Category Archives for "back pain"

More Common Low Back Pain with Wil Seto

Mark: Hi, it's Mark from Top Local. I'm here with Wil Seto of Insync Physio in Vancouver. We're going to talk about more common the most, maybe most, at least a common type of low back pain. How are you doing Wil? 

Wil: I'm doing really well. Thanks Mark. Yeah. 

Mark: Stumbling all over myself here. 

Wil: Yeah, and people stumble quite often over, you know what is the cause of the back pain. And what I want to talk about today is just a type of back pain that is actually very common, very common in athletes, and just like an everyday type of pain that comes up from lifting, twisting or even just sitting wrong. I mean, wrong in terms of posture, that's not really ideal or optimal. So type of back pain is basically caused by a strain in your iliolumbar ligaments, which is basically a connective tissue and ligaments that stabilize and connect the last two segments of your lower back vertebrae, which is your L4 and your L5.

And so basically you have five vertebrae that make up your lower back. And your L4 and your L5 is your last two vertebrae. And these ligaments, there's a couple of different bands and they connect under your pelvic bone. And that's called your iliolumbar ligament, or iliolumbar ligaments.

Mark: So when you actually like feel along the iliac crest or your pelvis in your back, is that where these are attaching, basically? 

Wil: Yeah, it's hard to feel because it's all so deeper. You have to like palpate basically through your muscle and you also have another layer of connective tissue. And so it is really tough. So when we're testing for, you know, we're obviously doing a couple of different tests to see if it is stressing that ligament. But then we're also ruling out on different things because, you know, with the presentation of this type of injury, it can also present itself as possibly other things too. And so we've got to make sure that it's not that as well. 

So there's always a barrage of different tests to really go through. And this type of back pain is also something that can, like when you have it for the first time, it may not be like, oh, it takes a day or two to heal. It may take a little longer because of the nature of how it stabilizes that lower back and that lumbar spine in the pelvic area. And especially if you've had it like as a chronic condition. So what I mean by that is, if it's been recurring, like, you know, you get over it, and then it happens again.

And so when it's a chronic condition, it doesn't necessarily have to be like a specific, like lifting or bending or twisting or athletic type of movement. So like I've seen it in rock climbers and soccer players and volleyball players, and you know, it's common in athletes. Very, very common. And I've seen it a lot. 

And then with non-athletes, pretty common too. So you can be really out of balance in that area, and then you do something like you're sitting kind of with non-optimal posture for awhile, or if you've been sick in bed for, you know, like week with the flu or, you know, in this case a few specific clients that have had COVID in they're in bed for a little longer and then pretty inactive. And then it ends up straining.  So those are the kinds of the ways that you know, it can be injured and it's a lot more common.

Mark:  Would possible ways of dealing with it be that you make core strength training, has to be part of your regular training regimen. Is that going to help? 

Wil: Absolutely longterm. Yeah, for sure. And we also want to do too, when you have this kind of injury, like, especially if it's not going away, like general rule of thumb, is that if you hurt your back, you're not really sure what it is. You know, iliolumbar ligament strains will usually, you know, it's more than just a 24 hour thing. You'll feel it for a couple of days, for sure. You want to get it assessed and see what's going on because you want to also address the specific deficits that's causing it. So it's not just the core strength issue. There's imbalances going on there that you need to address.

And then now that you have this strain, there's in essence, a type of hyper-mobility, or it's like, there's a little bit more play in there now. So it's less stable is what I'm saying. And so, because you have less stability in there. That core strength is very key and it's specific core strength too, to making sure that that actually becomes more stabilized in there. And especially if you're going back and doing anything physical, like if you have a physical job or sports for sure. And the reason why is because would that instability, it can lead to then like more serious injuries if you're not actually rehabbing it, like a disc injury. 

And studies have actually shown that when you actually have a lower back injury and you don't rehab it properly, you don't get the core strength and you don't get the muscle imbalances corrected, then there is actually a high recurrence of back injury and something more serious. And this is a good example of it. 

Mark: So what's a typical course of treatment? 

Wil: Yeah, so I'm thinking about a couple of people that came in with this type of injury recently. And the first thing I do is I address their mobility issues and figure out what's going on. So there's usually a lot of spasming and these people came in, I'm thinking about two specific patients that came in. One who is actually a little more athletic, recreationally. And then another client who's not athletic, but just sits a lot for her job. And they both present with the same type of things in terms of muscle spasms, a loss of mobility, and also a lot of imbalance happening.

