How to Train Clients With Low Back Pain

Low back pain is the leading cause of pain and disability worldwide. Globally, the prevalence of low back pain has increased 54 percent between 1990 and 2015 [1]. In light of this, it is naive to believe we are doing a better job at managing low back pain through protective messaging and training.

To me, this means that we need to change own beliefs about the spine and low back, so that we can properly coach, educate and empower our clients — low back pain or not.

Global burden of low back pain in disability adjusted life-years by age group [1]

Get Rid of Old Beliefs

In fitness, the first step is a basic conceptual change about biomechanics: understanding that, for most people, they are less important than we once thought [2,3]. We need to stop promoting the belief that people will break when they’re put under load in a way that doesn’t look good.

This fear and pathologization of movement is making a big problem worse, and perpetuating myths about our bodies through something called the nocebo effect (more on that later).

We can train ourselves to do almost anything — ask any dancer! — under any movement pattern and any load. The risk of injury is dependent on far more than just how we move.

Most people get injured doing things they’re not properly prepared for, versus doing things that don’t “look” quite right.

In the world of physical therapy and fitness, where the longstanding tendency has been to optimize movement and performance through “safe” biomechanics, this tends to make people uncomfortable.

Don’t get me wrong here: optimizing performance is something we can still foster, but never at the cost of pathologizing movement.

Several studies have shown that spinal flexion cannot be avoided, even when working to keep the spine in a “neutral” position with activities like the deadlift, the squat, good mornings and kettlebell swings [4-7]. If such movement cannot be avoided, no matter the loads or conditions, why do we pathologize it and teach people this will systematically result in low back pain?

If a deadlift is pain free, seek to make progress in performance, instead of assuming injury. I am lifting 125 pounds in each example completely free of pain and injury. Since this is the case, knowing my goals with this lift is more valuable than setting the expectation that this will hurt me.

Change Your Language

Fear and limiting beliefs about the fragility of the spine are hurting our clients, plain and simple. With that in mind, the next step in training clients with low back pain, would be to be mindful of our use of language.

People with low back pain need to hear reassuring, positive and empowering language, even in coaching cues. That means using language that does not scare or cause judgement but rather uses the power of suggestion for good.

Time and time again, I find myself working with women who are fearful of returning to the gym. Why? Because every time they went, they were told they were doing something “wrong.” This fear-mongering gym culture and the language that surrounds it are hurting women everywhere and contribute to our sense of fragility.

If this something we can control and work to improve, don’t you think women of the world would benefit?

This brings me back to something I mentioned earlier called the nocebo effect. The nocebo effect is when the power of suggestion causes harm. This happens through setting negative expectations of injury using threatening language or suggestive communication [8-11].

The nocebo effect is very real and very harmful, in particular for women who have been shown to respond more strongly to nocebos compared to their male counterparts [12].

Avoiding flexion is difficult even when attempting not to flex the lumbar spine [4]. While this is still widely debated in the literature, the impact of certainty in lifting mechanics serves as nocebo for many people and leads to hyper-vigilance and overprotective behavior that hinders performance.

As coaches, trainers and physios, we have an incredible opportunity to keep people from becoming unnecessarily medicalized, and to empower them to stay active and strong in ways they enjoy.

This means forgoing scary or potentially threatening language in our conversations with our clients and in our coaching cues, and choosing to communicate in ways that build a person’s positive beliefs about themselves and enhances their resiliency in the process.

One of the best things you can do for your clients is shift to positive, affirmative, reassuring language, and find ways to reminds them that they are strong, that their spines are robust, that they will recover, and that you are in their corner to help them reach their goals.

Some Examples

Instead of discouraging your client (“That looked terrible. You have the weakest core I’ve ever seen”), use empowering language instead:

“You’re so strong. Your spine is a stable, robust structure.”

Replace negative statements (“That looked terrible. Stop right now or you’ll get hurt.”) by positive ones:

“That looked awesome. Good job. I’m so proud of you.”

