If you pay attention to this once concept, could it change your results?

If you’ve come to see me for physiotherapy treatment or for physical training, you’ve probably noticed, I use the term, “it depends” a lot.

When engaged in debate and discourse in the health, fitness or rehabilitation industries, I tend to straddle the fence, rarely committing fully to one side or the other.

That’s because one side never has all the answers, or is the right choice, in all situations.

There are never any absolutes.

The missing ingredient is often context.

Without context, it’s easy to throw absolute statements around and come across as certain. But in a world with as many dynamic and fluid situations as you can imagine, context can change and impact so much.

For one client, taking rest in the short term may be what’s required to assist with tissue healing and a faster return to function in the long term.

Because she doesn’t ever sit still and is always on the go. Rest helps her.

For another, the key ingredient may be early return to specific movement or exercise.

Because he’s usually sits at a desk and is mostly sedentary. Movement helps him.

As you can see, it all depends on the context.

Context matters – it drives the intervention.

And context can change.

So the next time you’re not seeing results using XYZ athlete’s rehab program or following XYZ celebrity’s fitness routine, maybe it’s not the intervention that’s wrong, maybe it’s the context you’re using it in.

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.


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.

The Power of Posture

Are you always trying to find a comfortable position for your head?

Do your shoulders feel tight and stiff?

Do your neck and back ache on a regular basis?

The culprit to all that ails you may be your posture…

I could tell you all the things that could be wrong with your posture. But I’m not going to do that because I’m pretty sure you already have a few good ideas.

If you sit for work, make sure your chair or workstation is adjusted for your body.

Chairs, desks and computer monitors are NOT all built for one body type. And I am going to to make a guess that Bob from accounting doesn’t have the same body structure as you. In fact, you will likely need to adjust the height of your fancy or not so fancy chair, you may have to rearrange the items on your desk and you will almost certainly have to position your monitor for your own personalized optimal viewing angle.

Don’t buy in to the one size fits all mentality.

While that may work for all those fancy items you see on late night infomercials, it doesn’t work for most items that have to be purchased during regular business hours.

One size very seldom fits all.

Get neutral. Spine that is.

Physiotherapy in Woodbridge Spinal AlignmentNeutral spine postures start at your hips and pelvis. From there, your chest should be up up (don’t let it cave it – be proud!), your head should be held long and tall with your chin slightly tucked in. Think of a string attached to the crown of your head pulling you up to the ceiling. This position should place your nose as the farthest point forward.

If you’re reading this at work, stop for a minute and have a look around you. You’ll see that many of your colleagues lead with their chins.

This will help you avoid slouching, which in itself isn’t bad.

It only becomes a problem when you do it ALL THE TIME.

Which is a perfect lead in to the most important lesson from today’s blog post:

The best posture is the one that keeps changing.

So make sure you change your position often and avoid holding any postures for prolonged periods of time.

Yes, this means when you’re driving, sitting on the couch watching TV, or working at your desk.

So, tell me, how does YOUR posture stack up?

Dev Chengkalath, Physiotherapist

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!