Stumped – Lower Back Pain While Trying to Build Core
Okay…I’m stumped on this one. And I’ll willing to chalk this up to still being fairly new as a trainer. One of my clients has a very weak lower back and lower abdominals. In an effort to build these areas and strengthening them I have her doing the “superman” for lower back and then lower abdominal work that involves supporting her lower back by placing her hands under that area. However, even with her back supported she is still feeling discomfort and can’t complete reps…i’m lost on how to strengthening these specific areas when the exact moves used to strengthen her lower abs and core are causing discomfort due to weakness (i’m in an endless loop). My apologies if I’m missing something obvious, believe me i’m reading and studying and reading up and perusing work out programs…but would very much value some input and suggestions here. Thank you in advance!
You’ve received some great ideas so far, both in assessment and in exercise selection.
When you write “superman,” do you mean lying prone, tightening core, and then lifting both the feet and the hands at the same time? There is a lot of compression force on the low back with this particular move, so if this is the movement you are using, I have a few cues and progression ideas for you.
1) Every time I do a prone exercise, I ask the client to do three things. First = pull their belly button in and up, like they’re trying to lift their belly button off the mat. Second, tighten their glutes medially (towards each other). Third, press the glutes down towards the floor slightly and hold pelvis stable. It’s like a mini posterior pelvic tilt, but really what I want them to do is avoid excessive anterior pelvic tilt when they lift their legs, so I pre-stabilize the pelvis.
2) Lift two limbs at a time rather than all four. I like the combination of right arm + left leg, hold pause, then switch.
3) Another thing to consider, since your client can do a V-sit easily (rectus abdominis and hip flexors), is that maybe the deep core needs more work and the rectus is taking over. One way that I help my clients get this concept of engaging deeper into the core is to have them lie supine, place hands on their belly, and then do a crunch. The should feel the rectus tighten right away. Now, I tell them to keep the rectus soft (hand still on belly), and draw the belly button down and in, which takes engagement of the transverse abs (TA). The transverse abs take a little more work to engage. So when I tell my clients to set their core, I teach them first how to be aware of and contract the TA, and then to set the core by engaging the pelvic floor and TA first before beginning any other movement.
Hi, Rachel!
Great tips here so far here. I’m glad that your client was cleared for exercise, since that’s really the first step. I wanted to mention that sometimes the hand position can affect a client’s ability to do the ‘Superman’ move. As she improves her core strength, you could see if having arms by her sides or even under her armpits helps with the discomfort in her back.
Other exercises you can include are isometrics & anti-rotation movements. Basically, having your client engage her core during movements that aren’t specifically made for the core can help with body awareness & core muscle recruitment. Planks are great and can be pre-gressed as necessary to protect the low back (done on one or both knees, elbows, etc.). Anti-rotation is when the core stays straight & engaged while another limb moves. This type of stabilization is really great for the lower abs, low back & obliques. A move I use a lot is a cable or band rotation. The client stands next to a cable machine or band tethered at about waist height. They turn their arms & ribs away from the tether point but are not allowed to move their lower half. Keeping knees slightly bent, glutes tight, & arms long keeps the work loaded on the core, & it doesn’t take much resistance to get results! You can also have her try basic movements on one leg as this forces the pelvic stabilizers to get stronger (‘airplane’, ‘star’).
Always start with a pain-free range of motion. If the move causes pain, it should be removed from the program. You can always try it later when the client gets a little stronger.
Hey Rachel…if she has a recent knee injury that can have an effect too. Hopefully she is being rehabed properly by her medical team. Since the body is a kinetic chain of connected parts, limited mobility at the knee can also affect the ankle (she may not be getting full flexion or extension at the foot now if she has limited knee mobility) and if those parts aren’t moving properly you sometimes see compensations at the hip…such as excessive forward leaning or arching back. It could just be that once her knee problems are sorted out she could see improvements in her low back.
Hi Rachel,
Darcy is right on the mark. It can be challenging for a new trainer to see those little compensations that clients are really good at (and don’t know themselves).
Being able to do a full sit up can look impressive but is often only the result of a favorable weight distribution in the body. A person with long legs and more weight below the belly button can often execute those with ease by just relying on hip flexors.
Start her off even just with pelvic tilts and pelvic clock exercises and then gradually move to more advanced ones and see whether she can continue to stabilize her pelvis as she starts moving other part of her body. In the superman, the movement often comes from the lower back (by arching it even more). It takes practice to see that.
You are smart by using this forum to ask others. I am sure you will get more answers.
Karin Singleton
www.meltnc.com