And usually that's also really key too, because you want to look at what kind of areas are like really shortened in terms of muscles. And also you want to look at the movement patterns. So we're addressing the bigger picture of what's going on in their movement patterns and why that's caused it to strain. 

So for example, the person that sits a lot for her job, you know she does a sit and stand. So we corrected that. But also just looking at how she walks even something as simple as that and we need to really correct the alignment of that area and part of that is okay, you know what? Her hip flexors are super tight, pulling all that, compressing things. And then her other bigger back muscles are also super tight. In addition to the spasming, that's protecting the injured area. And then she's got weaknesses in certain areas that are not just from this injury.

And they're like chronic weaknesses that she's had which are very apparent because there's some atrophy going on. That's more than just like a week's worth of injury.  So those are important to address. She had a lot of tightness up in her upper back,  which meant that she wasn't moving through her upper spine and she's not getting this rotation movement. She is pretty active, but not athletic. You know, that she's going to move a lot through her lower back when she does things like gardening and everyday stuff. And so that puts more stress in that area. And then those muscles tend to get tighter and get used more like in the lower back area, causes it to be a precursor to something happening and she wasn't a big fan of stretching and mobility work and core work to begin with. And then we would address the muscle spasms and do things with manual therapy in that specific area, and also IMS, dry needling and stuff like that.

Mark: And what's the typical. Kind of treatment timeframes for this to get better. And of course it always depends on how bad it is, but, or how chronic it is, but what's a more typical recovery time. 

Wil: Yeah. So for someone who's experiencing that pain, especially like I'm talking about like these two individuals, you've had pain for a week and finally, like, I need to come and see someone about it because I don't know what's going on. And they're a little more concerned. You know, the ilia lumber ligament was specifically diagnosed then, you know, four to six weeks is a typical timeframe for it to heal. And it doesn't mean that you're not going to get any better. Like with both of these people within one session, they felt like night and day. So they went from like, basically a six to seven out of pain. Pain scale on a visual analog scale in terms of subjective rating, to like a three out of 10 within like 24 hours. Which is significant. 

And then when you look at that timeframe, like it's that healing process is important, because the soft tissue injury needs to heal where you strained it. And then once that sort of, you know, heals up. And then when we talk about the person who's more athletic, we get him doing more higher level core stuff, but, you know, he even came in to see me like six weeks later. And he was no longer having problems with that ilia lumbar area, but he was still having, yeah, it's like a one out of 10 pain Wil, and like, I can do stuff now. Six weeks later. But now he's like, I want to like start lifting more and, you know, it's sort of that process of like getting him ready physically to do that. And wanted to go in the gym and started lifting weights. And he liked to, you know, typical sort of gym routines that involve a lot of your traditional, like squats and deadlifts and bench press even too. So you gotta be careful with bench press even at this stage. 

Mark: So the basic message here is that the most common low back pain is not from discs. It's from this ligament you're talking about. 

Wil: Yeah. It's very common, which then can lead to possible disc injury, if you don't rehab it correctly and then make it a part of your daily routine. 

Mark: So if you're in Vancouver and you have lower back pain, you can call Insync Physio to book your appointment in Vancouver at 604-566-9716. In North Burnaby, they have a North Burnaby location as well, 604-298-4878. Or you can book online insyncphysio.com. Thanks Wil. 

Thanks Mark.

Lower Back Injuries – Core and Gluteus Medius 1-Leg Squats

With both sides of the pelvis level squat down on one leg sitting your butt back (like in a chair). Keep the knee over the ankle and aligned with your hip and second toe while preventing it from moving past the toes as you squat.

You also want to reach both arms out in front of you to keep balanced and bend your hips so your chest comes forward. Your weight is on your entire foot as you come straight back up. Place the emphasis on pushing through the heel while squeezing your butt all the way back up. Repeat this for 10-15 repetitions doing 3 sets on each side.

This can help with lower back pain if your core stabilizing and Gluteus Medius muscle weakness is consistently causing your pelvis and low back to compensate. The weakness in this area can also be caused by your lower back pain, pelvis or a lower limb deficiency such a as previous ankle or knee injury that was not rehabbed properly.

If you have any problems or questions with this exercise consult your local Physiotherapist before continuing.

