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

Part 3: The Physical Testing

Note: When i originally wrote part 3, it ended up quite a bit longer than I was expecting, so I’ve actually split it into 2 parts, the first of which you’re reading here and the second, which will be posted tomorrow.

Da Vinci's Vitruvian Man

Now that your physiotherapist has completed the medical history and has been observing you non-stop, it’s time to move on to the physical testing.

This is where the massive amounts of information from the the former two components are digested, analyzed and tested more rigorously. This is where those theories ruminating in our minds about what may be ailing you or what may be stopping you from your optimal level of performance are challenged, supported or rejected.

The physical testing will form the active part of your rehab or performance treatment. Unfortunately, this may also be the part of your visit that could cause discomfort or recreate your pain. This should be short lived and in the interest of gaining as much information about your situation as possible which will be used to create your treatment plan to get you out of pain and back to function.

There is typically a structured order by which we take our clients through the process so that we may gather the most pertinent information in a logical sequence. That being said, there is no one ideal method of running through a physical examination and you may find that various practitioners will have different approaches to testing for the same information.

In the end, it’s not so much how the information is gathered that matters most.

What matters most is what’s done with it.

That will ultimately make the positive or negative impact on your health or performance status.

Before I break down the physical testing, here’s my caveat: this is by no means an exhaustive or comprehensive discussion on the subject. This is merely a VERY brief overview to give you a basic understanding of why we do what we do and what we hope to achieve by doing it.

For the sake of brevity, I’ll be focusing tomorrow’s blog post on 3 areas:

1. Rage of Motion (ROM) (active, passive, joint play)

2. Strength (RIM, MMT, movements: squats, lunges, etc)

3. Special tests

Yours in movement.

Dev Chengkalath

The physical assessment: observation

Physiotherapy Medical History

In the first part of this series I outlined the importance of a client medical history. This medical history will typically highlight some, if not all, of the potential root causes and contributing factors of your low back pain.

This medical history gives us the foundation upon which to structure the next component of our physiotherapy assessment: the physical exam. This is where we can test and observe how your body moves, works and functions both as isolated parts and in unity as a whole. This is where we can figure out if you have any mobility issues, postural dysfunctions or biomechanical faults. Using this information then helps us figure out how we can work collaboratively (that’s right, you have to be an active participant for this to work!) to resolve them.

The physical assessment can be broken down in to two components:

1. Observation
2. Physical Testing

In today’s blog post, we’ll be focusing on observation.

Observation of your movement and postures starts from the minute you step in to the clinic. While it’s listed under the physical exam, this component can actually take place before, during, and after the medical history. In fact, I’ve secretly followed clients out to their cars (and corrected how they get in and out of them!) to see how they move without knowing they’re being watched.

Here's looking at you.

We physiotherapists like to watch how you move, if you have any compensation patterns, how you hold your body, how you shift your weight, how you walk, how you remove your jacket, and a host of other seemingly ordinary activities.

All of these can give us clues as to the cause and/or the source of your low back pain (see my post on “cause vs source” for more information). All of these can give us clues as to how we can help you fix them!

For example, a client who winces or has difficulty bending forward to remove her shoes tells us that her body doesn’t like flexing forward, all without saying a word. In fact, even how she bends forward furnishes useful information on potential movement issues.

Slouched Sitting Postures: Over time can lead to injury.

The client who who resists twisting while removing his suit jacket let’s us know he isn’t a fan of rotation. This information will allow us to set up further tests during the physical testing. Again, without saying a word.

The client who sits on the examination table, slumped and slouched, with shoulders rounded forwarded and chin protruding gives us an idea of his body awareness and the types of postures he likely adopts for long periods of time during the day.

This is but a small sample of how these vital bits of information that can be garnered without a word spoken.

As you can see, observation is one of physiotherapy‘s most powerful tools. It directly impacts and influences what physical tests we’ll choose and ultimately what interventions we’ll apply to help you relieve you low back pain, get you back to function and performing optimally.

Stay tuned as next week I’ll break down the physical testing component of the physical exam.

Yours in movement.

Dev Chengkalath

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

“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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