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

It seems as though my  Toronto physiotherapy practice doors act as some sort of magical entrance to the land of body awareness.

For the brief period of time that they’re with me, my clients allow themselves to be aware of what’s going on with their bodies.

For those brief moments, they reconnect with how their bodies function.

For that period of time, they are in control of their pain.

It’s true.

The number of times I have seen my clients turn their pain on and off in my treatment room is astounding.

While I don’t believe in physiotherapy miracles, I would even go so far as to say it’s almost magical.

And what’s more amazing about this pain control is that it’s done without powerful drugs, fancy high tech machinery, or, in most cases, any equipment at all.

There are almost no adverse reactions.

Contraindications are almost non-existent.

And the time investment, surprisingly, is just a few seconds at a time.

So at this point, you’re probably wondering what this panacea for pain relief really is.

It’s movement.

Don’t be confused.

It’s not just any movement, but movement with a purpose.

The simple act of moving your body in a precise fashion to retrain your tissues to respond in a specific way.

It’s movement designed to unload certain irritated joints and tissues, while activating inhibited ones.

It’s movement designed to improve your motor control and put you back in the driver’s seat of your body.

The Movements:

Over the last couple weeks I’ve had great success addressing a variety of aches, pains and dysfunctions with the following two motor control movements.

The first one, a forward wall slide, is fantastic for dealing with tight, painful shoulders and upper backs.

And the following video clip of quadruped rocking is extremely helpful in addressing hip and low back issues.

So if you’ve got some of those aches and pains, give these movements a try.

But remember, it’s not just about doing the movement for the sake of doing it, it’s about doing them with purpose. It’s about feeling what your body is doing. It’s about breathing. It’s about taking control of your body back.

Yours in movement.

Dev Chengkalath

The second point brought up in the previous couple posts relates to the risks of too much sitting and limiting everyday, non-exercise activity.

I’ve already spoken about the dangers of sitting in a quite a few of my previous physiotherapy blog posts, so I won’t belabour that point.

What I will say is that even for those who are fairly physically active, prolonged sitting will still cause problems, the same as it will for those who are more sedentary.

This is where NEPA comes into play.

NEPA or Non-Exercise Physical Activity (I’ve talked about it as NEAT or non-exercise activity thermogenesis previously) is all the other movement you do during your day that doesn’t count as exercise. The “everyday life activity”. This is where that leisurely stroll, the housework, and yes, even the fidgeting comes in to play.

Why is NEPA important?

Think of it this way…It’s a lot easier to get a few minutes of NEPA frequently throughout the day than it would be to set up an intense exercise activity regularly and consistently through your day.

If you can increase your non-exercise physical activity by 15-20 minutes a day in spurts of 1-2 minutes at a time, over the course of your week you will have added around 2 hours of increased movement. And most of you won’t even notice the added bouts of 1 minute movement.

It won’t interrupt your day.

It won’t cost you much in terms of time to take the stairs instead of the elevator, but the health benefits multiplied over a long period of time can be significant.

This takes me back to an article I was emailed some time ago.

According to that article, in the past 150 years non-exercise related calorie burning has dropped by about 2000 calories a day.

Yup.

2000.

That’s the same number that is used as the baseline total daily calories for calculating percentage of daily values for nutrient requirements in American food labeling.

150 years ago, we used to burn more calories with non-exercise related activities than we are supposed to take in daily today.

Now that’s something to think about.

Yours in movement.

Dev Chengkalath

Over the past couple of weeks a few articles have been published in the popular press that have seemingly undermined the usefulness of the physiotherapy profession, and by extension, given us physiotherapists a bad rap.

In my practice, there are three things I consider of utmost importance, my own golden triad if you will: my clients, my profession and my reputation. And I will endeavour to protect all three.

The following link will take you to one of the most prominent articles cutting down the physical therapy for injury rehabilitation.

“Treat me, but no tricks please”

After my first reading, I could feel my blood pressure bubble over and and those small hairs on the back of my neck rise in defensive posturing.

Within the first few lines of the article Gina Kolata wrote:

“But the letter the angry doctor had received from his insurer made me wonder whether physical therapy was different from the plasma treatment. Is there rigorous evidence showing it works?”

Here’s this journalist cutting up the profession which has given me so much and allowed me to help so many people.

Then it all made sense.

