ASK A PHYSIO - Back pain in PT Sessions
I have recently been running a book camp with my clients and a few of them are reporting back pain. What can I do to identify those who are at risk and what can I add to the program to manage these episodes? "
Stacey (Personal trainer)
Thank you for your question.
Back pain is a common problem in the exercising population. Most cases of back pain are multifactorial - ie they are brought on by a combination of a lack of range of motion, decreased core muscle strength for support, and tightened or overworked global muscles attempting to correct movements.
Here are some keys tests to predict and prevent back pain:
1. Perform a one leg squat: if the knee travels medially or the hip drops - your client may be lacking strength in the gluteals. This causes a shift through the pelvis when running creating a shearing effect in the lumbar spine. Strengthen this area with glute targeted exercises like bridges, step-ups, one leg squats, and exercise tubing crab walks.
2. Check lumbar extension: have your client lay prone and place their hands under their shoulders. Perform a push up action but leave their hips on the ground. If your client has good range of motion they should be able to be comfortable with fully extended elbows. This becomes a prescribed stretch if needed.
3. Check thoracic spine extension - Test your clients range by asking them to sit up in a chair - outstretch their arms - place their palms together - and see how far they can take their outstretched arms over their heads. A good result is 170 degrees and above - if your client does not have adequate thoracic spine extension then add plenty of foam roller extensions to their program.
4. Do an Active Straight Leg Raise test : have the patient lying supine, instruct them to lift their straight leg 10-20cm off the ground. Watch for pelvis movement. Clients with a well functioning core will maintain a stable pelvis automatically without the need for you to cue them to activate their core. If the pelvis on the opposite side lifts when the leg is lifted then there is a inner core control deficiency. These clients should be commenced on low grade core exercises such as knee roll-outs, supine bent knee lifts and pointers before being progressed to standing core and cables.
These tests are a good start however often these clients may still need hands on intervention and a comprehensive assessment from your local health professionals. Remember that if any of your clients have referred pain, weakness, numbness or pins and needles its essential they seek assessment by a health professional as soon as possible - this protects you from legal nightmares and ensures your client is back on their feet and training at their peak with you sooner.
Hope this helps Stacey.
Tamika Fasoli - Physiotherapist