Small steps, big results…

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.

 

 

Low Back Pain – A video guide

To follow up with the last post regarding back pain red flags, here’s a quick 11 minute video that explains the back pain process with some pretty neat illustrations and drawings.

If you have back pain, or know someone who does, this may be a good place to start.

 

Should I go see a doctor?

There you are, going about your daily routines. Washing your face. Brushing your teeth. Putting on your socks or shoes. Or perhaps you were involved in something more active like playing sports, golfing, or just going for a walk with your kids.

And then it happens.

That sudden grabbing sensation, powerful enough to make you catch your breath. Making you gasp audibly. Possibly dropping you to your knees. Or laying you flat out on the ground.

That feeling of pulsing fire spreading across your back with every wave of seemingly intractable spasm. The almost instant inability to move or function like you did just a few seconds ago.

Frozen in place. The fear. The anxiety. The apprehension. They all come rushing in.

Afraid that any little movement will set off another wave worse than the previous one.

That sinking sensation that something bad just happened.

Does that sound familiar?

In my years as a physiotherapist, the above is a fairly standard description of the first few minutes after an acute back spasm as often experienced by clients. I’ve received numerous phone calls, emails and texts from them over the years when this happens, and invariably the first question that comes up is the following:

“Should I go see a doctor?”

The answer, as it almost always comes up, is a resounding “it depends”.

While it might seem like the severity of the back pain is so intense that only immediate medical intervention and imaging (e.g. MRIs or X-rays) will give sweet relief, that’s not always the case for the former, and never the case for the latter.

In terms of emergency room wait times and hospital triage, someone heading to the ER for back pain and spasm may end up waiting for hours and hours, just to be seen. And often, they will be sent home with nothing more than a basic pain killer such as Tylenol and possibly some muscle relaxants for their troubles.

I don’t know about you, but I don’t know if that’s worth 7 or 8 hours of my life, especially because all that plays on the TV is CP24 on loop…

That being said, what if the back pain is caused by something more serious? What if a trip to the doctor or emergency room is the appropriate plan of action?

How could someone quickly and readily figure out if a trip to the doctor or ER is the best option?

Enter the Red Flags.

Red flags are a checklist of features, signs, symptoms or medical history that, if present, could indicate that more serious issues may be at hand. At the very least, these allow us to have a best practice approach as to when one should seek further medical investigation/treatment or when one should wait a few days to see how the natural course of the injury plays out.

Cancer

  • Any history of cancer
  • Any unexplained weight loss
  • Night pain or pain at rest
  • Failure to improve with treatment

Infection

  • Persistent fever
  • Recent bacterial infection (e.g. pneumonia, urinary tract infection etc)
  • Immuno-compromised (e.g. organ transplant, HIV, diabetes etc)
  • Intravenous drug abuse
  • Pain at rest

Cauda Equina Syndrome

  • Bowel or bladder issues (incontinence, retention)
  • Saddle anesthesia (loss of sensation in the groin/buttocks)
  • Bilateral lower extremity weakness or numbness

Significant Disc Herniation

  • Significant muscle weakness
  • Drop foot

Vertebral Fracture

  • Recent history of significant trauma (big fall, car crash, industrial accidents etc)
  • Any history of osteoporosis
  • Age greater than 70
  • Prolonged use of corticosteroid medication

While the above is not an exhaustive list, it is a good starting point.

That being said, if you have concerns, always follow up with the appropriate medical professional to be assessed in person. The internet, which happens to be where this post is found, should only be used for educational purposes and is not a substitute for, nor should it be construed as, medical advice.

Primal Human Performance

Red Flags

 

Is physiotherapy for me?

So who really needs physiotherapy anyway?

Is physiotherapy just for sports injuries like sprained ankles or knees? Or is it for post-surgical rehabilitation after ACL repairs or arthroscopic surgery?

Can it help someone with low back pain? Neck pain? Shoulder pain?

What if pain isn’t involved, but weakness is? What if lack of strength, or coordination, or endurance is the problem?

What if there is no pain or injury? Could physiotherapy still help improve human performance for someone who has no immediate limitations?

Ultimately, the reason most people seek out the expertise and knowledge of a registered physiotherapist is because they can’t do, or want to improve on, something that’s important to them.

This is often due to pain, loss of range of motion/flexibility, loss of strength or because of some medical intervention (e.g. surgery or bed rest). This loss of function could have an impact on so many different aspects of someone’s life from looking after their kids to playing sports, to something as simple as doing everyday chores or tasks such as driving.

However, with preventative health awareness on the rise, more and more people are looking to be more proactive.

They’re looking to do as much as they can to avoid being impacted by repetitive strain or overuse injuries before they occur. They’re looking to improve their base strength and fitness so they can minimize risk of a variety of lifestyle related diseases and disorders (diabetes, cancer, heart disease etc) as they age.

They’re looking for optimal health and ultimate performance. They want to be at their best.

So in the end, physiotherapy from a registered physiotherapist may be the right option if you’re looking to do the things you want to do, or get back to doing the things you want to do.

10 Thoughts About Things

Just a few quick thoughts that passed through my mind between clients yesterday evening. In fact, these may have been ALL my thoughts for the day:

  1. There is something special about watching heavy dead lifts done by a client who has just rehabbed from lumbar disc bulges and a surgery.
  2. Bio-Freeze gel is like a magical potion condensed in a tube; how do they get all that coldness squished up in there?
  3. Every single day I become more aware of just how important your glutes are. And by “your” glutes, I mean glutes in general, not your glutes specifically. Although, you should take care of your glutes.
  4. There are a lot of people out there with some form of back pain. And a large proportion of them have sadly resigned themselves to living with it instead of trying to fix it.
  5. Most of them have some form of glute involvement, dysfunction or amnesia.
  6. Chin ups, pull ups and all their variations are very satisfying to do. It reminds me of when I was a siamang in a past life. What’s more satisfying, though, is seeing an adult client do one for the 1st time ever in his life.
  7. Why does it seem so hard to break bad habits and so hard to form new ones? Damn you and your ilk, Haagen Dazs! Why can’t I just put the tub down before it’s empty?
  8. When done correctly, glute bridges will really make the backside burn. And make you walk all funny after. I’ve  just come to realize that I may be a little glute obsessed.
  9. Computers really make me slouch. A lot. For long periods of time. And I know better. Must work on awareness.
  10. I love my job. I get to help some pretty amazing people get back to doing the things they want to do. My clients are simply awesome.

Dev Chengkalath

Wake and Break

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

 

My Top 3 Core Exercises for People with Low Back Pain

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!