T Nation

Clients & Bad Backs!


#1

Hey Guys question on:

I have a few clients whom have bad lower backs, I'm looking into what causes them to have that problem, how long it's been bothering them etc. In the mean time i'm staying away from compound exercises that may stress that area and make it even worse.

What do other trainers do when faced with similar tasks?

Thanks


#2

Stretching the hip flexors via bulgarian squats.

I've had good results from static and contract-relax stretching of the lower body and abs/low back.

Pilates has been helpful too, there's a book by Allan Menezes that I found useful.


#3

You have to assess them to see if they have any obvious postural faults. Seeing tightness in the hip flexors can cause an anterior pelvic tilt and an excessive lordosis in the lower back, it seen sometimes in people with kyphosis-lordosis. Tightness in the hip flexors is not really common in lower back problems in my opinion though. What is common is the hamstring/glute tightness that causes a flat lower back. Whatever is tight stretch it out, what ever is weak, strengthen it.

Also, the external obliques are commonly a weak point in a variety of different back problems. The best bet is to take it slow. Avoiding compound lifts is not always the way to go IMO. Remember how weak these people are, they will get stronger with very simple exercises that you may not even consider an exercise. After strengthening the core, I often deadlift. I see deadlifts as a great exercise to strengthen the areas where most people are the weakest. Glutes, hamstrings, lower back, upper back, spinal erectors, there is even some oblique in there. But if the person has had a herniation or other major problem you make have to take a diff route.


#4

The first thing I do is try to correct any postural problems. Usually with older clients their problem has become structural so a lot of stretching is needed to try and regain normal ROM.

I then try to strengthen the muscles in the right area. A lot of this comes down to finding ways to train around pain. If the client is experiencing pain with every rep, i terminate the exercise. If they only experience pain when they let their posture drop etc.. then I give them prompts to keep good posture and we keep going. For instance, forward ab flexion seems to irritate clients who have bad backs/necks. Rotational movements however seem to be fine.

The important thing, is do not do anything that risks them getting worse. Even then we are not physio's, with injured clients we have to do exactly that. Make the problem worse and you'll have someone out there enthusiastically telling everyone they know how bad you are at the job.

Also, don't be afraid to refer clients on. If you don't have the skills or knowledge, send them to someone who does.


#5

I'm not up on the theory you guys are discussing, but I'll just throw in my personal experience. I've had a bad back since I was in my early teens (Scheuermann's disease... which is actually a disorder and not a disease). Ever since I've been deadlifting heavy (or doing any sort of back work for that matter), my back has felt great. I think a lot of my problems come from bad posture as well, since Scheuermann's tends to encourage shitty posture.


#6

I suggest stretching for better full ROM, maybe even trying to take some SIMPLE yoga moves and applying them correctly. Also, find some good ROM tests for the hip flexors and lower back to further evaluate. Involve a stability ball for crunches, flyes, etc. stability balls can be great for taking off back strain. However, you might still be able to do compound moves such as DB Rows using an incline bench. Like you said, it's improtant to find out what causes their back problems, if it's skeletal or obesity or just plain no lower back strength. In any case, seek advice if you're not 100% confident about what you're doing.


#7

you guys seem to know what you are talking about, so ill ask: what are some good stretches for lordosis. ive read neanderthal no more, but that was more about exercises


#8

Stretching the lower back is one of the single-worst things you can do. You need to build mobility in the HIPS and THORACIC SPINE and SCAPULAE while enhancing stability in the range of motion that the individuals already have at the lumbar spine. Most back problems involve excessive ROM at the lumbar spine to some degree.

Simultaneously, you'll usually need a boatload of glute activation work.

Mike and I created our DVD with problems like this in mind:

http://www.T-Nation.com/readTopic.do?id=878989


#9

when in doubt refer out. Let someone who is qualified figure out what's wrong and if you feel comfortable from there help them with it.

Usually though lower back pain is due to weak abs, tight hip flexors and hamstrings. JC Santana's approach works quite well IMO.

We soo too much in our society, so do things that help correct the problems it causes.


#10

I'm sorry, when I was refering to stretching I was refering to what I learned from the Mobility DVD...

This one's for EC: "Stretching the lower back is one of the single-worst things you can do." Don't you refer to the material on your DVD as dynamic, ballistic and static...stretching?


#11

Not EC (obviously) but from what I understand when I watch the DVD is that the first set of movements that relate to the lower back area deal with "flossing" and dissociating the lumbar spine from the pelvis.

Then the next part (birddogs/bridges, etc.) deal with glute activation. None of the above is stretching as they caution not to force the end R.O.M. in most of the initial exercises.

Hope that helps,

Pat


#12

All right, I just figured they were considered "Stretches", sorry. Thanks for clearing it up.

*I highly suggest the moves from the mobility DVD


#13

Worst use of whom EVAAAA!!!!


#14

Some good stuff to read:

http://www.T-Nation.com/findArticle.do?article=270spine2

http://www.T-Nation.com/findArticle.do?article=271spine2


#15

There is a HUGE difference between mobilizing the hips/scapulae/thoracic spine and mobilizing the lumbar spine.