What exercises are best...and should be avoided for someone who has lower back pain and knee pain?
I have to do an assessment and workout plan for a 54 year male client who has never lifted weights and has low back pain, knee pain and is pre-hypertensive... what exercises should I initially assess him on for our first session, and what was are best to avoid? this is for a full body strength training assessment......? Thank You
What I find fascinating is that during the intro I do before giving everyone their own pair of poles, I talk about posture and how posture drives all systems in the body. I list daily activities that compromise our posture: sitting in front of the computer, driving, watching TV, walking with our heads down and sitting listening to me! With that last comment, I see everyone grow 3" because they self correct their posture.
I have had measurable success with students who battle back, hip and knee pain. The corrective exercise of Nordic Walking allows them to increase time, distance and intensity with guidance. Better breathing from being upright plus supported spine, pelvis and knees leads to confidence! More confidence leaches feel-good hormones into the system and the upward cycle leads to more pain-free exercise. Usually, the increased amount of exercise translates into weight loss which puts less stress on the joints and back.
As you can see, I am a believer having witnessed people leave their pills and assistive devices behind to Nordic Walk tall and with less pain!
Great question. First and foremost, you need to clarify what type of pain the person is experiencing.
Dull ache-tends to be muscular
Shooting, numbness, tingling, fuzzy feeling-disc, occluded nerve
Stiff-muscular or joint
Second, if ANY client is experience shooting or neurological symptoms, training should not commence and the client should see a MD to be examined or a physio, to determine the extent of it.
Third, a book on a particular method is not going to solve the problem. Understanding the pathology or condition is paramount, how long they have had the pain, type, quality, severity, irritability(how long it takes to settle down) as well as their past medical history before even prescribing or designing a safe exercise program.
"Little is known about the level of aerobic fitness in patients with chronic LBP, although many rehabilitation programs focus on muscle strength, muscle coordination, or flexibility, especially of core trunk muscles, or some combination of these, as key components of rehabilitation. A number of studies and systematic reviews have shown that exercise is significantly more effective than rest for LBP. There is also a strong evidence that one one specific exercise regimen is superior. Exercise guidelines for individuals with LBP are therefore similar to the guidelines established by ACSM for apparently healthy populations, with appropriate adjustments.
The goals for exercise programming in individuals with LBP are to improve health and well-being increase exercise tolerance and prevent debilitation caused by inactivity. Exercise guidelines that minimize stress to the lower back should be started during the first two weeks of acute LBP. During the acute stage of severe LBP only, exercises for hip and back muscles could be delayed for at least two weeks and the intensity should be low, with gradual increases in intensity and duration. For those with chronic LBP, exercise intensity and duration should also be graded, gradual in progression, and time rather than pain contingent. This is particularly important in individuals who are debilitated or fearful of reinjury. Finally, given that adherence to any exercise or activity regimen is essential if benefits are to accrue, and given that on one exercise regimen is superior, it is essential that exercise or activity prescriptions consider client preference."
Hope this is helpful.
1. Maximal and submaximal exercise testing is unnecessary. (It may be warranted if risk factors/symptoms of CAD are present.
2. Strength: isometric trunk testing. (Measure isometric strength in multiple positions to find true peak torque.
3. Flexibility: Straight leg stretch inclinometry: angle to elicit pain or radiating symptoms.
All the best!
"There is also a strong evidence that one one specific exercise regimen is superior...
...and given that on one exercise regimen is superior, it is essential that exercise or activity prescriptions consider client preference."
I am not sure if this was a typo; if not, I don't understand what it is saying???
Is it suppose to be NO ONE EXERCISE...??? You type one one and on one...???
Please advise...and thanks.
I would avoid exercises that load trunk flexion. Trunk extension exercises, without exacerbated pain, should be emphasized, prone, trunk extension for example. With regard to the knee pain, I recommend avoiding any high impact lower extremity exercises, focusing instead on low impact (e.g., steps v. jumping.) And see an orthopedist.
I also am late to the game on this one, but have found that international back health expert Dr. Stuart McGill's book, "Low Back Disorders" (2007) is a great resource for working with clients who have Low Back Pain (LBP). There are several exercises in this book that people have been doing for years that Dr. McGill has found to be overly compressive on the lumbar spine, which I think would be worth avoiding...specifically "knees to chest stretch"(Page 96) and lying prone while extending both the arms and legs, which I have seen referred to as "supermans" or "swimming" (page 219). These are just a few that have been proven by his research to be extremely compressive and Dr. McGill feels should be avoided by those that have LBP. Agreed with LaRue, physician's clearance is priority number one! Then we can follow our "do no harm" mantra by proceeding with caution and using excellent resources like Dr. Mcgill's research to benefit our practices. Good Luck!