Hi. So today we're going to do deadlift. And this exercise is great and I really like it because it strengthens globally. And it strengthens our lower back. And it helps elongate the hamstrings and just helps us getting better movement globally in a functional chain. 

So this is what it looks like. What we're going to do is have our hands shoulder width apart, just making sure that they're going straight down. We're hinging through our hips here. And you're not going down like a squat, but moving your hips backwards, making sure that your shoulder is nice and set, your back is straight. From here come up, hinge again at your hips and then slowly coming straight down. And you can do this exercise three to four sets of 10, if you're able to. If you're going at a higher weight, come down with the reps in a little bit. So about eight to 10 reps, three to four sets.

Mark: Hi, it's Mark from Remarkable Speaking here. I'm with Wil Seto of Insync Physio in Vancouver. One of Vancouver's best physiotherapy clinics, many time winners of best physios in Vancouver and we're going to talk about scoliosis. How you doing Wil? 

Wil: Hey, Mark. I'm doing well thanks. How about you?

Mark: Good. So scoliosis, now we were talking ahead of time and you mentioned a couple of things. Functional versus structural scoliosis. What's the difference? 

Wil: Yeah. So structural scoliosis is usually a type of scoliosis where the bones and the spine form unevenly. And that usually happens earlier on in childhood. And so it's something that you develop and as you become an adult, it kind of sticks with you. And so there's very noticeable curvatures that when you do certain tests, you look at whether it is a functional or a structural scoliosis. You can determine pretty quickly from that. And if you get to be more specific, then you can actually measure like, you know, technically the curvature in terms of how badly it is.

Versus a functional scoliosis, really is a deviation or a normal sort of curvature in the spine, this lateral curvature. And that can be a result of like an injury that you have, and then you have like muscle spasms and you can have things that are pulling on the spine, in the bony segments and it rotates it. And then in that rotation or in that process of the injury that you're going through in the healing process, then that can look like you have the scoliosis, but then when you do certain tests that evens it out and you can see that it's less structural and functional.

Mark: So how often do you see the difference, those specific differences when someone comes in with scoliosis? 

Wil: Yeah. I see a lot of the second part, which is the functional, where it's sort of this like the nerve muscle stuff going on, where it's just an imbalance. And those things are quite common especially if you've undergone an injury.

And I think that's really the hard thing to really understand from most people is when, you know, they may have seen another healthcare professional or someone else that's looking after them. Or they may have heard the term scoliosis. Or they may have a neighbour or friend that has had scoliosis and they've talked about it.

And then, you know, they feel like, Oh man, is that what I have? I feel like I'm crooked. And then they automatically think about, oh, maybe I have scoliosis. And without even really, you know, thinking more deeply or really trying to understand what that is, then, you know, that sticks in your head. And that functional part of the scoliosis, is definitely more common in an adult. Because like I was saying before with the structural scoliosis, you usually get it developed as a child and it becomes sort of a congenital thing where you're born with. And then you have that throughout your whole life.

Whereas if not just like, as an adult, one day you wake up and you're like, oh, I got this structural scoliosis. Unless you go through you know, a major accident where things happen and then you get some of the major degenerative changes happening in the spine as it ages, but it's actually quite less prevalent.

Mark: So you can treat both as a physio who specializes in some of these things, you can treat both of these to make them, less painful. Is that a good assumption? 

Wil: Yes. Yes, for sure. So essentially, you're looking at obviously localizing the pain and trying to manage that for both scenarios. Now, when it's something that's more structural, you want to really look at increasing the blood flow and blood supply to certain areas and getting the muscle strength where it's really imbalanced, when it's a structural thing going on. A lot more success, obviously, you know, when you it's functional. And you really correct those imbalances and you do things to facilitate the healing process of whatever's going on in there.

Mark: So you mentioned you had a client that came in that had a structural, but that you actually helped. Walk us through that, please. 

Wil: Yeah. So you know, with this specific client, I mean this person had actually an issue in childhood, something surgical procedure done. And basically as a result, as they got older, you know, like it caused a deformity into the lower segments of the spine, where it was more than a certain amount of degrees that you can still physically see. Caused a lot of muscle imbalance as a result of the surgical procedure. And to be more specific, it was like basically removal of a kidney.

