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
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!
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.
Tasha. While I’m a bit late answering your question, I’d still like to address your question (even if not for this particular client). Whenever a client has physical or health “issues” such as chronic pain or an injury, in my opinion it’s a requirement that they at least see their physician and get his or her approval before starting their work with me. This will give them, and YOU some peace of mind. Additionally, by requiring this, you are giving their physician the opportunity to let you know if there are any things (exercises etc.) that are contraindicated and that you should definitely NOT be doing with your new client.
I don’t know what you mean by “pre-hypertensive.” What are your benchmarks for resting systolic and diastolic readings? First step—make sure your client has been cleared by his physician for vigorous exercise. Bryce excellently answered the question in depth.
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.
Look at the symptoms….back and knee. What do these have in common? The hip, other things that should be looked at are the thoracic spine and ankle. if the hip mobility is limited then the body will compensate by replacing stability in the lumbar and knee with mobility which is not its job. Do a thorough mobility screening active and passive then work on what needs to be addressed.