The 30-second article
• When training clients with low back pain you need to figure out whether they have a low risk niggle that you can help with or an injury that needs the attention of a physio or sports physician
• If you determine that they have a low risk niggle , you should try to ascertain whether their pain is flexion or extension-related
• Clients with flexion-related low back pain ( FRLBP ) can find relief in extension exercises , before being taught how to control their lumbar spine through hip flexion movements such as lifting
• Clients with extension-related low back pain ( ERLBP ) can find relief in flexion exercises and in sitting down , before being prescribed exercises in which they have to use their abs and glutes to improve control of the pelvis . clients ( see images 4 & 5 ).
In both groups , the lumbar spine is in relative extension when upright . I explain to my patients that if I took their finger and bent it backwards towards end of range and held it for 30 minutes then that finger joint would get sore . The same happens to the facet joints in their lumbar spine . Individuals with ERLBP will experience pain with standing still and often with running when there is more extension loading . They will often get relief by flexing or sitting down .
Typically they will be tight in the hips ( especially hip flexors ) and have poor abdominal and gluteal control . This group is the most rewarding to work with as you can make a difference quite quickly . Obviously each case is different , but most clients will have a reduction in pain if you can :
• correct their standing posture ( this will takes months to become habitual )
• loosen their hips , especially to gain more hip extension
• loosen their thoracic spines
• improve abdominal and gluteal control to reduce extension shear forces .
With the last point , you are aiming to improve control of the pelvis . In simplistic terms , choose exercises where the clients have to use their abs and glutes to avoid lumbar extension / anterior pelvic tilt . Push ups and bird-dog are good introductory exercises .
Next time you encounter a client with LBP , after determining that the client is low risk , see if you can classify them into FRLBP or ERLBP . This will allow you to guide your exercise prescription more specifically . If the client ’ s pain does not improve fairly quickly ( within 4 to 6 weeks ) or gets worse , then refer them to a physiotherapist or sports physician .
Adam Floyd B . Sc ( Physio ) B . PE ( Hons ) is a physiotherapist and exercise physiologist based in Perth . He is the owner of Regenerate Fitness and Rehabilitation which combines a large physiotherapy clinic with a full rehabilitation gym facility . regeneratehealth . com . au
28-30 APRIL 2017 / ICC SYDNEY
Adam is presenting at FILEX 2017 – read about his sessions , and register for the best weekend of your year , at filex . com . au / presenters
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