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.        

"No Pain, No Gain, Right???"

"No Pain, No Gain, Right???"

 

 

 

Wrong!!! Here's a quick tip when working with a back injury.  It is advised that therapeutic exercise for a lower back condition be pain-free.  If not, pain during the activity will create 'substitution' movement patterns as the spine attempts to protect itself from feeling the pain.  These 'substitution' movement patterns will cause more problems later on.  Your initial goal here is to relieve the inflamed tissues first, then work on regaining functional movement.   

Back Belt 2

More on Wearing Back Belts

 

 

The Valsalva Technique is a maneuver that people perform when they hold their breath and exert/squeeze/bear down.  Upon study, this technique creates an increase in Intra-Abdominal Pressure (IAP), which causes an increase in lumbar compression.  The prior theories stated that wearing a back belt would increase intra-abdominal pressure which would decrease compressive load.  However, this theory has been proven false.  As stated before, an increase in (IAP) pressure will increase lumbar compressive load.

 

The other theory was that the back belt will provide support to the lumbar extensor muscles.  The muscle activity of the extensors and the abdominals has been measured while a back belt was worn, and no significant change in muscle activity was shown. 

 

Also, when lifting and wearing a back belt, it was noted that blood pressure and heart rate rose significantly when compared to those lifting without a back belt.  With this, you would hope for a cardiovascular screening prior to any employer handing an employee a back belt to wear.  

 

Take home message:  The benefits of wearing the back belt are not as apparent as we once thought.  If a business requires its employees to wear these belts, their focus should be placed more on educating employees on overall fitness, body mechanics, lifting techniques and ergonomics so that they can rely on themselves for injury prevention rather than the back belt.  Interestingly, it was found that when wearing a back belt, the amount of weight a person was willing to lift rose 19%.  Does the back belt provide a false sense of security?  Either way, if you are used to wearing one, it is not advisable to eliminate it completely, but to wean yourself from it.     

Back Belts

Back Belts

 

 

 

 

How many of you have noticed the prevalence of employees in stores such as Walmart, Home Depot and Lowes wearing back belts?  As a therapist, many of my patients recovering from back injury are prescribed these also.  Do they really do what people say they do?  In 1994, the NIOSH (National Institute For Occupational Safety and Health) concluded that they do not prevent injuries or provide protection for workers who do not have a history of injury.  And although these belts may limit side-bending and rotation/twisting range of motion of the spine in standing, they do not limit these motions when the spine is flexed, which is the position of lifting when at work.  Therefore, upon lifting, these belts do not exactly do what people think.  

 



Protect Your Back Even With Light Lifts

Protect Your Back Even With Light Lifts

 

 

Over ten years ago, due to heavy lifting with incorrect technique, I was unlucky enough to develop a herniated disc in my lower back.  This was the worst pain I ever experienced.  Thanks to Physical Therapy school, I was able to manage it conservatively.  However, every now and then it would "go out on me," causing severe pain with even the slightest movement.  One day, after being pain free for a few months, I told a family member I would help them move.  We had to lift and carry a 55-inch rear projection TV (the bulky kind, not the nice flat screens we have today).  I did my part without a problem.  Upon finishing up that day, I bent over to pick up a pencil from the living room floor, and fell to my knees in agony.  After everything I lifted and carried that day, a simple number 2 pencil drops me to my knees?  While on the floor, I had plenty of time to think about what had  just happened.  Why did my back tolerate heavy lifting all day long, but when I lifted something as light as a pencil, my back went out on me?  I realized that with every heavy lift, I did not just carelessly walk up to the item and lift it.  Instead, I prepared my back by co-contracting the spinal stabilizers prior to each lift and carry.  That's when I realized that it doesn't matter how heavy the object you are lifting is.  If you bend over to pick up an item, it is wise to perform the lift with proper body mechanics and pre-stress and stabilize your spine.  This will minimize your chances of injuring or re-injuring your spine. 

"Your Hips Are Like Headlights On A Car"

"Your Hips Are Like Headlights On A Car"

 

 

When teaching a client about proper body mechanics and lifting techniques, a good visual cue is to tell them that their hips are like  headlights on a car. 

 

 

 

 

 

 

 

 

 

 

 

To safely drive at night, you must point the car's headlights in the direction that you want to go.  Functionally, to safely lift or reach, you must point your hip bones in the direction of the activity.  This spares the spine by minimizing lumbar rotation/twisting while bending/lifting.

 

Here, the hips are pointed to the right, while his bending/lifting activity is to his left

 

As she turns to the right, she pivots on her feet and moves as a 'whole,' squaring-off her hips in the direction of her action

Take home message: 
Always "square-off" your hips in the direction of your action.  Do not twist and lift from the left or right with your hips pointing in a different direction.
 

