Small steps, big results…

September 3, 2014 by

More often than not, by the time my clients come see me, they have a problem.

And to them, it’s often a big one. Well, big enough for them to seek outside help.

This can include general problems like low back pain or neck pain, sports injuries like sprained ankles or twisted knees, or functional limitations such as loss of strength or loss of flexibility after a surgery or medical procedure.

In almost every case, the rehabilitation protocol will follow a set procedure of problem solving which involves the use a technique called chunking.

What is chunking?

Chunking is exactly what it sounds like: breaking a bigger, more challenging problem into smaller, more manageable bits, or “chunks”.

Take for example someone coming in with low back pain.

Their present level of pain may be so bad that the idea of doing exercises makes them feel ill; their protective guards would go up and the minute I suggest exercise, they’d look at me like I was out of my mind – there would be no buy-in.

And without that buy-in, most physical therapy doesn’t work as well.

But if I know that specific movement would help get them out of pain and back to their regular activities, how could I overcome that initial resistance and get them to start?

By chunking it.

Instead of going head first in to more complicated exercises or rehab movements, I may just work on something that they already do or that they already need to do.

In many cases, I just work on the basic transition from lying to sitting, or sitting to standing – activities that they would need to do already anyway. By working on these simple tasks and enabling them to solve a small problem in the context of the bigger problem, my clients are empowered. Confidence goes up. And usually, pain levels go down. When pain goes down, function usually improves. And a positive feed-forward loop is created with subsequent chunks added in.

In the end, all these little chunks add up, creating big results.

The best part about chunking: it can be used for almost any problem, in any area of your life.

From human performance to debt management.

Now that’s a chunk of advice I’m glad I came across.

 

 

Filed Under: Back Pain, Human Performance, Mindset Tagged With: , , , , ,

Wake and Break

September 14, 2012 by

As the shrill scream of your morning alarm slices through your dreams of flying over tall buildings, and otherwise saving the world from destruction, you realize that your peaceful respite from wakefulness has unceremoniously come to an end.

Morning has broken and it’s time to start your day.

You slowly rub the sleep from your eyes, fling the warm, enveloping covers off your body and allow the frigid air of your bedroom to jolt you further from your reverie.

“Why does my back feel so stiff?” is your first, fleeting thought as you hunch forward on the edge of your bed, pawing for your fuzzy slippers with your feet. Your sleep-drunk legs have trouble locating their targets so you bend farther forward through your back to get a better look. From this forward bent position, you’re finally able to find the foot-hugging sanctuary of your slippers and your daily routine carries on.

You pull yourself to a somewhat upright position, stumble to the bathroom on your unsteady legs, turn on the tap, bend down to the sink and splash the last vestiges of sleep from your being…

So maybe you don’t dream of saving the world, and perhaps you don’t have fuzzy slippers. Heck, you might not even wash your face. But if you’re like most people, you likely go through some of the same movement patterns described above.

What’s the big deal?

The big deal is that your intervertebral discs (yup, the same discs that are often erroneously described as “slipped”) are actually in a hydrated state which unfortunately puts them at higher risk for injury with certain types movements, according to Dr. Stuart McGill’s research.

Why do the discs “inflate” overnight?

After having spent six to ten hours in a horizontal position while sleeping, the effects of gravity are minimized through your spine. So instead of being compressed (as they are when you’re upright), your discs are unloaded to a certain degree and actually suck up fluid like a sponge. This is why you’re actually taller after waking.

What can you do about it?

This is the simple part. Avoid flexion (bending forward) through your spine until the discs have had a chance to lose some of that fluid. See, I told you, simple.

McGill’s research suggests that it will take about an hour after waking for this to occur. After that golden hour, it’s safer to bend that way.

Now the hard part: avoiding flexion means you’ll have to modify how you get out of bed, how you sit on the edge of your bed, how you wash your face, brush your teeth and even sit on the toilet.

And depending on how fast you are at getting pretty in the morning, it would also mean you’ll have to avoid slouching at the breakfast table, if you even eat breakfast.

Yup, these are all automatic habits you’ve been reinforcing for years. It’s not going to be easy to change them, but as many former low back pain sufferers will tell you, they much prefer dribbling toothpaste down their chins than having bolts of lightning shoot down their legs.

Yours in movement.

