Fitness Coaching Tips for Helping Clients Reduce Back Pain
Hey, welcome back. My name is CJ cook Liska, the director of programming here at Jim Nazo. And today we’re gonna chat about lower back pain, more so looking from a top view down at what lower back pain is, especially from an applied functional scientists perspective. And then we’re going to dive a bit deeper into the neuro musculoskeletal system. And what kind of goes into programming for somebody who’s experiencing lower back pain, just the things to consider. That way, we don’t get so stuck in just prescribing a protocol for lower back pain, but we actually consider who the individual is in front of us, and what we can do for them to guide them, coach them and educate them out of their lower back pain, so they can function and live into a full life that’s full of vitality. So we got to look at lower back pain from three buckets in order to really understand what causes it because that’s not just one thing, the buckets are going to be physical, going to be behavioral, and going to be biological. And we’re gonna break down each of those kind of in a little bit more of the elements so that we can get a bigger picture a more full picture, a holistic view of lower back pain, and consider how to get out of it versus just put band aids on it never truly get rid of lower back pain and step away from the things that we love doing. So in our physical bucket, we’ve got gravity, we’ve got ground reaction force, and we’ve got mass and momentum. And each of those things contribute to how we move in our body, though they’re outside forces acting on us. So based on a relationship with gravity, how do we hold her body position? throughout our day, always sitting down always slumped a certain way? are we holding ourselves very stiff, rigid and confident? Are we more collapsed? Right? Where does our body bias how we hold ourselves as we’re interacting with gravity? Next question is, how do we interact with ground reaction force, that’s essentially the force when our foot hits the ground, what kind of chain reaction does that create through the rest of our system, foot hits the ground, we’re experiencing the force coming up to the ankle, the knee, the hip, and either down into our other side or up through our spine, and up and through upper body, even up to our neck into our arms. So how we take every single step is going to influence how we understand how every rep is either leading to more dysfunction, or more resiliency in our tissues and in our movement. And then the other thing to consider is going to be that mass momentum. So it could be speed, the mass of our body and the momentum of whatever direction we’re going. It could be that we’re holding a baby pet, a bag of dog food, a backpack, a bunch of books, whatever it is that we’re holding, or carrying,
how are we handling that mass momentum? Are we bracing and fighting against it? Are we working together with those forces contributing to a very fluid dynamic of each of those forces interacting within our own neuromuscular system, the next bucket we got to consider is the behavioral bucket. Essentially, this breaks down into cultural beliefs, breaks into our choices of movement, and then also breaks into our paths of least resistance or our attractor wells. So we linked in to our cultural beliefs. What does that mean? Well, when you hear aging, what does that typically make you think of, think of joints breaking down, body becoming less mobile, less agile, less coordinated, or you might see it as growing older, and you’re learning more about your body more about your systems and how these tissues interact, to create more fluid movement, based on our cultural beliefs, that’s going to set us up for better movement or worse movement as we’re getting older. So gotta think about how the client is in front of us. Do they believe that because they’re getting older, they’re gonna get lower back pain? Or do they see their lower back pain is an opportunity to get out of this and to move more functionally more fluidly? And with more freedom, then we’ve got our choices of movement. These are our actions and our positions that we choose to move in every day. If we’re going to pick something up off the ground, how do we choose to pick it up? Do we kneel down? Do we squat? Do we bend over? Do we lunge? How is it that we chose to pick up that object that was on the ground? How is it that we choose to reach for something up on a shelf, there’s many ways to do it. There’s no real wrong ways. But when we consider how we move very often throughout our days, and we do start to start to do it subconsciously, unconsciously, we start to understand that over time, those choices turn into paths of least resistance, or biases. Or essentially, we fall into an attractor well of movement that may inhibit our success, because now we only have one or two options, versus opening up our options on how to move and how to load our tissues. If we’re loading certain tissues over and over and over again, and we’re doing it inefficiently that’s gonna take us down a path of dysfunction. But if we’re changing up how we move, we noticed that when we bend over to something kind of pinged in our back, or we believe in that that’s just part of aging or believing that we didn’t have a choice of that movement and that was just what happens or do we think back like what did I just do right there and could I do better? Or can I make another choice of how I move? Those attractor wells are so, so so important as we go into programming for the individual in front of us. Because if they move in a certain way, and we’re asking them to move differently, can their body comprehend how to change their path? Or do they fall into a new compensation a new bailout, that we’re unaware of as the coach, because we can’t feel it, we can only see how they move. Because feeling and seeing a two very different things, we have to have this open communication behaviorally with our client, so that we have the opportunity to educate and to fill in some of those gaps, where they may not know how to move or how to coordinate tissues in a specific way. The more we train these new paths, the more those new paths become paths of least resistance. And if we’re creating those paths that are more efficient, now, as we’re moving unconsciously, and