FILEX 2017 PRESENTER
TRAINING CLIENTS WITH LOW BACK PAIN
By determining whether your client ’ s back pain is extension or flexion-related , you can more effectively drive their rehabilitation .
WORDS : ADAM FLOYD
H aving a client with low back pain
( LBP ) present for training can be very daunting for a fitness professional . However , it ’ s a situation that you will encounter , as up to 80 per cent of the population will have an episode of LBP at some stage . The cost to society in terms of lost working days and medical bills accounts for billions of dollars each year .
The aim of this article is to encourage PT ’ s to be more specific with their exercise prescription through classification of LBP , and to liaise with allied health professionals ( AHPs ) where required .
Assessing the risk
When a client presents with LBP the first conversation should be a subjective risk assessment . The aim of a risk assessment is simply to determine whether the issue is : a ) A low risk niggle that you can try and help with ; or b ) An injury that needs to be immediately referred to a doctor or AHP .
If the client has any of the following then immediate referral is recommended :
• Strong or severe pain : use a 1-10 scale and consider referral for anything above a 3 / 10
• Constant pain regardless of position ( indicating inflammatory pain )
• Any signs of neurological compromise ( a
‘ pinched nerve ’) which will be sharp referred leg pain , pins and needles , numbness or weakness
• LBP that is unexplained ( no obvious cause )
• A history of cancer
• Anything that is outside your sphere of competence .
Screening the client ’ s active range of motion ( ROM ) can help to determine the extent of the issue . Ask the client to bend forward as if touching their toes ( flexion ), bend backwards as far as they can ( extension ) and bend left and right , sliding their hand down the outside of their leg . If any of these movements are restricted or significantly limited by pain then , again , immediate referral is in order . If they can move comfortably through ROM then the issue is likely to be milder .
If the client has none of the above , they may have mild niggling LBP that seems mechanical in nature . However , as part of your duty of care , if the client has seen a physiotherapist or other AHP , you should make contact with that person in order to obtain advice about exercises you should and should not use with your client . If practical , attending the physio appointment with the client can be a great learning experience , engender loyalty in your client ( as they can see you really care ) and develop a new mutually beneficial referral source .
CEC ARTICLE
Classifying the pain
Once you ’ ve determined that the client ’ s low back pain is a low risk niggle that you can try and help with , you should attempt to classify whether their pain is flexion or extension-related . The aim of classification is to guide your intervention , and for this purpose we are going to keep it very simple – though bear in mind that LBP itself is seldom simple !
1 Flexion-related low back pain ( FRLBP )
Clients in this category develop LBP through sudden flexion under load ( such as lifting a bag of mulch in the garden ) or repeated / sustained flexion ( such as gardening all day or sitting on a long plane ride ). Some structures in our lumbar spine are not sensitive to immediate pain signals ( such as our discs ) and often the pain is felt one or two days after the incident . It is important therefore to ask the client what they have done over the preceding few days .
Clients with FRLBP generally do not like to flex in the early stages – they will tend to bow or not want to bend at all . Extension , meanwhile , is often comfortable and pain relieving ( think about what you want to do after a long car ride ). They will not like sitting and the pain is often worse in the mornings .
NETWORK AUTUMN 2017 | 27