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

In my practice as a physiotherapist in Toronto, I often come into contact with people who end up at the clinic seeking relief from their low back pain.

While many of their stories are unique, there are always certain similarities.

This holds true for not only back pain, but also shoulder pain, hip pain, knee pain or any other pain that you can imagine.

One of the most common questions I’m asked at the clinic is:

“How long will my low back pain last?”

And that, my friends, is a great question.

In some cases, my clients had low back issues resolved within days while others have taken months or longer.

But really, that just means I don’t know.

I wish I had a simple answer but since the actual mechanisms of low back pain are so varied and distinct for each sufferer, I wouldn’t honestly be able to answer that question with a blanket timeframe.

It just doesn’t exist.

There is no magic bullet, cure-all pill or results-guaranteed surgery. There is no exercise panacea.

Unfortunately.

However, in cases of mechanical low back pain, if you remove the root causes of the pain, the body has the incredible ability to heal itself.

While that task may appear simple, it’s not necessarily easy.

Fixing a bad back will take time and effort on your behalf. You will have to be consistent in working on improving your situation.

You’ll have to be willing to acquire the knowledge to learn what’s causing your pain or keeping you there.

You’ll have to be willing to break old habits, be aware of your postures and alter your positions.

You’ll have to be willing to do the work.

Basically,  you’ll have to give your body a chance to heal.

And that begs the question that has become the title of this blog post:

“How long will you let yourself suffer with lower back pain?”

What would you do to stop it?

What steps would you take?

What information would you need?

What price are you willing to pay?

What would you be willing to sacrifice?

These sound like hard questions to ask yourself, but they are absolutely necessary.

I’m looking forward to hearing your comments.

To your low back pain relief.

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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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

Quadruped Rocking.

This is one of those exercises that almost anyone can do without much difficulty. It takes very little time, doesn’t require any equipment and as most of my physical therapy client’s say “it’s easy”.

If you’re suffering from low back pain, give it a try the next time you’re slumped on the couch watching TV and a commercial comes on (please note sarcasm here…if you’ve been reading any of my posts, you should not be slouched when watching TV!).

As an added bonus, when executed properly it’ll improve your posture, activate your core and help stabilize your shoulders.

Yours in movement.

Dev Chengkalath