Novel movements for the low back

A day in the life of a physiotherapist –  Low Back

After talking about how I relieved my own neck pain with novel movements last week, I thought I would touch on some novel movements for the low back.

We can use the exact same strategy that I used for my neck in order to regain rotation through the back.  Remember that usually throughout the day, we move the top part on the bottom part.  When rotating our back, we move the upper trunk on the lower trunk (picture swinging a baseball bat or shooting in hockey).  Our nervous system recognizes this movement very quickly because it is a movement that we do all of the time.  If our brain thinks that moving into a rotated position is threatening, it might protect against that movement by producing pain or by turning on muscles that stop you from getting into that position. In order to get into the same rotated position without our brain protecting against this motion, we want to try a novel way of getting there.  Rotating from below is one option. 

Watch the video below and try it for yourself:

1)   In standing turn your body as far as you can and see how far you can see in that direction

2)   Lie on your back and keep your knees together. 

3)   Slowly and carefully rotate your knees from one side to the other while breathing in a controlled way

4)   After you have completed about 10 repetitions, retest the rotating in standing see if the movement is changed.

More commonly in low back pain, bending forward or bending back is the movement that hurts or is limited rather than rotating.  In this case, we want to find a novel way to flex (bend forward) or extend (bend backward) the low back without the brain producing pain or turning on muscles to stop you from getting into that position.

See the video below for a novel flexion and extension movement of the lower back. Once again, the results will be more dramatic if your nervous system is protecting against this movement, but most people will experience a significant gain in range of motion after performing this exercise.  Don’t take my word for it, try it yourself!

1)   Bend forward or bend back up to the point that you start to feel discomfort.  Remember how far you get.

2)   Get onto your hands and knees

3)   Slowly flex and extend your lower back while breathing in a slow and controlled way.  Do this by thinking about which direction your tailbone is pointing.  Point your tailbone up towards the ceiling as you extend and point your tailbone down towards the floor as you flex your back.

4)   After performing about 10 repetitions, stand back up and retest bending forward or bending back and see if the movement changes.

[Insert video: flexion or extension of the low back]

There are a couple of reasons that flexing and extending is easier in this position than it is in standing.

1)   Gravity is now perpendicular to our low back rather than parallel to our low back

·        Changing the direction of gravity relative to the back changes the movement enough that our brain does not recognize it as quickly

·        Our brain therefore doesn’t protect against the movement as quickly

2)   Our knees and hips are now flexed

·        When standing, we have more stretch or tension through the nervous tissue that crosses our back

·        Bending the knees and hips puts these tissues in relaxed position

·        When we bend forward or back, we can move further into the position before these sensitive tissues send signals of that may be protected against by the brain

There are lots of ways to perform novel movements to regain a painful or limited movement.  Moving from below or flexing and extending while on your hands and knees are just two examples.  Your physiotherapist can provide you with other strategies to get moving again.

*Note: this movement strategy is an effective option for your typical work to hard the day before or get up in the morning stiff low back pain. If your low back pain is associated with a traumatic event, prevents you from performing your daily activities, or persists for an extended period, I would recommend seeing a physiotherapy for a thorough assessment.

References:

1)   Blinkenstaff C (2011). Edgework for the neck. Available at: www.blog.forwardmotionpt.com

2)   Butler D, Moseley GL (2002). Explain Pain. Noi Group Puclications. Adelaide, Australia.

Eramosa Physiotherapy - EPA: A day in the life of a physiotherapist - Getting r...

Eramosa Physiotherapy - EPA: A day in the life of a physiotherapist - Getting r...: Last week, I used one patient experience as an example for how physiotherapists might use tape to reduce the threat value of a particular mo...

A day in the life of a physiotherapist - Getting rid of my own stiff neck:

Last week, I used one patient experience as an example for how physiotherapists might use tape to reduce the threat value of a particular movement and therefore reduce the pain associated with that movement.