Rather than zooming in on faults (“Your feet are flat and that’s why you have back pain.”), find ways to compliment your client.

“You are so incredible!”

Instead of making your client believe they have no options (“There’s only one way to do this and you’re doing it wrong.”), work to offer choices:

“You can do this a number of different ways, I’ll let you choose.”

Eschew scare tactics (“My dad has had back pain for 20 years, you better get checked.”), and choose to reassure your client:

“It’s going to be OK. You will adapt and get better.”

Once you’ve obtained the trust of your client through reassuring and positive language, you’ll want to work to find ways to keep them enjoying the activities they want to do — even in pain — and this is best achieved through activity modification.

Go for Modification, Not Avoidance

Activity modification is valuable for many people who are struggling with low back pain, but never at the cost of complete avoidance.

We know that avoidance often leads to deconditioning, which can lead to more distress and ultimately becomes a ripe environment for ongoing and persisting pain.

As with any training task, repetitive conditioning, graded exposure and consistency are key when working with a person experiencing low back pain. That means helping people with low back pain grade their exposure to tasks that will foster resiliency.

Modifying activities is a great starting point for many people. Often, this means unloading the activity that is most bothersome and recommending they perform it more frequently at the lower loads — essentially exposing them to the task more regularly so that they become more tolerant and resilient to that task.

If removing some of the load is still not tolerated, finding a way that person can perform the same exercise in a different capacity is precisely where you’d want to take things. But again, always with the expectation that you’ll return to the bothersome task when they feel ready and when acute symptoms have largely resolved.

Deadlift modifications for people with low back pain

For example, with something like the deadlift, moving from conventional stance to sumo stance could be a relevant modification. The sumo stance brings a person lower to the ground and tends to be a less threatening movement for most folks dealing with low back pain.

We have the power and responsibility to use our knowledge for good when training clients with low back pain. Show clients where they are strong, where they excel and pay them compliments that foster their confidence.

Educate yourself about the robustness of the spine. Know that it is not a body part to be feared, but rather revered. It is a sturdy and stable part of our bodies.

People with low back pain need you.

References

  1. Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, et al. What low back pain is and why we need to pay attention. Lancet. 2018;391: 2356–2367. https://www.ncbi.nlm.nih.gov/pubmed/29573870
  2. Dreischarf M, Rohlmann A, Graichen F, Bergmann G, Schmidt H. In vivo loads on a vertebral body replacement during different lifting techniques. J Biomech. 2016;49: 890–895. https://www.ncbi.nlm.nih.gov/pubmed/26603872
  3. van Dieën JH, Hoozemans MJM, Toussaint HM. Stoop or squat: a review of biomechanical studies on lifting technique. Clin Biomech . 1999;14: 685–696. https://www.ncbi.nlm.nih.gov/pubmed/10545622
  4. Holder LJ, AUT University. Faculty of Health and Environmental Sciences. The Effect of Lumbar Posture and Pelvis Fixation on Back Extensor Torque and Paravertebral Muscle Activation: A Thesis Submitted to Auckland University of Technology in Partial Fulfilment of the Requirements for the Degree of Master of Health Science (MHSc), 2013. http://aut.researchgateway.ac.nz/handle/10292/7204
  5. McGill SM, Marshall LW. Kettlebell swing, snatch, and bottoms-up carry: back and hip muscle activation, motion, and low back loads. J Strength Cond Res. 2012;26: 16–27. https://www.ncbi.nlm.nih.gov/pubmed/21997449
  6. Vigotsky AD, Harper EN, Ryan DR, Contreras B. Effects of load on good morning kinematics and EMG activity. PeerJ. 2015;3: e708. https://www.ncbi.nlm.nih.gov/pubmed/25653899
  7. Arjmand N, Shirazi-Adl A. Biomechanics of Changes in Lumbar Posture in Static Lifting. Spine . 2005;30: 2637–2648. https://www.ncbi.nlm.nih.gov/pubmed/16319750
  8. Stewart M, Loftus S. Sticks and Stones: The Impact of Language in Musculoskeletal Rehabilitation. J Orthop Sports Phys Ther. 2018;48: 519–522. https://www.ncbi.nlm.nih.gov/pubmed/30067920
  9. Lin IB, O’Sullivan PB, Coffin JA, Mak DB, Toussaint S, Straker LM. Disabling chronic low back pain as an iatrogenic disorder: a qualitative study in Aboriginal Australians. BMJ Open. 2013;3: e002654. https://www.ncbi.nlm.nih.gov/pubmed/30067920
  10. Evers AWM, Colloca L, Blease C, Annoni M, Atlas LY, Benedetti F, et al. Implications of Placebo and Nocebo Effects for Clinical Practice: Expert Consensus. Psychother Psychosom. 2018;87: 204–210. https://www.ncbi.nlm.nih.gov/pubmed/29895014
  11. Darlow B, Dowell A, Baxter GD, Mathieson F, Perry M, Dean S. The enduring impact of what clinicians say to people with low back pain. Ann Fam Med. 2013;11: 527–534. https://www.ncbi.nlm.nih.gov/pubmed/24218376

