Just a quick video clip of a more advanced physical therapy core exercise to help relieve low back pain: The Cross Over Plank.
Yours in movement.
Dev Chengkalath
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
While sitting and standing (think squatting) may seem like the most rudimentary task, it’s by far the most improperly executed activity that most of us do everyday.
Don’t believe me?
Take a look at the next person beside you, or within eyesight, to sit down (I’ll go over the standing part in tomorrow’s post).
Slouched Sitting Postures: Over time can lead to injury.
I’m not just saying have a cursory look.
Rather, I’m asking you to actually observe them going through the full cycle of this basic human movement.
What do you see?
If you look carefully, you’ll see some very interesting applications of physics at work.
Gravity in all its glory will accelerate those gluteals at 9.81 meters per second squared until the firm (or plush) surface of whatever seating receptacle becomes a barrier to any further downward gravity-assisted movement of the buttocks.
And this is usually where it gets really interesting.
For those of you out there who don’t spend your days observing people and how they move, you might not notice or even care. But for the rest of us physical therapy types, this is fascinating.
This is where imprecise compensatory repetitive motions come into play.
As soon as those glutes start their heavily gravity-assisted travel towards the seat, the “plop” is almost inevitable. You know the plop I’m talking about. It’s that free-fall into the chair when muscles are turned off and gravity does all the work.
Now as soon as those glutes hit the seat and no further downward motion takes place, for most people (and especially those with low back pain) there is a subtle loss of lumbar spine stability.
What does that loss of stability look like?
Well, this loss of motor control can be seen with the posterior tilt of the pelvis (think of this as tucking your tailbone underneath yourself) coupled with the rounding of the lower back and the forward carriage of the head (see above photo for slouched spine postures and forward head/neck position).
This wouldn’t be so bad if it were corrected right away. In fact, this correction is imperative to relieve low back pain!
Ideal Sitting Posture: Easy to find, hard to hold.
However, the major issue is that once this slouched posture has been achieved, it tends to be maintained thus becoming a prolonged posture (which coincidentally is one of two components of overuse tissue trauma, the other being repetitive motions).
So how do you fix it?
In tomorrow’s post, I’ll go through a detailed breakdown of the sit (and then the return to standing) and how you can fix it using the three part approach outlined in my previous post re-capping the causes of low back pain.
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
A fraction of the immense knowledge that this incredible physical therapist and educator possesses.
I am once again fortunate to have spent the last couple days learning from her and will post some of the biggest take home points within the next couple of days.
Yours in movement.
Dev Chengkalath
