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

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

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