Diagnosing and training clients with back pain

[Feakins]

Hi guys,

Im looking for any good recommendations for reading materials whether it be a book or online where as I can build some knowledge on how to diagnose and train clients with the intention of improving and maybe completely rehabbing back injuries and/or every day back pain. All within my scope, ofcourse

Cheers

[Feakins]

Also, does anyone here train diabetics?

[KyleAaron]

It's not in our scope of practice to diagnose the cause of or treat any pain.

Now, if you've been given a diagnosis by a competent medical professional - as opposed to a chiropractor, osteopath or the like - then you can, in consultation with the medical professional, act on it. Broadly-speaking, stronger is always better. You begin with limiting the range of motion, load it up over time, drop the load and increase the range of motion, then increase the load, and so on. For example, rack pulls building to deadlifts, etc.

Put another way, find a movement regression they can do without pain and progress it. If there's pain again the you back off and build up again. But only with a diagnosis from a competent medical professional. Which you ain't.

[Feakins]

I think when the subject is as black and white as it is, I should have worded my post a little better. My bad!

Anyway, I completely agree with what you've mentioned in regards to staying within the scope of practice. What if I get a 47 year old female come through the door who struggles with mild lower back discomfort when spending long periods of time on her feet, what direction should be taken here? Work within a range of motion that doesnt irritate or appear to worsen her back and gradually strengthen the posterior chain? Obviously aswell as doing some anterior chain work

Keep in mind im a relatively new trainer of about 6 months experience and obviously am not going to attempt to take on any of these clients before fully educating myself

[Feakins]

Thanks for what information you've already given also Kyle 🖒

[KyleAaron]

What if I get a 47 year old female come through the door who struggles with mild lower back discomfort when spending long periods of time on her feet, what direction should be taken here?

I don't care about discomfort. Working out causes discomfort. I care about pain. Let's assume she reports pain, they usually will, since the sort of person who gets to 47yo without working out has avoided exertion their whole lives, that is, they perceive discomfort as pain. So: first you clarify whether it's discomfort or pain.

With your hypothetical 47yo woman with back discomfort/pain, as with ANY client, you look in your toolbox of all the different kinds of squat, push, pull, hip hinge and loaded carry, all their variations of technique, range of motion, reps and sets and load, and find a variation they can do without pain and progress it.

Another way to put it is that things fall outside our scope of practice if there is pain or hindered movement. So we stay within the kind and range of motion that does not cause pain, and where they can move unhindered. You find a variation of the movement the person can do, and load it up. Later you return to the regular movements and things are fine. If not, get some help.

Some examples from my gym. A guy trains normally for a bit then reports shoulder pain, he'd had a previous injury there but couldn't tell me exactly what it was, hadn't required surgery or anything though. Low-bar back squats hurt, presses hurt. Okay, swap the barbell for a safety squat bar - now he's squatting without pain, great. Toss out the presses, put in more pulls and farmer's walks, which he can likewise perform without pain. A month goes by and things no longer hurt in his shoulder, alright let's try low-bar back squat again. No problem. Now, in a separate session, try presses. No problem. Why separate sessions? Well, he might be okay while he does them but wake up at 3am in pain, which one caused it? So we change one thing at a time and see what happens. If it hurts, stop. If it doesn't hurt, load it up - just more slowly and cautiously than you would if there were no history of pain.

We found a variation of the movement the person could do, and we loaded it up. Later we returned to the regular movements and things were fine.

A woman comes in and finds it hard to set her back when pulling from the floor, and reports lower back pain afterwards. No history of injury there, but she also had to start with the 15kg bar in squats, and 10kg in presses. In other words, she's just weak. But she can set up doing a hip hinge with a reduced range of motion, ie deadlifts are a problem but rack pulls aren't. So she does those for a month or two, then we take the bar to the floor and drop the load, ie we increase the range of motion. You do something similar by keeping the load the same, but lowering the bar each session. Anyway now she's deadlifting and it's all good.

We found a variation of the movement the person could do, and we loaded it up. Later we returned to the regular movements and things were fine.

But now one hip flexor has started hurting, and she can't squat - we tried reducing the load, it still hurt; we tried reducing the range of motion, it still hurt, we tried different kinds of squats, it still hurt. She took a week off because she was sick, came back, it still hurt. Oh well, take out squats entirely, the deadlifts will have to be the main strength driver until a physiotherapist tells us what's wrong.

With no variation of the movement the person can do, we refer for medical advice. Because movement is hindered to such a degree that no variation works.

With your hypothetical 47yo woman with back discomfort/pain, as with ANY client, you look in your toolbox of all the different kinds of squat, push, pull, hip hinge and loaded carry, all their variations of technique, range of motion, reps and sets and load, and find a variation they can do without pain and progress it.

So you need a toolbox. Think about the movements of squat, push, pull, hip hinge and loaded carry. Think of their biomechanics.

What's a "squat" involve? Hip flexion combined with knee flexion, followed by hip and knee extension. So what movements come under this broad category? Lunges, stepups, goblet squats, front squats, back squats, leg presses, one-legged leg presses, and so on and so forth. Which of those is easier to coach and perform? Might there be a difference between what a 20yo athletic person can handle on day one, and a 70yo person who's been sedentary their whole life?

And then think how each can be varied in range of motion. Is there a difference between a squat to a bench and a squat below parallel? A stepup to an aerobics step, and a stepup to a bench press? How can they be loaded up? Is there a difference between holding one 20kg dumbbell in both hands while squatting, and holding a 10kg dumbbell at each shoulder in a rack position? Is there a difference between doing 10 sets of 3 and doing 3 sets of 10? How can they be progressed in load?

Now do the same analysis and list for push, pull, hip hinge and loaded carry.

By this stage you should have several pages of notes, at the least. Now boil them down to at most a single page of guidelines for each movement. Think of it as like schooling. Children don't start with calculus, they start with counting to 10. Figure out whether you're dealing with a grade 1 or a grade 10, and progress them through to graduation.

[Feakins]

Found that really helpful, cheers Kyle 👍