What are the best strength exercises for someone (54 year old male) with low back pain and knee pain? This person is pre-hypertensive and has a BMIi of 39. Wants to lose quite a bit of weight and has never lifted weights before. Any suggestions on some exercises to be prescribed? (legs, core, back….). I don’t want to overwhelm him with too much.. since he has never lifted. How many reps and sets are appropriate for this client?… (8-12, obviously low weight… perhaps 2 sets? Thanks so much!
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.
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
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!
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.