Team Primal

 

Filed Under: Back Pain Tagged With: , , ,

My Top 3 Core Exercises for People with Low Back Pain

May 3, 2012 by

In the previous post, I wrote about the 3 worst abdominal exercises for people with low back pain.

In reality, I could have written a list of ten, fifteen or even more ab exercises that should be avoided.

The three exercises that ended up on my no-no list, ended up there for a variety of reasons. Since this blog can’t account for every individual difference and most people wouldn’t stick around to read my tome if I tried, I picked those exercises that I felt were most commonly used or encountered in the real world.

This means I chose the exercises that a LOT of people with low back pain are doing.

They’re doing them at home (sit ups/crunches) or they’re doing them at the gym (twist and extension machines). And they’re potentially aggravating their back pain situation while under the notion that they’re doing something that should be helping them.

That was my rationale for part 1.

Now onward to part 2:

For starters, gold star if you noticed that this post used the word “core” instead of “abdominal” in the title.

Most incomplete low back pain programs will tout the advantages of abdominal training to relieve pain and resolve dysfunction.

Unfortunately, it doesn’t work that way.

Our core is much more than just the abdominal muscles. It’s more than the pretty six pack (rectus abdominis) that’s visible along the front of lean bodies. It’s also more than just the other muscles that make up the abdominal box (internal obliques, external obliques, transverse abdominis, diaphragm and pelvic floor).

Since there are so many different definitions of the core, I’m not going to list them all out. Suffice to say that I believe the better functional definitions of the core should include muscles of the hip, back and torso. All of which should work cohesively to stabilize the spine and allow for appropriate mobility at the hips and shoulders.

How’s that for a vague description? But I digress…

Moving on to what you’ve all been waiting for, here are my top 3 picks for core exercises for people with low back pain:

  1. The Birddog:This exercise has been a staple in my clients’ low back rehab programs for years and has proven its worth and then some. In fact, it’s a staple in my own programs whenever I’m getting back into any heavy lifting involving compound movements such squats, overhead presses, and dead lifts. The kicker, I don’t have any low back problems. Why the birddog? Because it’s simple to execute but forces the exerciser to pay attention to what he or she is doing. I’ve never seen anyone build rippling washboard abs using this exercise alone, but that’s not its purpose. It’s designed as a scalable, entry-to-mid-level core activation exercise that minimizes the compressive loading on the spine while still activating the appropriate protective muscle patterns. Which really just means that it helps stabilize the spine without having to creating excess force. Huge benefit with less risk. As with most injury rehab or performance-based training programs, I’m always looking to tip the scales in favour of benefit over risk, as often as possible.

  2. The Hip Hinge:This is another stalwart of my spinal rehab programs for much the same reasons as the birddog above. It’s simple, requires no equipment, and teaches a fundamental movement pattern that has the ability to protect our spines from current injury or potential trauma. When executed correctly, the hip hinge teaches us to move through our hips while keeping our spines stable. In my injury rehab and physical therapy treatment book, that’s a great combination! Benefits 2 – Risk 0.

    Woodbridge Physiotherapy Vaughan Hip Hinge Exercise

    Hip Hinge Start and End Positions

  3. The Plank Variations:The ubiquitous plank…I actually like to break this exercise down into two distinct versions, the front plank and the side plank (each version can be either regressed or progressed according to ability and technical mastery of the person doing them). Again, this body weight based exercise requires no fancy equipment and very little space. It’s portable, straight-forward, and can teach numerous beneficial postural habits if we’re willing to learn from it. For most back pain sufferers, I prefer to start with the side plank variations as these minimize the loading on the spine while still engaging the core musculature. As technique and ability improve, these can be progressed to more challenging version then in to the front plank variations.

    Front Plank and Side Plank

The most important component of choosing the appropriate core exercise for low back pain is to make sure that the exercise doesn’t cause you any pain. If it hurts, that’s usually your body’s signal that something’s wrong. In the end, it comes down to making sure you’re doing all your exercises right because you get what you train.

And there you have it, my top 3 choices of core exercises for people with low back pain.

Agree? Disagree? Have your own exercises?

Feel free to share your thoughts!

And if you’re struggling with back pain, contact us today to get booked in for your assessment!

Filed Under: Back Pain, physiotherapy Tagged With: , , , , , , ,