And, and then over the years, this person's been really active, and really managing, you know, their problem but has had some back issues, now and again, but still being really active, like skier and runner and cyclist and all that stuff. So still able to do all those things at a very high recreational level. And at a level that the person really wants to enjoy. 

And so, you know, things that can happen over the course of the period, actually we've treated this person for all those things, is basically pinched nerve. Basically a strained back and then just like a shifting of the pelvis. And then pinching in the hip flexers and then sort of issues relating from the back that basically refer around in the hip. 

And so we want to just correct as much of the things that are going on that are really imbalance and pinching because we can still really unload a lot of those specific segments at the middle back or sort of the middle to lower back and the whole lower back area. Because that way it helps with more general movement mobility into those areas, which will allow more freer movement throughout the whole spinal segment, like basically from the neck all the way down to the pelvis and then even in the hips.

And as a result, then this person actually successfully has been able to get normalization and optimization of muscle control and muscle activation patterns to to be able to function, get back on his bike and to be able to work out and do CrossFit. And instead of like being able to just do like a burpee that looks really like what's going on in that burpee to like being able to actually do a full on range with the burpee, because now they've got more mobility and things aren't pinching anymore.

Mark: So other than accidents or a childhood illness or malformation of the spine, are there other possible causes of scoliosis? 

Wil: Yeah, and I think I talked about basically age related things. That's another factor and that's actually a huge part of it. And then like between in the growing years, you know, of like 11 to 18, even up to 20 years old, that can account up to 9% of the cases of scoliosis because they're still growing, then there may be sort of some of the scoliosis happening, but then it resolves after they finish growing. So then that is very treatable. 

I think in those growing years, that's also where we work with athletes, you know, where they're doing competitive sports, that we want to be a lot more cognizant of what they're doing to be able to maintain mobility and do recovery stuff, to be able to make sure that they're not imbalanced.

 I'll just giving you an example, a 16 year old and he was competitive rower and he was getting back pain. Had a little bit of scoliosis and we started to look at the imbalances. And over time we treated him for a couple years where he's like 19 now and he no longer has any more back pain.

Mark: So what can be the kind of course of treatment. The diagnosis sounds pretty complicated. You're looking at muscle function throughout all parts of the back, I'm sure and into extremities. Once you've diagnosed, whether it's functional or structural, what actions do you actually start getting people to do? And how long is it going to take? 

Wil: Yeah. So timeframe wise, it's a little bit harder to really say, you know, this is exactly when this is gonna get better. It's sort of a range. And then that's also considering that it's under a physical therapy or physiotherapy management sort of perspective. And in a physiotherapy perspective, you're also considering the possibility of using bracing. If it's a milder form of scoliosis with respect to the structural. And there's still things that you can do manually, you know, like segments that maybe are stuck and you need to do adjustment and manipulations to kinda get those moving. And that's important too. 

And then not just the joints, but manipulation of the soft tissue. Looking at what is tight and what's not. What's not moving properly. And then proper movement reeducation or proper muscle activation patterning, which is through exercise prescription. And that's really important. And then through that training, maybe using other modalities, like some muscle stimulation and to get these muscles going. Some taping to facilitate the activation of this, and then maybe like, I don't know, maybe like some insoles or whatnot to support the arches. Those are some things that we can do to influence the healing process and the rehab process of a person that is experiencing back pain. Upper, middle, or lower back pain because of scoliosis. 

Mark: And is it fair to say like, always, if you're feeling the pain don't rest and just wait for it to go away, get in, to see a physio sooner rather than later, because that will really accelerate your healing process.

Wil: Yeah, for sure, because there's other specific techniques and methods that can be used to help with the scoliosis. There's certain breathing exercises because we all know that in the mid back, if you breathe, then your rib cage expands and then it moves the vertebrae in certain ways.

And so just things that we can do, there's a lot of things that we can help with that will either, you know, lengthen the spine or get certain muscles moving and get certain joint facilitate a lot better. And then just having that education for you, having you become more aware of what things you can do at home.