Low Back Injury Rehab – Advanced Bird Dog

Start on your hands and knees with your spine in neutral alignment. Engage the inner core stability muscles of your lower spine by pulling the muscles below your belly button inward without changing your neutral spine posture.

Then, bring your hands forward on the mat and straighten the knees one at a time so that you’re on your toes. kick back and extend with one heel while keeping the hip square and lined up with the other hip and reach the opposite hand and arm forward. Hold this for 10 seconds doing10 reps on each side for 2-3 sets.

This is a great core stability strength exercise to help progressively strengthen your lower back after you have injured it. If you have pain or are unsure about what you are doing consult a local physiotherapist before continuing. 

Back Injury Management – Climbing Rehab Torso Twists

An important part of back injury management and rehabilitating it fully is to ensure that you have good rotational mobility in your spine. Here’s a simple but effective exercise that can help with improving the rotation mobility in your spine.

Sitting down on a chair with your feet flat on the floor check your left and right arms into abduction like you’re making the letter “T”. Then check your hip and butt anchored to the chair with your hands.

Sitting with your legs wide and arms straight reach your hand down the inside of the leg to the ankle and reach your opposite hand up to the ceiling trying to create the letter “T” with your arms while your butt is anchored to the chair. Hold this position for 30 seconds doing 3 sets on each side 2x/day.

This is a great mobility exercise to do for the spine as a warm up, a warm down or for recoveries after you finished climbing or training.

Low Back Pain & Injuries-One Leg Looped Band Bridges

Wrap a looped resistance band around your thighs just above your knees. Engage the core muscles below the belly button by pulling them inwards while you keep breathing.

Ensure your knees are aligned with your ankles and your hips while you take up the slack in the looped band. Push through your heels with the feet flat on the ground and bridge the butt up keeping both sides of the pelvis level with each other.

Then straighten out one leg, hold it here for 10 seconds, and then bend your knee and lower your butt back down. Repeat this for 10 repetitions doing 3 sets daily.

This exercise progression helps to further strengthen and rehab the functional strength of your low back whether it’s a chronic pain issue or more of a weakness from an acute injury that you have experienced. If you have pain or are unsure about what you are doing consult a local physiotherapist before continuing.

Low Back Pain

Is it a slipped disc? Is it a pinched nerve? What did I do to my lower back? These are questions that many of our clients have been coming into the clinic with. Hi, everyone it's Wil here from Insync Physio Sports Orthopedic Rehab Clinics. Back pain certainly can be painful, unpleasant and inconvenient, but what's not certain about what back pain is, is what causes it most of the time. 

Our physiotherapists have had clients come into our clinics with these exact questions and concerns about their lower back pain and dysfunctions. So the main thing to understand is that the cause of lower back pain in every back injury is not the same.

So for example, one client came into the clinic to see one of our physiotherapists with radiating pain going down her leg. Turns out that she had just had some imbalances in stiffness from her spine from a lack of mobility. And she didn't have a herniated disc or a slipped disc that she was worrying herself to death over. And she actually got better in just a few sessions. 

Another client came in with right butt pain. His progress was a little slower and our physiotherapist referred him back to his family physician to get further investigations done. Turns out that he had some more major wear and tear going on in the lower segments of his spine. But eventually he was able to get back to his sports, albeit more slowly and carefully after about four to five months. 

So the real key to getting better from your back pain is really understanding what causes it. And also what are the ways that you can actually approach to not only getting it better, but preventing it from actually happening again. Research studies indicate that if you don't rehab your lower back injury properly, then you actually have an increased chance of re-injuring it again, and even worse than you did the first time. 

So instead of consulting Dr. Google, I would highly recommend consulting a trained physiotherapist that can treat the root cause of your lower back pain and injury. That way you can really connect with how you really want to move again.

Back Pain and Low Back Injuries – Gluteus Medius Big Ball Push Ups

This exercise targets the activation of your gluteus medius muscles of your pelvis and hip.

Have the back of your ankle and heel pushing back on the front low side of a big ball against the wall. In side lying, make sure that your torso is not too far back or bent too much forward to avoid your hip being in a flexed position. With your spine and hip in neutral position push the back of your ankle and heel up to the top part of the ball maintaining contact on the ball the entire time.

A few key things to look for is to keep the toes pointing forward and towards your own nose so that you’re not rotating the hip and the toes upwards while you push the ball upwards. Bring the ball back down and repeat this 10 times for 3 sets on each side.

