3 Rules for Low Back Pain
Low back pain has become a staple in the health and fitness industry. Take a bunch of heavy objects, a poorly conditioned 48-year old, an overzealous trainer and an industry that makes money from training frequency and we’re bound to see things breaking.
SI joint pain, disc pathology, pain on extension, flexion or rotation. Low back pain comes in many shapes and sizes. There are some who live with LBP for their entire lives, gritting their teeth and pushing through the pain. Others experience it acutely when it’s brought on by activity, inactivity or just the right amount of activity. It’s a tricky beast to diagnose and treat properly.
Commonly, trainers revert to tried-and-true methods that are supported by doctors. The Watkins program, the McKenzie approach or anything by Stu McGill have been programs and methodologies that I’ve seen most frequently over the years. They work, most of the time.
When they don’t work we’re left wondering what’s going on. Is it posture-related? Is there disc pathology? Is what we’re doing making it worse?
I’ve certainly served my time making back pain worse. Whether it’s running someone through a Watkins program when they still have symptoms and can’t feel good positioning, or letting them flex and rotate in an uncontrolled environment. I’ve made countless mistakes when dealing with low back pain clientele. Sadly, it’s the best way to learn.
What I’ve learned is that no two back pain clients are the same. It’s important to appreciate that as I’ve found myself expecting results using the “it’s worked in the past” ideology. Blanket exercise prescription is no tool to use during low back pain. Assess and assess again!
Step one is understanding where there is pain. Is it when they flex or extend? Rotate left or right? What about walking? Running? Moving sideways? Once painful positions are understood we can settle on a simple rule.
Rule Number 1: Avoid pain at all costs
Let’s remember, if we’re a trainer or strength coach, our job is not to alleviate pain. It’s to improve health and fitness outcomes by moving well, moving often and promoting recovery. Once we take our skill set out of that environment, we will inevitably run into troubled waters that are way over our head.
Sometimes there’s a person who has pain all the time. Flexion, rotation, extension, standing still, moving around, breathing in, breathing out. This one is a tricky one with a simple solution, which takes us to our next rule of personal training with a LBP person.
Rule Number 2: Refer Refer Refer
This doesn’t mean we take the hands off approach and let someone else deal with it. This means we set a person up with a qualified professional and maintain communication, helping when necessary. Many people are uncomfortable moving to a clinical setting. Maintaining communication with the doctor can help solidify trainer/client relationships, which can help the person get and stay out of pain while also paying the bills for the trainer down the road.
Occasionally there’s people who stay in pain. They see all the professionals, they follow every program and still, there’s pain. These can cause some pretty severe emotional stress to both the person with LBP and the poor trainer trying to solve the world’s issues with their personal training certification. In these cases, there is usually an answer lying in the weeds waiting to be found. While searching, it’s important to utilize rule number three.
Rule Number 3: Be Relentlessly Optimistic
Someone has to be. People don’t come in to train to hear how bad or broken they are. Pain is a part of life and for a trainer to make every training session about pain is not only doing the person a disservice, it’s crushing their spirits. Huge no no. If our best efforts are still resulting in nonexistent outcomes, then we keep trying. Period.
Three rules that stem from a career of dealing with low back pain. Best of luck and stay positive out there!