Mark: If you've got some back pain and you're suspecting this, or you don't know, and you wanna find out, or you've been diagnosed and you wanna actually take some active participation in healing your back to the best that's possible. Get into see Insync Physio. You can reach them at insyncphysio.com, book online for either the Vancouver address or in North Burnaby. You can reach the Vancouver office at (604) 566-9716. Or you can book in Burnaby at (604) 298-4878. Thanks Wil. 

Wil: You're welcome Mark.

Mark: Hi, it's Mark from Remarkable Speaking. I'm here with Iyad Salloum, he's the chief clinical director of Insync Physio in North Burnaby. And we're going to talk about a really common thing. A lot of people call it sciatica. It's actually low back nerve pain. What's going on here typically, Iyad?

Iyad: So sciatica is kind of a broad term to describe pain along the sciatic nerve distribution. And I mean, if you think about it, the sciatic nerve kind of runs through the entire back of your leg. So it starts in the gluteal area and it goes down through your hamstrings, into the calf, into the foot. So broadly speaking, anytime you have pain on that distribution, it's called sciatica, but the sciatic nerve doesn't just come out of the back.

You have a bunch of little roots that joined together to form the sciatic nerve. So any disruption or injury or sensitization in any of those nerve roots could contribute to sciatica. And then after that, it travels through a bunch of tissues, so it goes through your gluteal muscles into the hamstrings down behind the knee, into the calf. And then it also feeds the front of the leg, like kind of your shin in the back of your calf. 

So once you think about it that way, you can have sciatica from multiple, multiple things. Typically the most people associated with some kind of diagnosis of a low back injury or a disc herniation with pressure on a nerve root. We don't see that being always necessary. That's not the only way you can get sciatica. There's a lot of reasons why a nerve can hurt. 

I'll tell you the funniest one I've seen in clinic, which is a person sitting on a toilet seat too long playing candy crush and their feet go numb. And then they're diagnosed with sciatica on the phone. But it's really simple for that person. We just don't need to apply direct pressure on that. And then there's the more kind of traumatic injuries. For example, somebody fell, hit their back on a post and then they start to develop these what we call radicular sites, where the nerve root is getting impacted. And they tend to lose a bit of the function in that nerve.

Mark: So what would the typical symptoms be that somebody would, it's just a low back pain? Is that, or is it a low radiating into your butt and your legs? 

Iyad: So it tends to be that exactly. We're looking at the low back cluster of sciatica or let's call it the nerve root issues. Yeah. You'd have a bit of low back pain or sometimes a lot of low back pain. It really depends on the person. Some people complain more of leg symptoms than back symptoms. And the pain radiates down the leg. And that's a really good sign that you should probably get it checked out. If you're getting some kind of sensation, it could be tightness, numbness, tingling, burning. Those all kind of tend to be nerve symptoms. 

Some people just have pain and they're like, it just hurts. I just don't know what to describe it as, it's just painful and it's uncomfortable and I can't sit. So that's what we'll end up seeing. But back pain tends to be usually associated if we're looking at the nerve root issues that contribute to sciatica. 

Mark: And generally, does it show up more when people are sitting or does it show up in movement and in walking and standing? 

Iyad: Excellent question. You have both. That's the confusing part. We used to think that it was only in sitting because when we used to think of things very mechanically and only that way. Yeah, we were like, oh, so if it hurts with sitting and it feels better with standing that it's gotta be this. And then what we're finding is, the more we study people and the more we look at it, it's not quite as simple as that. So it tends to be varied. You can have actually two people with the same injury presenting in exactly the opposite pattern.

So one feels better when they're standing and one feels better than you're sitting. And then vice versa. And then you have people who say, I love it when I walk by pain goes away. And some people say I can't walk because anytime I straightened my leg, I got a bit of a zinger going down my leg. So it really depends on that. Tends to be just like, if you just get assessed properly, we would be able to figure out what kind of way we can kind of manage that person, because again, you could have the exact injury in completely different presentations. 

