Dec 30 2009

Advanced Core Exercise to Relieve Low Back Pain: Cross Over Plank

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


Nov 11 2009

The Art of Sitting.The Fix.

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.

Neutral Spine: Sit to stand

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.

Bad Sit: Posterior Pelvic Tilt and Rounded Spine

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


Nov 10 2009

The Art of Sitting.

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.

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.

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


Jul 29 2009

Buttocks, Clamshells and Low Back Pain

It’s been a while since I’ve done any blogging and for that I apologize.

Things have been quite hectic with a whole slew of changes and happenings taking place.

So to get back into the swing of things, I’m just going to re-visit a very important component of low back pain rehabilitation.

Without further ado:

Your buttocks plays a vital role in saving your spine.

If you’ve read any of my previous posts, you’ll recognize that I’ve always touted gluteal activation and motor control exercises as one of the primary methods to get a handle on your low back pain. In physical therapy, exercise along with education, are our most powerful tools for resolving this and many other issues.

Your buttocks plays a vital role in saving your knees too.

So how do you get your butt back in gear?

There are four major activation movements I use at SHAPE Toronto to build better butts.

These are:

1. The clamshell.

2. Standing hip extensions.

3. The squat or sit-to-stand.

You can check out the above along with other important low back pain relieving movement in the exercise video area of my blog.

Yours in movement.

Dev Chengkalath


Jun 25 2009

Michael Jackson…The Smooth Criminal

As you’ve probably figured out, this post will have nothing to do with relieving low back pain, motor control or injury prevention.

It does, however, have much to do with human movement.

Michael Jackson passed away today. The response was incredible. Humans were moved.

Whether you were a fan or detractor, whether you are young or old, I am certain he influenced you more than you’re aware.

It’s been a few hours since I heard the news, but I think it’s only really starting to sink in.

Michael Jackson has died.

Though his eccentricity has overshadowed his former artistic prowess of late, Michael Jackson represented more than just a musician, more than a dancer, more than just the King of Pop.

He represented the ultimate cool, the ultimate smooth criminal.

Red leather jackets. Sparkly white gloves. And the moonwalk.

He inspired a generation and made his mark on the world.

Who’s bad?

A young Michael Jackson

A young Michael Jackson

Rest in peace.