1 2 3
Poor lumbar control during squat Waiter ’ s bow
Seated leg extension on ball
These clients need to be protected from flexion , initially , to allow the injury to heal , and this will generally be guided by a physiotherapist . So , no squats , deadlifts or sit-ups . You should encourage gentle mobilisation such as walking and unloaded exercises such as knees rolling side-toside ( feet on the floor lying on your back with knees bent ). The cobra stretch ( a yoga position ) is often helpful and pain relieving .
Once the injury is healing and the client is allowed to resume training , you need to teach them how to control their lumbar spine through hip flexion movements such as lifting . This is where teaching a well-controlled squat or deadlift becomes very important . However , the vast majority of trainers are not strict enough with maintaining ‘ lumbar neutral ’ in their clients . Obviously the topic of what constitutes the perfect squat opens a huge can of worms , but from a rehabilitation perspective we are looking for :
• equal movement through the hips , knees and ankles
• shins and trunk to be parallel at the bottom of the lift
• the curve of the lower back to be maintained through the bottom of the lift ( for this you must lift your client ’ s shirt and watch from the side – any posterior tilt , or tucking under of the pelvis , should be avoided – see image 1 ).
It is impossible to maintain strict lumbar control through a deep squat , so be conservative when training clients with
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Sway back posture
FRLBP and don ’ t go deep . Deadlifts are also useful , but never to the floor . Use Olympic plates and start with the weights on a rack or platform .
The main muscle group you are trying to strengthen with FRLBP is multifidus , which provides segmental control when lifting or bending . Before commencing any squat or deadlift exercise , train your client to be able to ‘ feel ’ if they are maintaining a good lumbar position . This can be done by teaching them how to bow by using a stick ( see image 2 ) and even through maintaining a better lumbar position in sitting with single leg extension ( see image 3 ). Then progress onto exercises under load such as squats ,
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 .
5
Lordotic / Kyphotic posture
6
Bird-dog exercise
but always stay conservative . Remember that they may not feel a re-injury during the workout , but can pull up sore the next day .
2 Extension-related low back pain ( ERLBP )
Clients that fall into this category have pain that is generally non-traumatic in nature , unless they have had a hyper-extension injury playing sport . The pain will develop over time and is extremely common in both sway back postures and the hyper-lordotic
28 | NETWORK AUTUMN 2017