And the other thing that's kind of confusing about this is, and this is where people sometimes, if you go on a kind of a wild chase to see what's going on with my back and you get imaging and people will come in, for example, without any symptoms of, let's say sciatica or pain down the leg, but then they're showing on an MRI that they have a disc bulge and they're confused. They're like it says here that I should be feeling leg pain, but I'm not, well that also can happen because a lot of people can have abnormal findings on scans and not present with any symptoms.

And that's the biggest breakthrough that we've had in learning about how to interpret imaging findings. You know, when we're seeing a disc bulge or degenerative disc disease on scans, they don't always correlate with symptoms. And that's where if you're just going hunting for something and you try to find something, you might find it, but we still can't say confidently that that's what's causing it.

So it tends to be largely a diagnosis done in clinic, based on what we find. We move you through a bunch of stuff. We do a bunch of tests, and then we will treat you that way. Regardless of what your scan says. 

Mark: So the diagnosis becomes critical then in terms of determining what your course of treatment is going to be?

Iyad: Yeah, because like we said, imagine if let's say two people have a symptomatic disc bulge, especially on the nerve, but one of them feels really good when they bend forward. The other one feels really good when they bend backwards. If we were to just treat based on just the imaging findings and not actually assess that person in clinic, we could be really making them suffer. One person really suffering the other person feeling good, for example. If we had just kind of like progressively pushing somebody into that sore spot. 

So what we ended up finding is usually the first assessment tends to be trying to figure out what's affected. So we would do a very thorough exam, like of the back. We would scan their nerves. We would do a bunch of testing for reflexes to see if the conduction spine. We're always vigilant for any potential red flags that we would need to send out to the ER, in cases like where and those tend to be very rare, but we're always vigilant for those obviously. And then we will try to figure out what positions and what movements that person's comfortable with. Get them moving slowly and kind of gradually. And they tend to do really well with the rehabilitation program, which is the good news, I guess.

Mark: If you have some back pain and you're not sure exactly what's going on, get to see the experts at Insync Physio. You can book in North Burnaby online at insyncphysio.com. You can also book for the Vancouver office if you wish to go there. If that's closer for you. To call the north Burnaby office they're at (604) 298-4878. Get in to see the experts. They'll look after you and make sure that your back is doing better, properly and for the long run. Insync Physio. Thanks, Iyad 

Thanks Mark.

In Rock Climbing part of the Physio / rehab that is really important to do for the spine is improving your upper back or thoracic spine mobility. You need this for large cross over or cross under maneuvers of the hands and sometimes the feet.

To improve your upper back mobility try doing this exercise two times per day and also at the start of every climbing warm up session. Start in 4 point position on your hands and the balls of your feet. Bring your left foot forward and steady yourself on the ball of your foot.

Then cross under all the way with your right hand and arm and then bring it back out and reach up and over. Repeat this for 10 reps on each side doing 3 sets. 

Mark: Hi, it's Mark from TLR. I'm here with Wil Seto of Insync Physio in Vancouver, many time winners of best physiotherapists in Vancouver as voted by their customers. And we're talking about lower back strain today. How are you doing Wil?  

Wil: I'm doing well. Thanks. 

Mark: This is I'm sure I know in, because our business is to look at this kind of stuff that this is something that's searched for. So it happens to a lot of people, I guess, even everyone has some sort of lower back problem in their life. Is that accurate? 

Wil: You know, majority of people, for sure. I mean, I think, you know, the is a certain degree of it. It could just be like something where you feel a little bit soreness, a little bit of a mild discomfort or something like that, to something that might be a little bit more, but still on the moderate to mild side where it's hampering your function. 

Mark: I'm sure there's many kinds of strains and clauses. Can you outline some of those? 

Wil: Yeah. So one of the biggest things that most people come in and when it's more severe, you know, they think of like, oh, did I herniated a disc? Or did I do something really serious? So that's definitely a possibility when strain your back or when you hurt it. And then a big part of what you want to consider, when you think about what kind of an injury it is, is like, well, what were you doing? Like what happened? And I think a lot of what I've been seeing lately, too, just with the pandemic and lot of people working at home is more less the herniation. And people coming in and then just doing a lot more sitting and it's more postural. And they end up having more on the other end of the spectrum where it's not a disc, I don't want to downplay it, but it's a less severe than a disc. 