 For more on Posture & Body Mechanics, go to: Posture & Body Mechanics DVD for over 80 minutes of education videos



Provide Justification For Everything You Do

Provide Justification For Everything You Do



 

Nowadays, everyone wants the most bang for their buck.  They want to train effectively and efficiently without wasting time.  As a trainer, you want to gain your client's trust and respect.  Most clients will come to you wanting to lose weight or "tone up."  And many of them will have underlying issues that training may bring to the surface, such as knee pain, back pain, etc...  It is your job to perform an initial assessment asking your client what their goals are, and if they have any pre-existing conditions that may slow their progress towards meeting those goals.  Once you gather a detailed history of your client, you can begin to "prescribe" goal oriented exercises.  You will combine what you have learned about their "weaknesses" with what you know about their goals and devise a training program based on this information.  Now you will not only be focused on their fitness, but also their wellness.  You will have justification for each exercise that you offer.  The reasoning will not just be "to break a sweat" or "burn out your biceps."  You will be able to explain that each exercise will prevent further injury, while developing their physique.  For example, if you have your client perform diagonal patterns with their upper extremities, you can explain that these patterns are functional in nature and will assist their daily reaching or overhead activities.  Using the plank exercise to introduce trunk control can be used for clients who have a history of lower back issues, as increasing trunk stability will assist in sparing the spine.  This should definitely be your goal as no trainer wants to 'hurt' their client.  Your clients will be impressed and pleased with this training style.  They will respect you for your knowledge and you will probably gain another referral source.   

Grip Training While Jumping Rope?

Grip Training While Jumping Rope?

 

 

Jumping rope provides a total body conditioning workout, with a focus on improving strength, agility, coordination, foot work and endurance.  You have the option of using a weighted jump rope or a speed rope, both of which provide the benefits previously listed.  A speed rope focuses on speed and quickness and is better for developing coordination and conditioning, while weighted jump ropes enhance strength of the upper body and burn more calories, which helps with weight loss. 

No matter which type of jump rope you use, adding NEUROGRIPS to the mix will not only provide the benefits listed above, but will also emphasize hand grip, wrist and forearm strength, and endurance.  Using NEUROGRIPS will increase the jump rope handle grip diameter by approximately 1 inch, making grasping of the rope handles more challenging.  This will raise your heart rate, burn more calories and provide you with yet another opportunity to incorporate grip training into your daily workout routine, without having to set additional time aside for the traditional grip training exercises.  


STANDARD JUMP ROPE



BAREHANDED GRIP - COMPLETE CLOSURE WITH FINGERTIPS TOUCHING PALM

NEUROGRIPS - NOTICE THE DISTANCE BETWEEN THE FINGERTIPS AND PALM - ABLE TO COMPRESS THE NEUROGRIP IN ORDER TO HOLD HANDLE - A REAL FOREARM BURNER!

 

Start training with NEUROGRIPS!

Go to www.strengthondemand.com



Worker's Compensation Light Duty

Worker's Compensation Light Duty

 

I have been treating a patient referred to me by Worker's Compensation.  This patient had a diagnosis of lower back pain.  His job consists of sitting at a desk for 8 hours straight with only two 15 minute breaks to get up to use the bathroom and an hour lunch.  Many propose that the time spent in sitting should be limited to 50 minutes before a short 'standing' break is taken.  

This patient states only the timed breaks described are allowed by the supervisor.  Therefore, I suggested that during this break, the employee perform the opposite movement/activity that they were performing while working.  Since sitting imposes flexion on the spine, which stresses the intervertebral disc's annulus fibrosis and may lead to disc posterior "creep," it is suggested that you stand up tall, raise the arms overhead, and push the hands toward the ceiling with a deep inhale.  This will fully extend the lower back, which reduces the annulus stresses.  I recommended that this patient stand as often as possible throughout the work day to go through the necessary work related paperwork.  Instead of sitting in a chair, bending forward to go through a bin of papers, place the bin on a higher surface and stand to do the same activity.  This will allow you to continue doing your job (so your supervisor can't complain), while at the same time 'sparing' your spine.  Your goal is to continually change positions so that the strain on your spine is not focused solely on one location, but shifts. It seems that patients who come to me with lower back pain are those who remain in the same position for extended periods of time.  If they were able to change positions frequently during their shift, their spine would be 'healthier.'  Unfortunately, once these patients are injured, they are usually placed on light duty, which consists of sitting in one position for even longer times during the work day, with minimal physical activity.   

Twisting Activities And Your Lower Back

Twisting Activities And Your Lower Back



 

 

Activities that require twisting your trunk while simultaneously increasing torque  (building axial torque) may lead to lower back trouble! 

 

 

Twisting motion disables the support fibers of the intervertebral disc's annulus fibrosis, which may lead to a bulging or herniated disc. 

 

Since it is believed that there are no muscles designed to produce only torso rotation (axial torque), then there is a limitation to muscles resisting rotational torque. Therefore, your goal is to generate rotational torque, while restricting torso twist.

Limits Torso Rotation

 

 

 

 

     

Vacuuming and Lower Back Pain

Vacuuming and Lower Back Pain

 

Many times, a patient with a diagnosis of lower back pain will tell me that the pain seems to increase when vacuuming. 

Most people tend to push/pull the vacuum with one arm.  The vacuum is held to one side, which places a twisting torque on the lower back.  This force causes man increase in lower back pain.

 

 In this picture, the man is holding the vacuum with two hands directly in front of his belly button.  The force is directed through the lower back with no rotational torque and is therefore less aggravating to the lower back.  Because of this, I usually advise my patients to try their best to keep the handle of the vacuum directly in front of their belly button region, at least until the acute symptoms subside.  As this new technique may not be familiar, it will protect the spine.  The more spine-sparing techniques that you perform during the day, the more you minimize the chances of symptom return.