I gave online Physiotherapy a try and I wanted to walk you through the process of my diagnosis, physiotherapy exercises for upper back pain that I was recommended and my progress pictures!
[Update – See my most recent backbend progress, July 2020]
- What is Phyxable?
- My Background Flexibility
- Assessment Results & Diagnosis
- Week 1: Physiotherapy Exercises for Upper Back Pain & Release
- My Current Progress Pictures (April 24, 2020)
What is Phyxable?
Phyxable is a one-on-one video consultation platform that connects you with a registered Physiotherapist or Chiropractor in Canada. Currently, the platform is very basic – I was able to book my free consultation through League but you can also do this on their website. The only additional information needed at this time is your email, which you would use to enter the video call.
In the video call, all you would see on the screen is the doctor and 3 control buttons (the microphone, video and end call button) – can’t really go wrong here!
Prior to the full body assessment, you would be sent a link to fill out your profile and sign some virtual consent forms –again, very MPV product. I would met my physio through the same link to the video chat room at the time of the appointment. At the end of the session, we would go over the next steps and book the next appointment.
My Background Flexibility
I’ve always wanted to see a physiotherapist about my back pain and low back stiffness. Recently, I started working on my back bends and I wanted someone to be able to tell me which parts I needed to work on.
Prior to the appointment, I had upper back pain that would come and go every few months. The pain would persist for days or even weeks until I gave in and got a massage. I also noticed that my lower back could not round out (extend) when I was doing floor work in dance class. Instead, I stopped going to class because I couldn’t roll. Overall, I’ve been told that I had good posture –so why was I experiencing pain?
Assessment Results & Diagnosis
After the a 20-minute consultation and 45-minute full body assessment, we were able to pinpoint what the issues were! To be honest, I didn’t expect to get much of out a few virtual sessions.
For the tests, the doctor checked my posture, had me do some squats with raised arms, one-legged squats, internal and external shoulder rotations, side plank holds (1 minute on each side), pigeon pose etc. I excelled at most exercises but there were some tests where my movement was extremely limited.
We Identified 3 Problem Areas:
- Weakness in the shoulder blades, from overcompensating trapezius muscle – It turns out that my shoulder mobility was purely a ball and socket rotation whereas two-thirds should actually be from the shoulder blades. As a result, my shoulders roll forward in the socket which affects my posture.
- Low back mobility issue – I was told that this is uncommon, normally people have instability in their lower backs. I have good extension but no flexion (what I called the “flat back”).
- Hip instability – my hips push outwards while my knees collapse inward making it very difficult for me to do one-legged squats without shaking a lot! If I were to do long distance running or hikes, this would cause issues.
Some minor areas were butt winking while squatting (I suspect that this may be the cause of my lower back problems when I used to weight lift). I also have winged scapula on both sides. This limits the scapula from moving forward and up through the thoracic spine for overhead movements (for example, handstands). Both of which I didn’t realize I had!
The next steps were to focus on on stretching and releasing tightness in the upper traps and pec minor. As well as strengthening my scapula – in particular my mid trap, lower traps, rhomboid and serratus anterior. Strengthening the back muscles will help pull my shoulders back, correct my posture and improve any pains.
Week 1: Physiotherapy Exercises for Upper Back Pain & Release
According to the diagnosis, we were on the same page about working on my T-Spine mobility (Thoracic spine) before getting into segmental mobility for the lower back. Fixing my lower back was more of a performance improvement because I want to work on deeper backbends (For example, bridge/wheel pose or dancer’s pose).
- Release: Tennis ball to roll out pec minor.
- Strengthen: TYWI in kneeling position, T-Spine rotation.
- Stretch: Cat cow (focusing on hollowing out my stomach)
My Current Progress Pictures
Here I will be going through the recommended physiotherapy exercises for upper back pain and my “before” pictures to keep track of my progress.
1) Release: Pec Minor
Exercise: 10 passes or when the pain as subsided by 30-40%.