Disc injuries that in themselves can also be minor as well. So sometimes you might not even get back pain interestingly enough. And to say that you don't have back pain when you're getting a disc injury, it all depends on the symptoms that you're getting and other things you might have, like a lot of neurological things like gross weakness. And so those things need to be looked at and addressed. 

So with some of the clients that our physio team has been seeing lately, we've had people that have been coming in with more sort of minor back stuff where they can move and function, but it's still affecting their capacity to do things at a hundred percent. So for example, at rock climber who, you know, he had just gotten a new puppy. And basically he's been experiencing some more back pain. It could be disc, it could be maybe like a smaller joint. So the disc is basically the joint in the middle of the back, but then it could be something that's more minor, which is in the smaller joints of the back. And that's usually more common. 

So if you're over straining your back and you're not getting enough sleep, and then a lot of things where you're just utilizing your posture in ways that are basically not optimal in sitting. You know, it could be that. And with this individual, and then with another individual I'm thinking of too, that, you know, he's doing a little more shovelling, you know, it's a little joint in the back. I mean, it could be, like I said again, a disc, but then when we assessed it, it definitely looked like it was a little bit more into the little joints in the back.

So in terms of actually figuring that out, there's certain tests that we do and you touch and feel the area. And there's certain tests that actually indicate whether it's this or that. And then those are really important to also kind of determine if it's this or that, or if it's even something more serious.

So with something that's a little bit more involving the smaller joints in the back, there's certain things that we do more specific around the rehab and treatments. 

Mark: So symptoms can be just pain or weakness. In the back? Or in the legs? Is that kind of fair? 

Wil: Yeah. And even when you strain these little joints in the back called your facets, you can actually even have like a limp. And it can be from like a mild degree of it to like something more severe where you can barely walk. So that's why it gets really confusing. Where you're kind of like, oh geez, did I really hurt my back? Or what's going on? Because when you have swelling in those little joints and it becomes a little more than just a mild irritation, then it can cause compression in the nerves that come out between the vertebrae of the spine.

And so then that can cause a radiating pain or pain to shoot down or other symptoms that may mimic something more like a disc or whatnot. So you have to really get that looked at if it goes on for more than three days. 

Mark: So once you've kind of got a history, here's what the possible cause is, here we've diagnosed what we think the issues are. Then what's a typical course of treatment?

Wil: Yeah. So if it's these little joints called the facets and then the muscles all around, they're being really spasmy. The first thing that you want to do and especially like, you know, you've been suffering for this for a few days now, and it's still quite sore.

Then it's really important to actually work on pain management because you really need to get yourself moving. Because if you don't really address that pain and I'm a component of really doing things more naturally and just making sure that you don't have to take anything for it, to just do things on more of a natural basis for exercise or hands-on treatment kind of thing. But you really gotta address that pain and you definitely don't want to be going on bedrest and trying to stay bedbound definitely not more than like two days, for sure.

You get a lot of deconditioning effects. And a lot of negative things going on when you're not trying to modify your activity. And modifying your posture. And so doing those modifications initially are really helpful and then doing some active mobility things that just to just get things moving initially, is really important. 

So in terms of getting stronger is also important. Like doing a little things in those first 72 hours after the injury, because you don't want it to be totally deconditioned. That's really important. So that's huge because a lot of people think, oh, you know, like I'm just gonna need to stay in bed until this gets better. And that's really not good.

Mark: So you want to stay active, and then you're going to lay out like a course of treatment, basically. What does that look like? I know it depends on what it is, but give us a range. 

Wil: Yeah. So obviously with this type of injury, utilizing like when you come into the clinic, addressing that specific area that's been injured, and manual therapy is really, really good to open things up, get things moving, resetting some of the muscle tone around there. And also helping with the rehab process by facilitating certain muscle movements and joint movements. 

So that's our goal in the clinic is to help facilitate that. And then on a rehab perspective at a time, you know, so the initial period is to just get things moving. And get things activated in modifying the activity levels.