This is a great exercise to build more functional core and pelvic muscle strength after a low back injury. If you have any problems or questions with this exercise consult your local Physiotherapist before continuing. 

Pandemic Back Pain

Mark: Hi, it's Mark from Top Local. I'm here with Wil Seto, Insync Physio in Vancouver, many time winners of Best Physiotherapists in Vancouver, Best Physiotherapists Clinic, and will himself has one Best Physiotherapists in Vancouver as voted by his customers. And of course, today, we're going to talk about something that's a little bit different pandemic back pain. What the heck is pandemic back? 

Wil: Yeah. Yeah, they basically you know, with this pandemic that we're all living through right now, it's just a lot more people working at home and trying to set up whatever they think is you know, sort of a workstation or an office it can be ranging from like super great ergonomics to really poor. And I still see the people that have the great ergonomics. To especially the people that have poor ergonomics, you know, back pain. 

And so the other thing that's also important to understand with how this pandemic back pain is also the history behind each individual. Like I can say right now before the pandemic, like I used to see maybe like 25, 30% of this in the clinic on my caseload, and it's jumped from like 25 to 30% to more than 75% of everybody, if not more, like they have some form of this pandemic back pain. So someone comes in for, yeah, it's my shoulder and they're trying to stay active, but then they also work at home a lot.  But then my, yeah, my neck and my back also hurts too. 

And so a lot of it is posture related. So when we talk about pandemic back pain, it's really just the postural insufficiencies. And if you have a preexisting injury, or co-existing injury and that can actually contribute to that pandemic back pain even more. And so obviously, you know, that's a huge factor, but then if you've never had any history and you start getting this pandemic back pain, then that's also another can of worms.

So, you know, if you're doing a lot of sitting and I've said this to a lot of people before and sitting is like the new smoking. It's basically, so horrible for your body. And when you're sitting, especially if you're doing a lot you know, that's all you do 8, 10 plus hours a day. Your hip flexors will get really tight and everything just stiffens up and you get obviously lack of blood flow in your whole body and the muscles.

And then you get all this compression in certain areas in your spine. Then what happens is that your body learns that. And then you start to develop a new normal for your range of motion and your mobility. And then also the muscle extensibility, you know, so the joint mobility, joint range of motion and the muscle extensibility, all that starts to adapt to your new way of working and how we've been working mostly from home now, a lot of people.

And so someone that doesn't have a previous history, now this is the thing that I want to talk about today, because this is the thing that really has been on rise with the whole pandemic. And so I started to see all these muscle imbalances. So the biggest thing is really when you have a lot of imbalance happening in your hips and like, I see people like they wanted to try and get a running a little more, but then if their hips are super tight, then they're going to start having issues in their lower back. Like your hip flexors are really tight. It can change the alignment. And the positioning of your pelvic bones and then cause more compression in your lower back. And it can increase your what's called your lumbar lordosis, which is a natural curve in your lower back.

And so there's like, you know, a few main hip flexors, muscles that make up your hip flexors. And so when you're sitting all day long, you know, those hip flexors will just shorten. And then if you're not doing things that augment that by trying to switch up your position, stand a little bit, sit a little bit, then that will start to be adaptively more sore.

And even with standing, you know, someone comes in, I had a client that came in , I stand all day long. I don't know why my back hurts. Well, you know, it's that long position. And if your hip flexors are tight to begin with, and you're standing all day long, then now your back is going to have that increase a lordotic curve even more. And then you're getting even more compression in certain areas. 

So they did some research studies where they looked at even just the imbalances that are happening in the hips and if certain areas are less flexible or less mobile, and then you have weaknesses in certain areas, then, you know, when you go to walk or you go to run, you know, that's going to be accentuated.

And so then you're going to start to have the sort of repetitive strain and what we call running related injuries. And I treat a lot of runners. We treat a lot of runners in the clinic and we have like a treadmill to look at, the biomechanics and to really assess, you know, the mechanics of running.

And it's interesting to see before we even get them on the treadmill. It's like, you got all this going on and just by looking at alignment and movement, we can already do a lot of things to help with that. 

Mark: So the answer isn't having a standing desk like I have here, it's a standing and has sitting desk because I have listened to my good friend Wil and I don't stay in one position all the time. I like to talk standing up though. I feel more natural with that, but it's switching between the two on a regular basis is really important all day long. 

