Help with difficult clients (low back pain)

[Maynard311862]

Hey guys, I was hoping some of the more experienced trainers could help me with this.

When I was hired at my gym, I was replacing another trainer and so I took over all of his clients. To be honest, I don't think the man was even certified. After listening to my clients talk about him, he placed a lot of them in a great position to be injured. Having deconditioned, middle-aged clients do single-leg squats on the machines with 90+ pounds on them, kettle bell lunges with a 45 pound kettlebell (which actually hurt this clients back and she JUST returned to the gym recently), pyramid style sets on a fly machine with a client who is new to exercise. The list goes on and on.

Anyways, I have taken over these clients, assessed them myself, and brought many of them back to the stability/endurance phase of the OPT model, and focused on corrective exercises where needed.

I have a few clients that are incredibly stubborn. They suffer from low back pain. And when I say this, they struggle to do planks for 30 seconds. Not because of a weakness in the core, but because of low back pain. (Before I get criticized I do realize that the lumbar spine is a part of the core and I have explained this to my clients.)

They expect me to keep giving them exercises but they can't do any of the ones that I give them. ,stability ball crunches, reverse crunches on a bench, bench knee tucks, side-planks, stability ball knee pull-ins, mb rotations (standing and/or seated) have ALL made them stop or complain of low back pain. I introduced floor bridges, SB bridges, marching, even had a list of corrective exercises from a chiropractor in UMass but they are simply not interested. I even had one client tell me "Well I don't pay you to correct my low back pain, I pain you to lose the fat from my stomach."

I'm at my wits end. I don't understand why they won't let me correct it so we can progress to more difficult exercises in the future, and I simply can not find any exercises to work the core that will not hurt their low back.

So I guess my question is this. Are their any exercises that are corrective for the low back, but are interesting and fun so that my clients won't know I am correcting it? Or are their any core exercises that won't put pressure on the low back?

Thanks guys.

[SFT]

If your clients have back pain during planks there could be a few things going on. Now some trainers cue people to keep their butts down during planks and push-ups. In many cases, this leads to the client having a considerable lordotic curve of the lumbar spine. Instead of relying on muscles to do the work, they are almost hanging their bodyweight by their connective tissues. Make sure that this is not the case and I would even see if the pain persist when having them tilt their pelvis posteriorly by drawing in the belly button.

As far as the rest of your post goes, if multiple trainees are saying something, then you need to take a step back and make an honest assessment. Corrective exercise is great and all, but you shouldn't be playing physical therapist. If they are there for weight loss, then you should be spending time helping them towards that end. At the very least, some people see a reduction in their lower back pain by losing weight.

I'm certain that you can come up with a circuit that is metabolically demanding, but also helps to increase their abdominal strength. From what it sounds like, you are spending all this time with corrective exercise and they feel as if the workouts aren't difficult. At the end of the day, whatever the client perceives is the way it is. If you don't give them what they want, they will go elsewhere. If they were there strictly to work on their lower back pain, then they would go to a physical therapist who could likely help them more than you or I can.

If they can't do ANY exercises without back pain, then it is time for you to refer out.

[KyleAaron]

As trainers, our job is to teach correct movement. Correct movement is the best corrective exercise. You don't need to fck about with swiss balls and all that nonsense. See this article.

The longer version is... consider this: if someone had elbow pain, would you give them curls and tricep pulldowns? If they had knee pain, would you give them machine leg extensions? If not, then why would you give someone with back pain lumbar flexion, lateral flexion and rotation exercises? They need to not move their spines. Planks, side planks, paloff press, whatever version you like. Their backs are ALL hurting because you're hurting them. The guy before you did it wrong, you're doing it wrong, just in a different way.

If they can't do a plank, have them do a plank from the knees. If they can't do a plank from the knees, have them sit up straight while doing cable rows to their belly. And so on. Do they find planks boring? Of course! Try this: jump onto the bike and FLAT OUT for 3 minutes. Now jump straight off, plank for 10-30". Back on, rest for remainder of the minute. Repeat. 3 sets in all.

Or how about this. Grab a 5kg dumbbell.
For 60", goblet squat.
30" press with right hand
30" press with left hand
30" split stance bent-over row right hand
30" row left hand
60" hip hinge
60" - plank for 10"-30", rest for remainder of minute
repeat for 2-4 rounds in all
If you can coach kettlebells, add swings, snatches, etc as appropriate.

Suddenly planks are not boring.

"Well I don't pay you to correct my low back pain, I pain you to lose the fat from my stomach."
"If your low back hurts, this restricts what you can do. If it doesn't hurt, you can do more during workouts, which means burning more energy, which means less belly fat. See that guy deadlifting 100kg? You think that's burning energy? You can't do that, if we deal with your low back pain, you'll be able to work towards doing that."

Explore DanJohn.net, buy Intervention. What I'm saying will make more sense over time.