That way you're not totally turned off all the muscles aren't totally shut off and trying to re-engage that core. And so after you've moved beyond that stage, then you're also looking at the pain levels coming down. And things are starting to heal. And this is where you're looking at the first 72 hours, 48 to 72 hours when you have acute phase. You have a lot of that swelling and then anything after sort of that 48 to 72 hours, up to even like five days to like a week is kind of that period where now it's the second phase of the healing of the injury. Where now you want to work on getting even stronger.

And then trying to work towards more of that full range of movement that you had before. And then also one of the things that's really good to implement at this period is a little bit more cardio as well. Cause as you implement one more cardio, the blood flow really helps with the healing. 

And also there's been studies that have been shown that when you actually start to do more cardio, you get a little bit more fluid going in your spinal cord. And that helps with a certain pain modulation, which also helps with the whole rehab process. And then now you move into like, after the first week, and maybe even the like the second week, as long as you're not reaggravating it and things are kind of on this trajectory where you're healing. 

Then you really want to look at what you need to do to strengthen it because the strengthening process, which we call the remodelling phase now, which is like that final phase, can last from this period where it starts at post seven days, post 14 days up to three, four months of just rehabbing the strength and getting your full, not only your full function but preventing this from happening again. 

And then what usually happens, and it's funny because our physio team has seen this is that we've seen repeat clients that come in because things that felt great and then they kind of slacked off and oh, oh, look, it's snowing. And then they're going to shovel all that snow, and it's wet snow. But they slacked off from the rehab and they got a little weaker and then they ended up restraining something. And there's a lot of research to show that when you aren't strong and you had a pre-existing back injury and then go back to do something and then you can really increase your chance of reinjuring that same injury or doing something worse.

Mark: So on a bigger, like 10,000 foot view of prevention for back injury, specifically, what would you recommend as the steps that someone should take? 

Wil: Yeah, that's a big question. 

Mark: Well, give me three, like here's the three big ones that you need to do. 

Wil: Yeah. Well, I honestly, number one, get enough rest, get enough sleep. That's huge because your body needs that regeneration. So let's say you're doing everything else right. But you're not getting enough sleep. That is going to get you. Sleep is so important. 

 Number two is really, I think if you're looking at sleep, eating right. So those two kind of go together, sleep and eat right. And then I guess number two would be really making sure that you keep up with some kind of fitness. If you have days where you go, oh, I've got to shovel the snow and then you're not really in shape, make sure you try and keep some form of exercise, whether it's daily walks or even just some low level of fitness. And that's really, really, really important. 

And I think the third thing is just your posture. When it comes to sitting and work. And it's hard when you're working to really be cognizant of how you're sitting all the time. And to really be aware and setting timers, setting up your workstation. So that way you can change up like from sitting to standing every 45 minutes. And having a little spot where you can stretch out from like maybe five minutes after every hour is really helpful. Even myself and our physio team, we even catch ourselves having bad posture. And I think that that's one of the key things to really prevent, you know, things from going out because it's the long creep effect. 

So if you're sitting there for a long time, you don't realize it, then you know, your back takes the strain. And then you're also checked out of your awareness of how your body's feeling. So those are the big. 

Mark: If you've got some back problems the guys to see are Insync Physio. You can book your appointment at insyncphysio.com. They have two locations. One in Vancouver, you can call them at (604) 566-9716 or in North Burnaby, (604) 298-4878. You got to call and book ahead. They're always busy. But they are experts in this. Like I said, they're multi time winners of best physiotherapists, both in Burnaby and Vancouver as voted by their customers. People love these guys. You need to get in there and see them get feeling better. Insync Physio. Thanks Wil. 

Wil: Thanks Mark.

Mark: Hi, it's Mark from TLR. I'm here with Wil Seto of Insync Physio in Vancouver, multi time, winners of best physiotherapists in Vancouver and in Burnaby. And we're going to talk about herniated disc. How are you doing Wil? 

Wil: Hey, Mark I'm doing well. Thanks.

Mark: Herniated discs. That horrible sounding thing. What's this all about? 