Wil: Yeah. As a ergonomic strategy yes. And then if you're like looking into getting into something that you haven't really done before, if you're doing a little bit more of, or if you're doing a lot more sitting now, and then you're still maintaining your sport of running or whatever it is. Looking at making sure that you have that mobility in your hips. Have that mobility and the strength to be able to compliment you to keep doing, or to start that new sport or activity that you want to do.

Mark: Yeah. So what's the treatment protocol? What's the prognosis for somebody with pandemic back pain? 

Wil: Yeah. So with someone that has never had a trauma or anything like that, and it's just sort of creeping up on them. And the most common thing that I find is all these muscle imbalances. So we want to start to correct that. We want to basically start to get areas in the hip, areas in the back even to be more mobile. So it's about the mobility of the joints. The mobility of the whole segments around the back so it's also the upper back. So if it's lower back pain that you're getting, then you want to make sure everything above there is moving well. And then the hips and pelvis are moving well. 

And then the supporting strengthen core stabilization. And so there's a lot of different things that we can do in the clinic, obviously, that kind of help facilitate that from doing a lot of like soft tissue release techniques that, even getting in there with some IMS with some dry needling kind of thing, and then very specific exercise rehab stuff to really kind of facilitate that process.

Mark: And typically what's the more of a normal treatment course. 

Wil: Yeah, it ranges like it can be someone like, you know within a session or two they're like, wow. It's from like, you know, an eight out of 10 pain to like now it's like a one to two out of 10 pain. And just one or two sessions to like, it takes them up to like maybe even four or five sessions, depending on how chronic and how long you've left it for or they left it for. Yeah to basically up to maybe even eight to 10 sessions and be like, I'm totally 100% better. 

Mark: Well, let me ask you a little bit of a wild card question here, because I bet you see this a lot. People come in, they feel better, they got some exercises, they kind of started doing it. And over time a month, two, three months later, they're not doing those exercises anymore. Is that a really good way to do things? 

Wil: Yeah, obviously not. And I think the biggest thing is that a lot of the times, once it becomes out of sight then becomes out of mind. So the pain goes away and then you think you can let it slip. And then once the imbalances start to come back and you may not even be symptomatic, I may not have pain, but once those imbalances that to creep up, then it's a lot harder to try and rectify that. But you can, you definitely can because you know, it just takes a little bit of work. But then sometimes it gets to the point where now you're in this pain and this function, and then, you know, it becomes desperate. But yeah, it's definitely not ideal. 

Mark: So, if you're desperate with back pain, the guys to see your Insync Physio. We highly recommend that you don't wait until you're desperate and go and see Wil because they'll get it fixed up really quickly and get you on an exercise program that will keep you fit and healthy and surviving this whole pandemic hoo-ha in a much better way.

So reach them at their website insyncphysio.com. You can book online for both of their offices right there. Or you can call. For Vancouver at the Cambie Street office is at (604) 566-9716. Or in North Burnaby, you can call (604) 298-4878. Get yourself booked. Get in there. Get feeling better. Let's survive this thing. Wear a mask.

Thanks Wil. 

Wil: You bet. Thanks Mark.

Low Back Pain Injuries – Single Leg Bridges

Start out lying on your back with your knees bent. Hug one knee to your chest. With the opposite leg, squeeze your bottom and push through your heel to raise the hips up towards the ceiling. Hold at the top for 10 seconds. Slowly lower down.

Repeat 3 sets of 10 repetitions.

This exercise is great for low back pain to strengthen the gluteal muscles. 

Chronic Low Back Pain – Forward Lunge Reach Ups

Progressively strengthening your core stability muscles after a back injury can help you become functionally stronger.

Start by lunging forward with your right foot and reaching up with the opposite arm and hand high up above your head while keeping the low back in neutral position. When you lunge forward make sure your knee stays over your ankle and aligned with your second toe, hip and shoulder and that the low back doesn’t arch. Don’t let your knee fall into the middle or go past the front of your toes and the opposite arm reaching straight up without deviating past the midline or off to the side.

Push back up to the start with the forward foot and repeat this for 10 repetitions doing 3 sets for each side.

This exercise is great for returning to activities and sports that require a lunge and reaching motion. If you’re unsure about the exercise or have uncertainty about where you’re at with your lower back book an appointment and have one of our Physiotherapists at either our North Burnaby or Vancouver locations to check things out. 

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