Vambheim S, Flaten MA. A systematic review of sex differences in the placebo and the nocebo effect. J Pain Res. 2017;10: 1831–1839. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5548268/

 

The post How to Train Clients With Low Back Pain appeared first on Girls Gone Strong.



from Girls Gone Strong https://ift.tt/2NiOUHY
via IFTTT

Comments

Post a Comment

Popular posts from this blog

Muscle Babes Perfect Lean Body Mass Fitness

Image
As a muscle babe do you find it difficult to maintain your lean body mass fitness? If you are so concerned about building a lean muscle , you should also not forget to include taking care of your physical body appearance. The tips in this guide will assist you execute a workout routine to your everyday schedule on how to build muscle fast as a muscle babe . The result of getting to become one of the girls with muscle requires practicing fitness routines regularly. How To Get Started As A Muscle Babe To achieve success building muscle for women , reducing your workout soreness is important. This is why you need to perform sufficient cool down exercises. This cool down period allows your muscles to loosen up and relax after your workout is completed and signs to your body that the journey to becoming muscle babes is close by. Attempting to cool down correctly after exercising may cause extra soreness as well as cramping to happen. How To Become Fit For Girls With Muscle
Read more

How to Talk to a Loved One About Alcohol

Image
Drinking alcohol is common. In the United States, for example, the 2015 National Survey on Drug Use and Health (NSDUH) reported that more than 86 percent of people 18 and older have drank alcohol at least once in their lifetime, and over 50 percent reported they drank some in the last month [1]. Many people can enjoy alcohol without negative physical, psychological, or social consequences. In other words, these individuals can “drink in safety.” Others, however, can drink too much, too fast, or too often, and these patterns of alcohol consumption can lead to negative consequences. It can sometimes be hard to know for certain if a friend’s or family member’s relationship with alcohol is safe, or if it might be problematic. Even more confusing is knowing how — or even if — to talk about alcohol with someone you care about, if you’ve been concerned about their drinking. If your interest was piqued by the title of this article, the short answer is yes, you should talk to your loved one.
Read more

What You Can Do to Support Survivors of Sexual Violence

Image
While we as a culture work to confront the crisis of sexual violence, we have witnessed waves of survivor disclosures via movements like #MeToo , #TimesUp , and #NotOkay . For the health, safety, and emotional wellbeing of survivors of sexual violence, it is critically important that support providers — including friends and family members — be prepared to provide positive, helpful reactions to survivors who come forward. This article aims to outline the difference between positive and negative reactions to sexual violence as identified in the fields of clinical psychology and criminology. Our hope is that this piece will better prepare readers to provide loving, compassionate support to the survivors in their lives who choose to disclose, and to contribute to a safer culture for survivors regardless of their disclosure decision. Positive and Negative Reactions Social reactions to disclosures of violence have a significant impact on health outcomes for survivors, and are commonly ch
Read more