Wil: Yeah. So a herniated disc, you know, some people may even have a herniated disc and they don't even have pain. That's the thing. There's very different degrees to having a herniated disc. But what it is essentially is, when you look at your spine like the lower back is a really good example because that's where usually is most common. But you have three joints in your spine. So you have the two small ones which are called your facet joints. And then you have the one in the centre, which is basically where your disc sits. And that's the area where, you know, usually when you have a disc herniation. 

And so if you actually think about a disc herniation, kind of like a jelly donut, and if you straighten the back in a way where you bend forward too much and you strain the ligaments kind of in the back side of the back. And then what happens is like if you push the jelly donut and the jelly squeezes out, that's kind of what happens when you herniate a disc. And there's, like I said, varying degrees to severity of it too. So can we really mild where you actually don't even have back pain and that herniated disc can start to pinch up on a nerve. Or where it can be very inflamed and it could be like, basically, you know, super, super painful where you can't even like stand up or sit or move and you have to be bed bound.

Mark: So what are the symptoms other than pain? 

Wil: Yeah. Well one of the other major things that I should also mention is that if you have a herniated disc that can pinch in on your spinal cord, there's certain symptoms there that, you know, you want to make sure that you're not having issues with your bowel or bladder movements that's important.

And then any major gross motor stuff that happening as well as it pinches in. And if you lose all you know, bowel, bladder function and your motor controls all gone. So that's obviously on the extreme end. And that's when you want to definitely go to the emergency for that kind of stuff.

And there's usually a lot of pain with that as well. And so symptomology wise, like you're looking at things where even sitting is painful and standing is painful. But the worst will be like bending forward because you're putting more strain. So usually if you have like an a mechanism or a way of you can remembering how you possibly did it, where you're oh yeah, you know, it was shovelling snow for a while and it was bent over in a bad posture. And then all of a sudden, like I felt something in my left side of my lower back, but then the third hurting even more later. So that could be sort of how it happens. Or it could just be like even sitting for long periods of time. Now that we're in this kind of time and an era of like working from home and you're ergonomic setup isn't great. And maybe sitting in the bad chair. And that compression, you know, into the disc.

Speaking of compression, I've had snowboarders and skiers that have made jumps and they've landed on their tailbone and it's caused compression fractures into where the disc connects to the vertebrae. And then injuring the disc at the same time. So those are all sort of different ways that you can injure and how the pain that comes on. 

I had someone that actually just, they were already set up to have it happen. Where they had all this muscle imbalance and they went to go pick up literally a paperclip on the floor and their back just went out, so to speak. And they had super bad pain and they thought they just pulled a muscle. But it turned out to be what I thought to be a herniated disc. 

We also had another person who were at worlds. I was working with this athlete and he had flown to be with the team and to be with us. And then days to the competition, he comes up to me and say, Hey, Wil, I think I have a bit of a problem with my little toe. And I'm like, what do you mean? Oh, it just feels tingly. And then I start to ask him more questions. And oh yeah, and I don't feel strong on this whole right side. And I'm like, really? And then, so I did a thorough assessment and I suspected them afterwards that he had been playing with a herniated disc. And I said to him, I gave him the low down and I said, you can keep playing, but you might injure it more.

He kept playing. And he did have worsening symptoms. In the end, when he finally went home, I recommended him to go see a doctor and because he didn't have healthcare coverage here, and he was able to manage the symptoms while we were traveling at worlds. He didn't want to see the doctor while we were away, which I thought was silly. And then he went home, had a scan done and he had a very severe herniated disc on the right side of his L5 S1. Had surgery the next day. Wow. And then his numbness was gone and full strength back in his foot. It blew my mind away. 

So there's varying degrees of the disc issue when you have a disc herniation. And then I had someone that just had mild stuff going on that it just seemed like a back strain. Didn't even have any of the neurological, like weakness or anything like that going on. And he decided to get an MRI on his own accord and it showed that it had some disc herniation at a couple levels. But he was pretty good function. He just had some mild discomfort. 

Mark: So is it, when you're diagnosing this now, you know, as it x-rays, is it eventually, as you see more and more indications of severity, you're moving me into, okay. You got to get an x-ray, you got to get an MRI. How do you diagnose this and how what's the difference?