This week, I would like to use myself as an example.  This morning, I woke up with a sore neck.  It’s not excruciating, but it is annoying and it prevents me from turning my head all the way to left.  For some reason, my brain does not want me to turn my head to the left because it interprets that movement as threatening.  Currently, it is protecting against that movement by causing pain and contracting muscles to prevent me from turning my head.

Similar to the way I wanted to change the nervous system input associated with bending forward for Henry last week by putting a stretch through the skin on his lower back, I would like to change the to the nervous system input associated with rotating my neck to the left.  Taping is something that is hard to do on your own, so I am going to use a movement strategy.

Essentially, I want to perform a novel movement pattern that gets me into the position of left rotation without the brain stopping me by producing pain or turning on the muscles that stop me from moving into that position. 

Usually, during day-to-day activities, the head turns on top of your body (picture checking your blind spot while driving).  My nervous system is really good at recognizing that movement and protecting against it, so the strategy I am going to use is to rotate my body underneath my head.  This novel movement pattern is one that my brain does not have an opinion of yet and therefore it will not protect against it as quickly.  It provides me with a way to get into the position of left rotation until my nervous system learns that it is safe for me to rotate left and calms down its protective mechanisms.

Watch the video below and try it for yourself.  The results are most dramatic if you have neck pain stopping you from achieving full motion, but nearly everyone will experience a significant improvement in range of motion with this exercise.  Don’t take my word for it, try it for yourself!

[Insert video: rotation of the neck from below]

There are lots of ways to perform novel movements to regain a painful or limited movement.  Moving from below is just one example.  Your physiotherapist can provide you with other strategies to get moving again.

*Note: this movement strategy is an effective option for your typical get up in the morning stiff neck pain. If your neck pain is associated with a traumatic event, prevents you from performing your daily activities, or persists for an extended period, I would recommend seeing a physiotherapy for a thorough assessment.

References:

1)   Blinkenstaff C (2011). Edgework for the neck. Available at: www.blog.forwardmotionpt.com

2)   Butler D, Moseley GL (2002). Explain Pain. Noi Group Puclications. Adelaide, Australia.

A day in the Life of A Physiotherapist

A day in the life of a physiotherapist – October 14, 2011 by Jordan Miller, Registered Physiotherapist

As a physiotherapist, I find the most exciting time with a patient to be the day that I get to discharge them.  It’s not that I do not enjoying seeing my patients, I do, but discharge means that patient has reached their goals and that is why I am a physiotherapist

Today, I discharged a patient that I have been seeing for about 8 weeks.  She had been diagnosed with fibromyalgia and osteoarthritis and has been in pain for most of her life. On her first visit, she reported that her feet and knees were the most painful parts and limiting her from her day to day activities.

When I first saw her, I asked her, “What would you like to accomplish with physiotherapy?” or stated in another way, “12 weeks from now, how will we know that physiotherapy was successful?”  The patient responded with one simple goal: to be able to take a bath.  She said that if she could get into and out of her bath, she could accomplish everything else that she was currently having difficulty with.

So, we had a goal. This goal was a longer-term goal for her as when I first saw her, she was unable to get up from a chair without pushing up from the chair with her hands. She was a long ways from being able to get up from the bottom of a tub. In this case, we had to set a number of shorter-term goals in order to progressively work towards the long-term goal. We started with exercises aimed at increasing her pain free range to achieve the range of motion needed to get into the tub and strengthening exercises to develop the strength needed to lower herself safely into the tub and to get back out again after a soak.  We gradually progressed to more functional exercises mimicking the process of getting into or out of the bath.

This week, she has taken two baths and I probably won’t see her in the clinic again.  While I thoroughly enjoyed having her in the clinic, I am happy that I do not need to see her again.

The take home message from this story is that physiotherapy should be about reaching your own goals.  You will be in charge of guiding your own treatment and determining whether or not treatment is successful.  Your physiotherapist can help you reach those goals by making sure your goals are realistic and by providing the tools and intermediate steps to get there. If you are going to attend physiotherapy, make sure that both you and your physiotherapist know what the goals are.

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