Since low back pain is afflicting 80% of the population and all signs point to this percentage continuing to increase, all IFPA Certified Personal Fitness Trainers must have a sound, scientifically based system for healthy back assessment.
Low back pain is the result of atrophied muscles that are too weak to support the spine or hypertonic muscles that are too tight to allow a functional range of motion (F.R.O.M.).
The following six (6) tests to assess back health will not only give you an accurate assessment of the health of the client’s back, but will help you determine the proper exercise prescription and program design.
By understanding the underlying cause of an indicated deficiency, when a client cannot properly perform the test, you can assess which muscles are weak and which muscles are tight and recommend corrective exercises for each deficiency.
Test 1: Supine Single-Leg Lift
1. Instruct the client: Lie on your back on a mat on the floor.
2. Lift your right leg as high as you can without bending either knee.
There should be no other movement in the knee, hip, back, or any other part of the body, including any type of rotation in the hip or back. Adequate F.R.O.M. is to elevate the leg to 90 degrees with both knees straight and no other bodily movement. If the client has highly de-conditioned abdominals, the leg will begin to rise erratically.
Obviously, this would indicate extremely weak abdominals and the need for abdominal strength exercise. In this case, the trainer should assist the client in elevating the leg to the client’s F.R.O.M., but under no circumstances should the trainer attempt to “push” the leg into a deeper stretch.
If the client cannot get the leg to the 90 degree position or beyond, then the trainer knows the client has hypertonic hamstring muscles. This would require an exercise prescription to increase flexibility in the hamstring group.
For the healthy back test: score one (1) point if your client can elevate their right leg to 90 degrees and one (1) point if they can elevate their left leg to 90 degrees.
Test 2: Back Extension and Hold
1. Instruct your client to lie face down on a bench or table with their upper body extended off the bench or table from their waist up (at the belly button).
2. The trainer will secure the client’s ankles to prevent them from falling off the bench or table.
3. The client interlaces the fingers of both hands and holds the hands with the knuckles touching the forehead and elbows extended out to the sides.
4. Begin, bent at the waist and the upper body lowered.
Instruct the client to slowly raise their body until the upper body is in straight alignment with the lower body and bench, parallel to the floor. Hold the position for 10 seconds. If the client is unable to hold the position for 10 seconds, the back muscles are weak and will need strengthening. If the client is unable to reach the parallel position, the back muscles are very weak.
Watch and query the client on where they feel the greatest weakness. The low back muscles are the quadiatus lumborum and the erector spinae muscles begin in the low back, but extend in segments up along the entire spinal column to the base of the back of the skull. Careful assessment will determine which muscles are weakest in order to determine the best possible exercise prescription.
Test 3: Curl-Up
1. Instruct the client to lie supine, on their back, with their knees bent and their arms held straight along their sides.
2. Curl-up by rolling the head, shoulder and upper back until the client’s shoulder blades leave the floor. If the client cannot perform the motion, their abdominals are weak and will require abdominal exercise, such as the Crunch to strengthen the abdominals.
3. Score 1 point if your client can Curl-up with the arms held straight in front of their bodies and hold the position for ten (10) seconds without having to lift their feet off the floor. Score an additional point if they can Curl-up with their arms across their chest and hold the position for 10 seconds.
Test 4: Single-Leg Lift in Prone Position
1. Instruct your client to lie facedown on a mat on the floor (Prone Position, facedown). Keeping both legs straight, have them lift their right leg as high as possible without any other bodily movement (i.e.: no hip or trunk rotation toward the lifting leg). Hold for 10 seconds.
2. Repeat with the left leg.
3. Score one point if the client can lift and hold their right leg at least twelve (12) inches off the floor for a minimum of ten (10) seconds and 1 point if they can do the same with their left.
4. If they cannot lift either or both legs at least twelve (12) inches then the assessment shows hypertonicity in the hip flexors. If they can elevate the legs twelve inches, but cannot hold it, then the assessment indicates muscle weakness in the hamstrings, gluteals and/or lower back muscles
Test 5: Knee to Chest
1. Instruct the client to lie on their back on the floor or mat (Supine Position).
2. Start with both legs straight on the floor. Keep the left leg down and straight and have the client bring their right knee up toward their chest until they can grab the right knee and pull it tightly against their chest. Inability to pull the knee and thigh to the chest with the opposite leg held straight on the floor is indicative of hypertonic adductors, gluteals, and/or lower back muscles.
3. Repeat with left leg.
4. Score on (1) point if your client can keep their left leg touching the floor while they hold their right knee and thigh on their chest. Score one (1) additional point if they can do the same with the left knee and thigh on their chest.
Test 6: Standing Wall Posture Test
1. Instruct your client to stand against a wall with their heels, hips, shoulders and back of the head against the wall with feet together.
2. Instruct your client to press their neck and lower back against the wall without bending their knees or lifting their heels off the floor.
3. Try to place your hand between your client’s low back and the wall.
Score two (2) points if your client can press their back against the wall (against your hand) and hold it there for 10 seconds without bending their knees or raising their heels. Score one (1) point if your back is one inch or less from reaching the wall.
Healthy Back Test Scoring Table
|Above Average Risk||6-8|
|High Risk||5 or less|