Network Magazine Spring 2021 | Page 62

P is for PASSIVE
Passive tissues are those that you cannot contract , the non-contractile tissue , i . e . bones , ligaments , discs .
A is for ACTIVE
Active tissues are those that you can contract , i . e . muscles .

If a problem has a movement direction issue , then it is time to correct the movement pattern

M is for MOVEMENT
Movement patterns are the way we use the Active and the Passive tissues to live and lift .
In low backs , most injury occurs when a poor movement pattern ( M ) occurs , or is repeated , that involves a weak muscle / group ( A ), and the passive tissue ( P ) is loaded to a point where it fails and injury results .
Understanding this relationship is the key to training a client who has experienced , or has a history of , low back problems .
We need to :
• address and correct poor movement patterns
• strengthen weak muscle groups
• understand and consider daily work / life postures
Do you need to know what has been injured ?
Often , I ask a client “ What is your problem ?” and they will answer “ I have a disc bulge at …”. I immediately stop the client and say , “ I didn ’ t ask you what your diagnosis is , I asked you what your problem is . What are you having trouble doing that you are seeking my assistance with ?” The client ’ s answer will help define the true problem .
Interestingly , you do not need to know the specific tissue that has been injured . What you do need to know is what movement or posture produces the pain . We call this the ‘ biomechanical trigger ’. Solving the problem of the biomechanical trigger gives us our training plan .
With further education you can learn which tissue or structure is the source of the pain , which is useful when explaining the rationale for your exercise and programming choices to your client . I teach the science of anatomy and biomechanics for this in my courses . Remember : it ’ s more important to know the movement triggers than it is the actual structure .
Understanding directional assessment
The two most common triggers involve directions of movement . Clients will tend to be flexion or extension intolerant . For example , a fast bowler who has back pain may be extension intolerant when they lean back to deliver the ball , as this is lumbar extension . A bodybuilder , meanwhile , may have back pain at the bottom stage of the squat when they ‘ butt wink ’, due to lumbar flexion .
Once we understand this , we can examine other related factors . The most common problems we encounter are flexion intolerances : these are often in those who come to us with a disc bulge diagnosis . Aggravating postures and movements that are consistent with this presentation include problems with bending forwards , tying shoes and an intolerance of longer sitting periods .
Discussing the aggravating factors with your client will tend to give you the answers you need to be aware of when creating a training program that a client can tolerate .
The solution must be specific
Remember our car trouble ? Do not bother looking under the hood when the problem is a flat tyre . Your training programs for low back problem clients must be specific , not general .
This requires us to adhere to the SAID principle : Specific Adaptation to Imposed Demand .
Addressing the movement
If a problem has a movement direction issue , then it is time to correct the movement pattern . How your client moves into that direction will need to be addressed in the program . The most common problem in ongoing low back issues is knowing the difference between flexion moment ( in which muscles are activated , regardless of any movement occurring ) and flexion movement ( bending like a fishing rod ). Even most physiotherapists I have spoken to do not know this simple but important distinction . Essentially , we find the trigger is often due to poor hip contribution to bending forward : the person uses their lumbar flexion too early , has muscle weakness in holding a neutral spine and at the painful segment there is flexion stress . These are areas that a competent fitness trainer can address !
62 | NETWORK SPRING 2021