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Corrective Exercise Program Design For Back Pain

Until recently, the primary role of personal trainers has been to help people lose weight, or more accurately: lose fat, build muscle, “firm and tone-up”, improve athletic performance, enhance aesthetic “looks” and improve overall health. Personal trainers use exercise instruction, prescriptions, education and motivation to help their clients achieve these goals.

Unfortunately, there is solid research by the CDC that indicates:

  • An estimated 126 million adults (55.7 percent) reported some type of pain.
  • An estimated 50 million adults (20.4 percent) experience chronic pain
  • An estimated 19.6 million adults (8 percent) had high-impact chronic pain.

Compile these stats along with the following info:

  • The 55 years old and older population are the fastest-growing segment of people joining the gym.
  • Most personal trainers do not have the necessary skills, to safely and effectively train people with musculoskeletal issues, pain or other disorders.

This is the realm of Corrective Exercise. You can become a far more valuable Personal Trainer to your clients by mastery of this realm.

For example, nearly 80% of the population may experience serious back pain episodes, some time in their life. According to the Mayo Clinic, Back pain is one of the most common reasons people go to the doctor or miss work, and it is a leading cause of disability worldwide. Most people have back pain at least once.

Keep in mind their back-pain episodes can be far more than painful, it can be debilitating. Lying in bed and just taking a deep breath can be excruciating.

The two main deviations that cause discomfort, injury, pain and movement dysfunction in the lower back and throughout the lumbopelvic girdle are:

  • Anterior Pelvic Tilt
  • Excessive Lumbar Lordosis

For a person standing normally and in perfect skeletal alignment, you will observe their pelvis naturally rotating anteriorly at about 10 degrees.

Greater than a 10 degrees anterior pelvic tilt can lead to excessive lumbar tilt-back pain and movement dysfunction.

Your visual assessment is relatively simple.

With your client in front of you, observe them from the side. If the waistband of their pants is slightly lower in front than the back, that equates to approximately a 10-degree anterior pelvic tilt. If the tilt is greater than that, proceed to a “Manual Assessment”.

The Manual Assessment or “Hands-On” Assessment for Anterior Pelvic tilt, Excessive Lumbar Lordosis and Lumbo-Pelvic Hip Girdle are relatively easy to perform.

Have your client stand barefoot with the heels of their feet, shoulder-width apart, with their heels, gluteals, back, shoulders and head against a wall.

Make sure all 5 parts are touching the wall. You will then place the palm of your hand, flat against the wall next to your client’s low back and slide your palm along the wall, behind your client’s lower back.

To evaluate your client, you evaluate the space between the wall and your client’s lower back “arch”.

  • If you cannot get the tips of your fingers behind your client’s back, there is no “Arch”.

This indicates your client has a posterior pelvic tilt. This is unusual and will not be addressed in this article.

  • If you can only get your fingers behind your client’s back up to about your second knuckle of your fingers, this indicates an acceptable degree of pelvic tilt.
  • If you can get your whole hand or arm through the arch, this indicates an excessive lumbar lordosis.
  • The greater the space between your hand/arm and your client’s back, the greater the deviation and the worse your client’s lumbar lordosis actually is.

In many cases, you can correct your clients’ minor anterior pelvic tilt issues through the “Palms-on-pelvis technique” for finding a neutral lumbopelvic hip position.

To teach your clients this technique:

  • Have the client stand straight, feet shoulder-width apart
  • Place the palms of their hands on their “Hip Bone” (The long bony protuberance on the anterior pelvis), with fingers parallel to the floor
  • Fingers should be slightly below the height of their belly button
  • Slide their hands medially until their index and middle fingers touch
  • Have the client look down at their fingers while standing straight
  • They should be able to clearly see both their index and middle fingers
  • If they cannot clearly see both, their pelvis is probably in excessive anterior tilt
  • Coach your client to “tuck their butt” or pelvis under (tilt is posterior) until they can see both their index and middle fingers
  • When they can see both index and middle fingers clearly, they have achieved a relatively neutral pelvis (10-degree pelvic tilt)
  • Have the client return to the wall position again with heels, gluteals, back, shoulders and head against the wall
  • Have your client use the “Palms-on-pelvis” technique to again achieve a neutral pelvic tilt
  • Coach them verbally to achieve a neutral pelvic tilt
  • Put the palm of your hand against the wall and slide it behind their back
  • Coach them until only the first 2 knuckles of your hand can fit behind their back
  • Make sure your client keeps their knees straight and heels, gluteals, back, shoulders and head against the wall

Some of your clients may not be able to achieve a neutral pelvic position. This is usually due to one of three problems:

  • Clients with long term chronic back dysfunction due to misalignment problems
  • Chronic low back pain
  • Client is obese

The complete exercise prescriptions, programming and management for correcting the problems described above require far more time and detail than can be addressed in this forum.

The general exercise prescription will fall into 3 areas:

  • Myofascial Release Exercise
  • Stretching Exercises
  • Strengthening Exercises

You may recall from some of my previous Sports Medicine articles that most joint disorders are caused by one side becoming hypertonic: overly strong/overly tight and the other side: weakened and stretched. 

The Corrective Exercise Prescription would be to use stretching exercises to increase the range of motion of the hypertonic side while using strengthening exercises to strengthen the weaker/stretched side.

Since many IFPA Certified Trainers are required to self-isolate during this World-Wide Pandemic, now is a great time to take this as an opportunity to expand your scope of practice, your value and a chance to help many people live longer, healthier, happier and pain-free lives! 

The Corrective Exercise Specialist Certification will give you the knowledge, skills, and abilities you need to safely and effectively manage Low Back Syndrome as well as all the other dysfunctions that occur around joints.

The Pandemic will end. We will get through this together.

Good Luck and God Bless us ALL, Best Regards, Dr. Jim Bell

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