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

Putting it all together: Treatment

You’ve now completed your medical history, you’ve been observed, you’ve been put through all the physical tests…

So what does it all mean?

The treatment component of the physiotherapy visit is where everything should come together and get you started back on the path to doing what you love to do, be it playing with your kids, gardening or high performance sport.

As discussed previously, the history and observation gave us the clues to set up the physical tests. The physical tests in turn gave us your baseline data; the “what you need to fix”.

The treatment is where all that information is put to good use. This is where it is processed, analyzed and converted in to a physical rehabilitation or performance program.

What exactly does this program entail?

Well, in my books, each program should cover three major aspects.

If any of these three are lacking, there is risk of perpetuating or exacerbating the injury or dysfunction.

Using a client with low back pain as the example, this is how I would potentially set up a treatment plan.

Knowledge is power

1. Knowledge: Does my client know what component(s) of his or her life is/are causing or contributing to the low back pain? Is he or she aware of how to remove some, if not most, of these or minimize their impact? Have I helped my client realize the impact of both internal and external factors (e.g. body structure as internal factor, work environment as external factor)? Basically, does my client understand what steps need to be taken consistently to resolve the issue(s)?

2. Motor Control: This is where I make sure that my client is clear on the impact of his or her daily postures and how he or she can improve/modify them. After treatment, my client should be comfortable understanding how any muscle imbalances play a role, how mobility (excessive or lack thereof) at various joints (e.g. immobile hips, hypermobile lumbar spine) may influence tissue damage and how specific movement patterns may determine repetitive stress or overuse (e.g. poor sit to stand mechanics). Not only should my clients understand these motor control areas, they should be able to teach me what they need to do to resolve them (e.g. stretches, exercises, proper movements/postures etc).

3. Conditioning: Have you ever been injured only to use that injury as your reason to stop all physical activity? Or have you had your healthcare provider tell you to “take rest” for extended periods of time? This break from exercise has the potential to lead to significant de-conditioning and further prolong healing time. Often, it is quite possible to work “around” an injury by choosing the appropriate exercises or activities to maintain or even improve overall conditioning levels while allowing injured tissues to heal!

And there you have it.

A treatment plan outline for a client suffering from low back pain. Using this outline, the details would be specific to the individual coming in for treatment. It would represent what that individual would likely have to do to work towards relieving low back pain.

Yours in 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

Over the next couple weeks, I’ll take you through a general physiotherapy assessment to figure out what you’ve been doing to beat up your back for so long and what you can do about it.

• In part one, I’ll detail the often ignored importance of a basic medical history.
• In part two, which will be posted in a few days, I’ll delve into the first component of the physical assessment: observation
• In part three, to follow next week, I’ll discuss physical testing.
• In part four, I’ll outline some potential treatment options.
• And in part five, I’ll outline what you need to do to stay out of pain.

So stick around for the next couple weeks and stop beating up your back!

Part 1: Medical History

While this component of the assessment may seem a bit mundane, it’s probably one of the most important aspects of the whole process.

My clients come in thinking they’re going to get answers. The first thing they get are questions. Lots of them!

This is where my clients always wonder why I’m asking them so many open ended questions, or whether or not those questions have anything to do why they’ve come to my clinic to see me. This is also where they wonder, sometimes out loud, why they’re paying me to “chat” with them instead of treating them!

Believe it or not, your medical history will almost always give clues as to the cause and extent of any of your mobility problems. As I’ve stated numerous times before, without knowing the nature of the root cause of your physiotherapy issues, it’s almost impossible to resolve them.

This remains the case with relieving low back pain as well.

Not only does your medical history help with ruling out red flags or serious pathology that require medical intervention, it’ll also give me the clues that I need to figure out what you’ve done, how you’ve done it and potential methods on how we can fix it.

This could be something as simple as you telling me that you work 60 hours a week sitting at a computer or hunched over a drafting table.

It could be you describing what time of day the pain is better or worse.

It could be you just stating, in your own words, what types of activities are easy or challenging for you.

Or it could be you simply describing the type or quality of your pain and discomfort.

And these questions are just the first steps. Gathering all the pertinent information from the medical history sets the foundation for your physiotherapy assessment that follows.

What may seem simple or innocuous to you might actually be the clue that opens up another direction of questions and queries, all intent on helping you find your path to pain free living.

Yours in movement.

Dev Chengkalath

Let’s face it.

