Have Your Client Keep A Diary

Have Your Client Keep A Diary

 

Many times, clients you are training for their lower back pain seem to take one step forward and two steps back, or may make very slow progress combined with many setbacks.  Upon asking them "what happened," they say that they "have no idea."  You should not stop with that, though.  Most of the time, clients don't realize that even the slightest change in activity level or any additional activity performed may be the cause of their setback.  You should not be satisfied with their answer.  You need to probe further.  Have them walk you through their day, asking them throughout if what they are describing is their normal routine or not.  In this situation, I usually recommend my client keep a daily diary of activities and responses.  I tell them to write down what they do and how they feel afterwards.  If they feel lower back pain, they should stop and think about what activities preceded it.  However, explain to them that it is very important not to anticipate the pain.  They should not be so fearful that pain will result from an activity that they become 'bed-bound.'  You will want them to maintain as much of their regular routine as possible.  The diary will help you, as their educator, to alter the mechanics of the activities in order for them to be performed pain-free.  Sometimes, the slightest change in body mechanics, posture, body position or lifting technique will completely eliminate their pain.  The diary will give you a baseline focus for your sessions.  It will help you to not only make continuous assessments, but will also allow you to provide the appropriate corrective exercises.        

Protect Your Lower Back By Engaging Your Core

Check out this quick video on how to engage your core during exercise.  Learn to use a feedback technique (your own hands) to make sure your core is contracted properly.  Now, it is your job to make sure you maintain this contraction throughout the entire workout.  No need to focus so much on timing your breathing during the positive/negative portion of the contraction (I'm sure you have all heard "exhale upon exertion") for spinal stability when you use this technique.  Mastering this skill will greatly reduce your chances of injuring your lower back.

http://www.youtube.com/watch?v=gGT8ckhUrE8

ONCE AND FOR ALL, SHOULD I USE HEAT OR ICE??

Many patients and clients have asked me whether they should use heat or ice on an injured or sore body part.  There seems to be many opinions about this.  What has worked for me in the past and what I tell my patients/clients is this:
1.  If it is an acute injury, meaning it is days/weeks old such as surgery, ice is the only option.
2.  If it is subacute or chronic, meaning it is months old, heat may be used.
Reasoning: After initial injury, inflammatory agents rush to the injured site.  To minimize swelling/edema, ice is applied.  Ice may be applied from session to session.  However, after a few weeks or even months swelling may continue to be present.  At this point, heat, specifically moist heat may be applied.  The heat will increase blood flow to the recovering site notonly bringing healing agents to the area, but actually "flushing" the remaining inflammatory agents and swelling out of the region.
Exceptions: 
1.  Some overuse injuries such as shoulder impingement, tendinitis, etc... may be a chronic condition, meaning it began months ago.  However, continued use of the body part may cause consistent pain due to aggravation and further inflammation.  Meaning, you never leave the Acute stage and should continue to use ice, particularly after a workout when it is most aggravated.
2.  Being that I live in Florida, I have only had a handful of patients who do not mind ice.  Those who do not like ice actually tense up their entire body when it is applied.  With these clients, you are better off not even using either modality if they are in the acute stage.  The tension caused by applying the ice can actually cause more pain for the patient.

Here is a economical way of making your own ice pack:
Fill a freezer ziplock with 3 cups water and 1 cup rubbing alcohol.  Make sure most of the air is out of the ziplock before freezing it.  Seal it and freeze it overnight.  It will freeze into a gel-like substance and so conforms to whatever body part you apply it to.

Hope this helps.  Good Luck