Answers (10)
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I would consider quite the opposite approach. It's probable that both his lower back pain and knee pain are related, in that there is probably dysfunction in the lumbo-pelvic-hip girdle. You'll want to have a multi-faceted approach to working with him, since he has limitations and is obviously larger than most clients. Sounds like things he'll need are cardiovascular conditioning (best from a seated position since he is large or treadmill walking) and core stabilization exercises. You may need to determine which areas may have dysfunction before implementing a strength training program, to ensure that things may not be contraindicated. A couple exercises that may benefit this client are planks (probably modified), balance exercises (single leg stance), and a ball squat, curl to press (maybe start with a quarter squat, or wherever the client breaks form). Hope this helps.
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Should I focus on machines and avoid free weights until he is more adapted to exercise?
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I would begin by strengthening his core, he will need that stability and strength for everything to follow. Bridges are a good one to start with (what's not to like about lying down?) focus on both squeezing and pushing with glutes, and next set have him 'pull" hips up using his abs(keep the glutes neutral). this completely changes the feel of the exercise and the muscles targeted. Another begining core exercise is pelvic tilts. Lying supine with neutral spine have him flatten low back to the floor hold and release. just a small movement but effective for getting the feel of contracting the core.
Machines are great in the beginning to teach how to dial in on a specific muscle contraction so they can be used to get him to understand how to contract a certain muscle. but moving to free weights as soon as possible will be much more functional and give him a better workout because he will use more muscles to stabilize and more calories burned
Machines are great in the beginning to teach how to dial in on a specific muscle contraction so they can be used to get him to understand how to contract a certain muscle. but moving to free weights as soon as possible will be much more functional and give him a better workout because he will use more muscles to stabilize and more calories burned
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This is a very very difficult question to answer without doing any formal assessment. I would suggest looking into Dr. Stuart McGill's work. "Low Back Disorders" or "Ultimate Back Performance" as they are two excellent resources for not only helping yourself but your clients and patients. He is one of the top researchers regarding spine biomechanics!
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Is this person medically cleared? Has he seen any medical professional about the issue? If so I would start with what has or hasn't worked so far then take a good look at his hips. If there is pain in the knee and low back (which are areas that require stabilization) then there is most likely tightness/weakness in the hips(which requires mobility and strength).
When the hips have limited mobility then the knee and Lumbar area are forced to compensate with increased mobility to make up for movement not happening in the hips. This can cause problems. As Joy stated (hi Joy!) it could also be a tracking issue, which is why a medical professional should be consulted.
When the hips have limited mobility then the knee and Lumbar area are forced to compensate with increased mobility to make up for movement not happening in the hips. This can cause problems. As Joy stated (hi Joy!) it could also be a tracking issue, which is why a medical professional should be consulted.
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All of the responses are excellent. I would only add that the best low back exercise I know is the, and I hope I'm not wrongly quoting yoga, cobra. In a prone position, clasp the hands behind the neck, and with no lower body contraction, extend the trunk off the floor. It doesn't have to be a big movement, maybe only 15-20 degrees of extension.
If he hasn't already, a visit with his orthopedist to clarify the etiology of his knee pain would be a good idea.
If he hasn't already, a visit with his orthopedist to clarify the etiology of his knee pain would be a good idea.
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Hi Tasha,
Unfortunately, this is a pretty general question and without having an actual assessment "results", it is not wise to try and help with program design. A few thoughts: is he medically cleared to workout - and are there any contraindications?
Some more food for thought: the knees could hurt because of his weight, degenerative issues and/or bad tracking. Have you done a functional movement screen (or a similar postural assessment)? The low back could hurt because of tight hamstrings. And the two can be related. And they could be playing off each other.
I would do a proper assessment and work on body alignment and core exercises to start (ie., cat/cow, bird dog, bridges, side clam, curl up, etc.) as well as some general strength training (light weights - so as to concentrate on proper form - and then some machines [just to start]); a good introduction and be enthused. Also, I would suggest to maybe do cardio spurts in between (as well as cardio on other days)...all the while making sure to not add extra compression to the back (for now); and again only if medically cleared.
I wish you well with this client.
Best, Joy
Unfortunately, this is a pretty general question and without having an actual assessment "results", it is not wise to try and help with program design. A few thoughts: is he medically cleared to workout - and are there any contraindications?
Some more food for thought: the knees could hurt because of his weight, degenerative issues and/or bad tracking. Have you done a functional movement screen (or a similar postural assessment)? The low back could hurt because of tight hamstrings. And the two can be related. And they could be playing off each other.
I would do a proper assessment and work on body alignment and core exercises to start (ie., cat/cow, bird dog, bridges, side clam, curl up, etc.) as well as some general strength training (light weights - so as to concentrate on proper form - and then some machines [just to start]); a good introduction and be enthused. Also, I would suggest to maybe do cardio spurts in between (as well as cardio on other days)...all the while making sure to not add extra compression to the back (for now); and again only if medically cleared.
I wish you well with this client.
Best, Joy
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If he has back pain tell him to see a chiropractor perhaps or try looking in the mirror sometime to see himself for how he really is (when he lifts heavy objects that is).
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I proper assessment is necessary, but swimming would be a great start. I am also a big fan of strength training but in this cas yoga may be a great option. Step 1, check w your Doc..
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I would have him begin with a walking program and some very limited isometric exercises for his quads and hamstrings.
I would concentrate on getting him to move his body rather than try to lift weights.
With that being said, he needs to be medically cleared for sure!
Diet is another component.
I would concentrate on getting him to move his body rather than try to lift weights.
With that being said, he needs to be medically cleared for sure!
Diet is another component.