Back Pain Sucks.

And it really does get in the way of life.

But it doesn’t have to!

Over the past few years in my physiotherapy practice I’ve had the pleasure of working with some wise and insightful clients on their journey towards a back pain free life.

For some of these individuals, the constant irritating pain has been a loyal companion over long stretches. At times abating to a dull nagging “friend” that tags along for the ride. And at other times rushing to the forefront of their awareness in crushing, life-altering waves of excruciating spasms.

Through their pain, suffering and journey towards salvation, each of these clients has taught me something new about living life with back pain.

Without further ado, here are the top 5 things that my clients have taught me about back pain:

1. You can do something about it: You don’t need to live with the pain. There are solutions out there. You may just need to dig a little deeper and search a littler harder. Ask around. Find out what others you know who have had back pain have done. This doesn’t mean their solutions will work for you, but at least it’ll give you someplace to start.

2. Keep moving: Exercise almost always helps. In most cases of low back pain, appropriate movement will help. It will keep joints lubricated, muscles working and mental outlook up. If you’re carrying a few extra pounds, losing those will ease the load on your spine and other joints. Even dropping 10 lbs will significantly decrease the wear and tear on your body. Getting in shape will dramatically improve your capacity to tolerate various stresses, mental and physical.

3. Empower yourself: Be your own best advocate. Only you truly know how your back pain impacts you. Only you are the “expert” on your own life. It’s easy for someone else to sit across a desk from you and say “stop doing ____.” They aren’t the ones living your life. It’s much better if the people who are supposed to help you, work with you, to generate workable solutions that can be implemented in your “real world” and not in some imaginary or unattainable “ideal world”.

4. Consistency is key: Stay on track and keep at it. Don’t give up. Be relentless. There will be peaks and valleys on your journey towards relieving low back pain but in the end, you will find a solution that works for you, a solution that will let you get back to the business of enjoying life.

5.  Know and respect your body’s limits. The body is capable of some pretty amazing feats. It can heal and repair itself from some pretty incredible situations if given the opportunity. This does not mean you can’t push the limits or even reset them. By all means, this should be the goal when looking at reaching new heights of human movement and performance. Just do so safely within the tolerances of your body structures.

If you have any insights on relieving low back pain, I’d be interested in hearing about them. Drop me a comment and let me know.

Yours in movement.

Dev Chengkalath

It seems to me that people like lists.

They’re short. Concise. And should be to the point.

And if created correctly, they’re pretty easy for most people to remember.

So here goes…

This is my list of the five worst things you’ve done to you low back today:

1. You’ve flexed through your lumbar spine on fully hydrated intervertebral discs (yup, these are the same discs involved in those famous disc herniations or “slipped discs”). In fact, this was probably the first thing you did this morning upon awakening from your more than likely short and insufficient sleep.

• Sitting bent forward on the edge of your bed in that sleep induced haze right after you wake up.
• Sitting in that same bent forward and flexed position on the toilet.
• Brushing your teeth, washing your face, and maybe even standing slouched in the shower.
• Hunched over the breakfast table (you SHOULD be eating breakfast!).

2. You’ve spent more than 30 minutes (this being a fairly conservative guess) in a static and continuous slouched posture.

• Collapsed on yourself with your ribs resting on your pelvis during your commute to work (this includes planes, trains and various forms of automobiles).
• In your standard computer posture in front of that technological wonder that was designed to make your life easier and more manageable. This position likely has you with your head protruding and your shoulders rounded forward for extended periods of time.
• On the couch watching your favourite television programming (typically for a few hours) after a long, grueling and tiring day at the office.

Slouched Sitting Postures: Over time can lead to injury.

3. You sit. And sit. And sit. Enough said. Follow the link if you need more info on the dangers of sitting.

4. You wear high heels. This one is mostly for the women out there, although, who am I to judge? This piece of fashion will confer the wearer with an instant and noticeable alteration of lower limb appearance. But at what cost?

• Centre of gravity shifts with resultant changes in weight bearing
• Increase in lumbar spine curvature (increased lordosis, possibly excessive)
• Altered muscle recruitment patterns, biomechanics and gait patterns

5. You decided that you were too tired to exercise today. This follows along with number 2. And number 3. I think everyone is aware that exercise is good for you so there’s no need to belabor that point. It’s just a matter of prioritizing it to get it done.

Yours in movement.

Dev Chengkalath