Wil: Yeah aside from the clinical tests that we do, this is more a medical management, where they look at, seeing the doctor and usually they do get an x-ray. But that's not what I would recommend first. You know, you want to really treat it conservatively and really work on, a lot of the times you know, really doing that rehab is the best, best way to treat it.

Like doing your physio is the best way to treat it. Doing things to really address the imbalances that are happening and the weaknesses because things get really tight when you have that disc and you want to do things to influence more decompression in there you know, and traction definitely really helps.

But you want to get things to decompress more naturally, take the load off by like really taking those muscles that are like this, and getting them to be more relaxed. And then engaging the core and then retraining that stability system. That is key. And then really working on a really good extension protocol, things that actually helped to influence that extension motion.

So there's this whole method of really being able to start to get that mobility back into the spine in a really positive way. Because you want to make sure that you do things with a herniated disc where you're addressing mobility deficits and your core stability deficits.

Mark: So when you're outlining a course of treatment, of course, it varies pretty dramatically. I'm sure. Depending on how severe the hernia is, but what can you give us kind of like a range of what the course of treatment might look like? 

Wil: Yeah. So typically for, and this is all very dependent too, on the healing process of the disc and you have to really respect that. That's the thing. It's not like a sprained ankle, or even just like a like those little joints in the back, the facet strain. It's more, you have to respect the disc injury because it's bit of a different healing process. And so when I say that, typically a disc injury can heal anywhere from four to six weeks, fully, which is great.

So then that's what you're looking at, but when it gets to be a really bad disc herniation. Those can even last up to well beyond four to six months, even up to maybe a full year, depending on what's going on. And this is where like, if it's that bad and you're looking at okay, well, there's a little bit more going on on a neurological level where, you have a lot of gross, severe stuff going on with muscle strength loss, and neurological issues.

Then that's where I definitely want to refer over to medical management, have a referral to a doctor and really get things going on that way because that's something that's a little bit more than just conservative treatment. 

Mark: And that's where you would work in concert with the doctor where the doctor's looking and checking to make sure. And then referring back to you to give, to outline the recovery process, the exercises, the treatment, basically that they're going to go through, is that how that works? 

Wil: Yeah, for sure. We definitely work with doctors on that, but usually, the most advised course of treatment is doing the rehab first. And if things aren't working out there, we're definitely all reaching out to the doctors and even, like I said, with pain management, getting some stuff to really hone down the pain because we don't want you to be bedbound for this long. That's not good. We're going to get you going. And then if it's that bad of a herniation, then let's get some more information. Let's see what's going on.

Mark: If you've got a herniated disc or suspect you have a herniated disc, or you got just back pain, the guys to see your Insync Physio in Vancouver and in North Burnaby. You can reach them and book at insyncphysio.com. That's their website. Both locations are on there, or you can call and book. The Cambie location in Vancouver, it's 604-566-9716 or the North Burnaby location, 604-298-4878. Get in there, get some help. Find out what's going on. Get the heck out of bed and get moving again. Thanks Wil. 

Wil: Thanks Mark. You bet.

Place a ball underneath you between your hands. This will be the centre position for the ball as you will be moving it out to one of four positions each time and back to centre again.

Begin in a plank position and engage your lower core by trying to make yourself skinnier below your belly button at your waist line. Supporting yourself in a plank with your right side, move the ball from centre to up above, then back to centre, then from centre out to the left and then back to centre, and then from centre to below and then back to centre again.

Finally from centre out to the far right and back to centre again. Switch and plank on the left side now and move the ball with your right hand. Do 10 reps on each side daily. 

You can utilize this exercise for rock climbing and many other different sports that require strong core stability for you low back such as baseball, volley ball, rock climbing or ultimate frisbee. 

Begin in front plank position with your low back core muscles activated. Keep your shoulder blade muscles engaged and step your left foot out to the side and then bring it back to the start position.

Then step your right foot to the side and then bring it back to the start position. Repeat 10 repetitions for each direction for 3 sets daily. 

This will help build strength in your core stability muscles after a lower back injury.

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.