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

Is the core more than abs?

This post series is NOT going to be a treatise on the definition of the core.

Suffice to say that there are many different interpretations about that subject.

Some consider only the abdominal musculature to be the core.

Others would consider pretty much everything in the torso and midsection to be integral to core function.

In fact, with more research going into fascial lines and connections, I bet we’ll see even more complex core models come in to play in the near future!

That being said, in this post series I’m just going to discuss WHY a functioning core (no matter what your definition) is fundamental for avoiding or resolving low back pain and many other musculoskeletal aches and pains.

As I’ve written before, I believe the core has two main functions. These are:

1. To resist movement. This can be further broken down into resisting flexion (forward bending), extension (bending backwards), side flexion (bending to the side) or any combination of these (rotations).

2. To transfer energy. This includes creating the ability to run, jump, throw, or do pretty much any activity that requires movement in a gravity rich environment.

So why are these two core functions important?

As discussed previously here (causes of low back pain), one of the common elements that often appears is motor control issues. A malfunctioning core falls into this category.

Keeping in mind the first of the two core functions, we can see that resisting movement is a stability function. And that’s what the core should be doing.

Our bodies are constantly under attack by all sorts of forces, many of these which are directly or indirectly influenced by gravity. They are referenced by many titles and go by many different names: shear, torsion, pressure, traction, compression, distraction and so on.

These forces, whether big or small, are constantly wearing down our bodies like water erodes rock and stone over time. These forces will eventually cause enough damage that something will give and we end up in pain or injured.

Eroding Forces

If our core is properly functioning, our bodies are better able to tolerate and dissipate these forces. Our bodies are better able to ward off the negative effects.

Let’s dig a little deeper and see just how a properly functioning core can spare your spine.

When all systems are working properly, the core muscles function to stabilize the many spinal components. If there is less movement through the spine, then there is less potential for wear, tear and damage. The spine is buffered against these eroding forces.

Now don’t get me wrong…I’m not saying that your spine shouldn’t move at all!

Quite the opposite.

There should be a SMALL amount of movement that takes place between the joints of the spinal column.

This is normal and required.

However, in my experience, most people move way TOO MUCH through their lower back thus putting all sorts of body parts at risk for injury, including the discs, joints, and ligaments.

Now moving on to the second core function of transferring energy.

The typical problem here is the potential for inefficient transfer of energy.

This faulty transfer can occur between our bodies and the environment (e.g. loss of energy between the ground and our feet when running) or even between body segments (e.g. loss of power from hips to shoulder to arm to hand when throwing a baseball).

Over time, these energy leaks lead to compensatory movements. These “cheating” ways of movement don’t allow our body to properly buffer against those daily forces, which then puts of muscles, tendons, joints and discs at risk for pain or injury.

So how do you fix these?

In my next post, I’ll outline a short, basic core training program that I’ve used to help clients better understand and apply proper core function to resist movement, to transfer energy and get them back to enjoying a pain free life.

Yours in movement.

Dev Chengkalath

As can be clearly seen from her video below, she knows the hips don’t lie.

And because I’ve been inspired by Shakira and her masterful hip mobility, today I’m going to make a case for why you should really take heed of her deep insight on the honesty of this often overlooked joint.

For all of my desk jockey readers out there, pay special attention.

I could go into a lengthy description of the hip joint and all the associated musculature and potential compensations that can occur.

But I won’t.

I tried that many years ago with my clients and soon realized that the look that settled on on their faces was not actually interest, or even feigned interest, but rather the intricate contortion of the small facial muscles into a very purposeful look of “I don’t give a shit”.

Mentally, I suspect that this was probably their first out of body experience. They were making their grocery lists, reviewing their emails or possibly even replaying the latest episode of American Idol from their memory banks.

The hip bone is connected to the leg bone..

Lesson learned…Most of my clients don’t really care to know a whole lot about the anatomy behind their pain. They just want to know the bare minimum to enable them to do what they have to do to fix their problems.

So here’s the gist of why happy hips equal happy spine.

The body, in all its elegance, simply executes the directives sent by the brain. If the brain wants a certain movement done, the body will do everything it can to make it happen.

Even if said movement happens to be damaging.

If the hips don’t move, the required movement will come from somewhere else. Unfortunately, in most cases, this happens to be from the vulnerable lumbar spine.

Many people with low back pain have tight or restricted hip mobility.

Some aren’t able to extend their legs backward through the hip joints properly. So their bodies will help create that extension by moving excessively through the lower spine.

Others aren’t able to flex their hips up, so their bodies compensate by flexing through the low back instead in order to achieve the desired range of motion.

Both of these compensations override the built in protective mechanism that is key to our back health: the ability to activate our built in corset to brace against both internal and external forces.

Over time and with repeated flexion and extension compensation movements, the tissues of the back are slowly worn down. Until something breaks, something gives or something hurts.

So if you don’t like hurting, take care of your hips and keep them mobile.

In the next post I’ll go over a couple of my favourite hip mobility drills.

And remember, your hips don’t lie.

Yours in movement.

Dev Chengkalath

In our fast-paced world with gadgets, gizmos and computers, we’re often put in a position where we don’t need to move a whole lot for long periods of time. Our worlds are designed with ultimate convenience in mind. They’re designed to make things as “easy” for us as possible, for us to get things done with the “least” amount of effort expended.

Think about how often you sit hunched over  in front of your computer, or how long you’ll crash on the couch at the end of your workday.  Or how about those long commutes on planes, trains or automobiles?

Over time, with this consistent sedentary behaviour, you’ll more than likely start feeling those little aches and pains all over, those creaking joints, those tight muscles, and the diffuse soreness in various body parts. It’ll get harder to go up and down a set of stairs without huffing and puffing to catch your breath. Carrying your groceries will feel like you’ve entered a powerlifting meet.

All of these add up and if ignored for too long, eventually someone has to pay the piper. And by that time, the piper is asking for a king’s ransom.

So how do you avoid needing to pay the piper?

If there’s one thing you should be doing a bit more of every day it’s this: moving.

That’s it. It is that simple. Don’t make it complicated, just get it done.

This could mean simply taking the stairs instead of the elevator at work. Or it could mean going for a brisk 30 minute walk during your lunch hour instead of sitting for the full hour. In even more basic terms, it could mean just taking a few really deep breaths while at your desk or  just making sure you change your postures every 15 minutes while you’re working away.

Yours in movement.

Dev Chengkalath

P.S. If you’re interested in learning how you can protect your back and get out of pain using powerful Neutral Spine techniques, be sure to pick up a copy of my Neutral Spine Special Report for only $9.95!

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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

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