Program progression for clients with back problems?
One of my clients has a myriad of back problems including herniated discs, spondylolisthesis, low back pain, sciatica, etc. I have been gradually been helping the client to increase hip mobility and back strength to the point where performing certain activities is less painful, but the ultimate goal is to alleviate the pain all together if possible. The client is able to plank for 1 min 30 sec without issue, so I've been adding knee tucks to the plank recently, which the client claims is uncomfortable, but doable. I've also been working on increasing overall body strength with the use of the weight machine in the client's home (BodyCraft GL Home Gym). My question is, how can I keep the program from getting stale, while also progressing the client? I like to use the equipment clients have purchased, but there's only so many things you can do over and over and over again, without the client getting bored (especially when they admit that they only exercise out of necessity, not for enjoymeu)! Any ideas are welcome and appreciated! Side note: the client is also a recreational golfer and would like to incorporate exercises to improve back/hip mobility for that as well.
There are quite a lot of excellent postures and series that can be done with no equipment at all that will require activation of the deep postural muscles, as well as stretch through the places that tend to tighten in the low back area. Teaching the client how to practice the belly and root locks (mulha and uddiyana bandhas), and doing some of the plank variations, particularly those with lateral extension, can be very helpful. The use of breath can also be helpful for decreasing the stress that can accompany tension, that can make tense muscles worse. Pigeon is great for sciatica, but I would caution to make sure you understand precise alignment and how to prop the limbs before you have her enter it.... in fact I usually offer it in supine variation if the knees or back or hips have trouble with it.
Do be aware that yoga is a lot more than just putting someone in down dog. I have practiced it over 40 years, and taught it over 20 years and still consider myself to be learning every day. I wouldn't suggest teaching a yoga class without the requisite training, but I think taking some of the techniques into your training might give you some new and interesting flavor for which you are looking.
May I suggest you find a book by Judith Lasater? She is a PT and extremely senior yoga teacher whose work I find very helpful. I like her book 'Yogabody', but really all of her stuff is good.
I talked about some of these issues in a couple of my blog entries. If you would have any interest in looking at them, here are the links:
Also, if you are interested and have not seen it yet, NPR had an interesting piece on exercise and low back pain:
I would also be careful of spinal flexion as Janet recommends.
To address the boredom issue, the clients like it when I alternate moves between sessions to make room for other moves. Their notebooks for independent work days, are full of options to choose from.
If you find and tell the client that certain exercises will improve the golf game, that should perk them up.
You may also do well by bringing your own equipment to help change things up.
Natalie aka NAPS 2 B Fit.
I have made the intensity difficult enough to challenge football and hockey players. And have used aquatic exercise to help clients regain ROM and stability. The benefits go beyond all other forms of exercise as it is one of the most therapuetic activities available due to the action of the water moving over the tissues.
For back issues and sciatica, aquatic exercise allows clients to engage muscles under load while not loading the spine and joints along the line of gravity (muscle contratctions without nerve compression). The aquatic environment will allow greater ROM as well.