This helps work on functional mobility– understanding the touch and feel of the muscles you are trying to work on. In this case, I needed to find my pec minor- a small muscle underneath the pectoralis major towards the inside of the shoulder. This muscle helps to bring the scapular forward. Tightness in the pec minor brought my shoulders forward and I needed to stretch them out (through release or stretching).
I try to roll out my pec minor a few times throughout the day when I’m taking breaks. Initially, it didn’t hurt too much until I found the tight spots- now it’s super painful!
Variation 1: Arm Behind the Back
- Use your fingers to press and locate you pec minor.
- Place a massage ball or tennis ball in the squishy spot.
- Slowly roll back and forth in 1 inch motions. Then continue rolling inwards to find other areas that are tender.
- Repeat on the other side.
Variation 2: Internal and External Shoulder Rotation
- After completing the first variation, position your arm at a 90 degree angle with your thumbs up.
- Perform 5 internal and external rotations. Think about lengthening the muscles as you rotate.
- Repeat on the other side.
You may notice a burst of emotions when you roll out- for example, sadness, anger, hate. For this muscle, I felt hate..
2) TYWI in Kneeling Position
Exercise: 6 reps of TYWI per side x 3.
This exercise helps to strength and really engage the muscles in your scapula. I find that to be the most difficult part -differentiating scapula movement from just raising my arm. Do each movement slow with control and hold for a few seconds at the top.
- Start on all fours, making sure that all your joints are stacked (shoulders above wrists and hips above your knees).
- “T” – Raise your arm out perpendicular to the body, focus on lifting with the scapula rather than lifting up with your arm.
- “Y” – Raise your arm out at a 45 degree angle, pull your shoulder blade back and up to life your arm.
- “W” – Point your thumb up and make a “W” shape with your arm. Use your shoulder blade to press in as you externally rotate your forearm back (think ‘telling someone to take a hike!’).
- “I” – Raise your arm back in a straight line, lift and squeeze your shoulder blade as if you are compressing a towel. This is the easiest of the 4 movements.
3) T-Spine Rotation
Exercise: 10 reps per side x 3.
For this exercise, make sure that you are in a neutral position the entire way through (don’t just lift your arm, you want to use your back to rotate your arm up and back).
- Start on all fours with one arm behind your head.
- Rotate your arm to touch the ground then continue by rotating your back to bring your elbow up towards the ceiling. Again, you shouldn’t just be moving your arm.
- Repeat on the other side.
4) Cat Cow focusing on Hollowing Out
Exercise: 15 reps x 3.
Cat cow helps bring movement to your spine and improve back flexibility. This was my favourite of the exercises because I do these every morning! This pose is a good indicator of which part of your back does the bending while you are in flexion (cow) and extension (cat). I bend mostly with my upper back and my lower back remains quite flat.
- Start on all fours.
- On the inhale, lift your chest forward and up to create an arch in your back. You should avoid feeling a crunch your low back.
- On the exhale, press against the ground and draw your mid back up towards the ceiling. For low back mobility, my goal was to focus on hollowing out (drawing my belly button towards my tailbone) to feel the stretch in my low back.
After taking a few virtual physiotherapy sessions, I realized that I have a lot to work on for my back pain. A lot of the pain was caused my things that I did on a regular basis without realizing that they were bad for my back and posture. For example, I did heavy lifting for back days thinking that I was working out my back but instead my traps did all the work. I also had a bad chair and wore a backpack for over a year knowing that it was making my back hurt. If I could go back, I’d tell my younger self to not get a small backpack (meant for rock climbers…) then expect to carry a laptop in it everyday.
Now, I can clearly trace back to all the little things I did overtime that led to my current back pains. Anyways, I’m working to fix it now by following these recommended physiotherapy exercises for upper back pain. It’ll be a long process.. but I’ll happily start working on it now than wait for later!
[Update Oct 2020: My upper back pain and rounded shoulder has been corrected! Now I don’t have to consciously pull my shoulders back after I learned how to correctly use my shoulder blades yayyy. Currently working on my back bends]