I learned (or re-learned) this week as they pertain to physical therapy, human movement and sometimes even life.

1. Human anatomy hasn’t changed, but our understanding of it has. The interconnectedness of the body is astounding and we’re just really starting to realize how this plays a much bigger role in physiotherapy, injury rehabilitation and performance training than previously thought.

2. Surrounding yourself with people who are passionate (and much smarter than you) is a great way to get inspired. And getting inspired is a great way to become better at your craft.

3. Always try to learn something new from every situation encountered. Once you learn it, apply it often so that it becomes internalized. This is also another great way to improve your craft.

4. Know your anatomy inside-out. And I don’t mean just the origins, insertions or innervations. I’m talking about functional anatomy, force couples, co-contractions, synergists and antagonists. Although knowing these won’t unravel all the mysteries of the body, it sure will help when trying to diagnose or treat complicated, multi-factorial and confusing cases.

5. Seek out the cause of the dysfunction, don’t just settle for treating the source of the pain. I wrote about cause vs source previously, but it’s always good to be reminded to differentiate between the two. Our current medical model often stops shy of actually discerning the root cause, while we look to deal with the source. This is not only short-sighted, but leads to poor long-term outcomes.

6. Always question why you do what you do. Don’t be happy with the status quo. But don’t complain either unless you’re willing to be the one to step up and initiate change. As Gandhi once said: ” Be the change you want to see in the world.”

7. The body is an amazing piece of biological machinery that can adapt to the most extreme conditions, incredible stresses or seemingly impossible challenges we place upon it. The mind, however, doesn’t always possess the same fortitude. Fortunately, this can be corrected.

8. Straight from the mouth of Shirley Sahrmann: “You get what you train.” To expand upon that elegant statement think about how you spend your days? Slouched? Slumped? Flexed? Why are you in pain? Think of it this way, your body is constantly under training, 24 hours a day, 7 days a week, 365 days a year. How are you training your body? That is the importance of the everyday.

9. When considering all that you know, it’s quite amazing to realize how much it is that you know you really don’t know.

10. I have the best job in the world as a physiotherapist in Toronto. I’m free to think critically, I’m constantly challenged and I love what I do. How many people can say the same?

Yours in movement.

Dev Chengkalath