Therapeutic ultrasound

A few lines later, I realized that Ms. Kolata lumped all physiotherapists with what I refer to as “CHUM therapists” (Cold/Heat/Ultrasound/Massage):

“When I’ve gone to physical therapy, the treatments I’ve had — ice and heat, massage, ultrasound — always seemed like a waste of time. I usually went once or twice before stopping.”

It seems as though my profession had been boiled down to a few “modalities” of treatment that are typically used as quick time filler or that could or should otherwise be done at home.

Ice Pack: Not really physical therapy

It seemed as though the actual “physical” aspect had been forgotten.

Most importantly, the cerebral nature of our job description was completely omitted.

And this reminded me of something the esteemed Dr. Shirley Sahrmann, physiotherapist extraordinaire, spoke about at one of her movement impairment syndrome courses. I can’t recall her words verbatim, but in broad terms she lamented the fact that the way the industry is set up, we get paid for procedures, not to think.

Modalities are procedures. Actual physical therapy work such as progressive exercise programming requires thinking. And time.

As physiotherapists, we should be first and foremost educators. We should be teaching our clients what may be causing them pain. We should be teaching them what they can do to  get out of that pain. And we should certainly be teaching them how to stay out of that pain.

And we should be using movement as our medication of choice.

Yours in movement.

Dev Chengkalath

Toronto Physiotherapist

As the name implies, this isn’t for those people who are in the midst of an acute low back pain attack.

In fact, I would say this isn’t a physiotherapy core exercise for most people who are in any form of pain…

…Unless they can get out of the pain through abdominal bracing and using a neutral spine position. And they can hold that position without much difficulty.

That being said, in my Toronto physiotherapy practice, I use this exercise often when my client has progressed from the basic core re-training program to add a little variety to the exercise and rehabilitation program.

In this dynamic variation of the plank exericse, the key is to keep your body in that set “plank” position, without allowing your hips or your low back to sag or peak, while you raise and lower your body from your forearms to your hands.

This follows the idea of avoiding excessive flexion or extension based (forward or backward bending) positions through the low back (as discussed in the 3 Worst Core Exercises For People With Low Back Pain).

Yours in planking (dynamically or otherwise!)

Dev Chengkalath

Over the last couple of blog posts I’ve explored the basic concept of sitting.

Surprisingly, when broken down, it’s not as simple as it seems. It’s not all about just plunking yourself down into your seat. There are rules and regulations to be followed for optimal spine health.

This holds true for the simple art of standing as well.

The Art of Standing

Standing is probably the first movement pattern that we lose over time. Sadly, in many cases, the loss of this ability will ultimately lead to the loss of personal independence.

So what can you do to hold on to your youth?

Practice proper standing.

Or more specifically, fix your sit to stand. This is what I spend countless hours helping my clients understand at my Toronto physiotherapy practice.

Since I’ve covered the optimal sit in the previous couple posts, I won’t belabor the point other than to reiterate how important that initial component of the sit to stand really is. It sets you up for success in the latter half, the stand.

The stand:

Let’s start off with the final position of the sit with your spine in neutral. Make sure your feet are wide enough apart. This will give you an appropriate base of support from which to initiate the standing motion. For most people, a hip to shoulder width distance tends to work well.

Now that your feet are set and you have a good foundation to start from, it’s time to switch focus to the hips.

As you start that standing movement, lean forward through your torso. By leaning forward, I don’t mean you should be flexing through your spine! This is a very important point to keep in mind.

Your back still maintains that neutral position with the motion taking place through your hips.

As you lift yourself up into a standing position, you should be bringing your hips forward by thrusting through your buttock. Think of this as hinging through your hips. The following video clip demonstrates the hip hinge pattern with movement through the hips while the spine remains in neutral.

A common movement pattern mistake here is using the muscles of the low back to ratchet or “pull” yourself up. This will put all sorts of potentially harmful forces through your low back.

Putting it all together:

Now that you’ve got the sit from before and you’re aware of how to initiate the stand, it’s time to integrate all those bits of information together and complete the sit to stand as demonstrated in the following video.

While this may not seem like a lot, if those of you with low back pain paid attention to how you executed this movement, over time you’d save your spine from some significant trauma.

Think of it this way, how many times do you sit and stand in a day? In a week? In a month?

Now if you could remove those unnecessary forces, how would your back feel?

Yours in movement.

Dev Chengkalath