subconsciously, we choose to move in a better path, or a more optimal path rather than one that we just fall into. Because it was easy, we weren’t thinking about it. Now, the third bucket we’ve got to consider is biological. And I’d say this one isn’t actually the most important, but it is very important to consider when we go into programming actual movements and understanding, are we training the bones or training the muscle? Are we training the nerves? The answer should be yes, we want to look at this from my skeletal perspective. We want to look at this from a muscular perspective. And then also from a neurological perspective, more of the bones, more the muscles and more the nerves and proprioception. If we look at the body and low back pain, from a skeletal perspective, not just the only one, but a very important one, we know that each of our points, bones are stacked on top of each other. And in between bones, there are the joints, where the kind of the bones connect to each other. Makes sense, we’ve got to consider that there’s a most ability complex in each of those joints through each of those bones. What I mean by that? Well, from a system point of view, our body is split up in the spectrum of joints that prefer more motion and joints that prefer more stability. It’s not one of the other, it’s very much a spectrum and a percentage of one to the other, that depending on your daily function. Depending on your job, depending on your lifestyle, your body is going to find those biases. So we look at it from a very top down perspective, pretty simple. feet and ankles, they’re more mobile, they’ve got a lot more degrees of freedom, sagittal plane frontal plane and transverse plane, while the knees are more focused on stability, they move freely in the sagittal plane, but not so much in others. So the knees are more of a stable joint above that are our hips, right where our femur is attached into our pelvis. And we know that that is high mobility, it can move a lot in flexion and extension, a reduction in abduction and an internal and external rotation. Guess what’s just above that, our lumbar spine, that area of our body, those five pieces are much more stable, the bones are thicker, there’s a little bit less space between each of those bones stacked on top those vertebra. So we’d say that the lumbar spine in its full unit is more stable. You right up above that 12 pieces of your thoracic spine a lot more freedom to move. In fact, that’s what allows our body to twist and turn to lean each way and to extend and to flex up above that more at our shoulder blades a little bit more stable. There’s some freedom and elevation depression, and those rotations and lateral flexions. But even more mobility is available at the actual shoulder joint itself, where the humerus attaches up into this space here, you’ve got a lot of that sideways lateral motions, you’ve got the flexion and extension, you’ve got that internal extra rotation or more that transverse plane a reduction and adduction. And then at the elbows a lot of freedom and flexion extension, but not so much in other planes of motion. Well, then at the wrist in the hands, we have much more freedom. And if we come back to our neck in between the shoulder blade space, that more mobile up top here. So if we look at the body as a most ability complex, now we can start to look that lumbar spine and lumbar discomfort for more of a given take is the lower back being asked to move more in all three planes of motion and that’s contributing to the pain or is the thoracic and hip to stable are those tissues very locked in making that whole area stiff and rigid and only move that whole unit moves together and now we’re getting a little extra stress at lumbar. The truth is it could be any of those but we’ve got to think about the lumbar spines. Friends when it comes to bones above and bones below or joints above and joints below breaking down a little bit further down at the lumbar spine. If this tissue is being asked to move more laterally, more flexion and extension, more rotation that’s going to put a ton of pressure on the discs in between those vertebra and even more so on the nerves, especially going into that sciatic nerve pressure when you’re breathing or pressure when you’re trying to extend if our thoracic spine can’t move very much in flexion extension, lateral motion rotation, something’s got to make up for that and it’s either above the shoulders, shoulder blades or down in your lumbar and that’s what’s going to cause that lumbar spine to have to move more. Whatever you’re asking of your spine or your body your body’s gonna figure out a way to self organize figure out a way to do it to do that motion that you’re asking about. Now, same thing down in the hips, if the hips are lacking motion, extension and flexion in a reduction abduction in more than internal external rotation, now we got to think, well, the knees are going to either be asked more, or the lumbar spine is going to be asked more to move. And we know that if the knees are being asked to move a lot more, we’re going to get knee dysfunction. But especially in that lumbar spine, hips aren’t doing it, something else is going to be doing it for it. So that’s our skeletal portion. We can always break that down further, I encourage you guys to ask questions about that mobility complex, even put writing your own comments on how you view the most ability complex and integrate that into your practice. The next part is more of the muscular system. How are our muscles able to produce tension between those joints, are they able to communicate that tension, or we bypassing very big muscles and asking the little guys to do it down around the lumbar spine, so muscular, if we rotate, if we laterally flex, if we extend and flex forward, there’s a lot we’re asking of our anterior core tissue, chest tissue coming down into the front side, there’s a lot that we’re asking of our lateral core tissue. And there’s a lot that we’re asking from our posterior core tissue. With every single motion we do, every muscle is doing something it’s lengthening or shortening. We call that he concentric tension not concentric, not eccentric, but the combination of both. One muscle can do both at the same time in different parts of the tissue. Depending on where those muscles attach at the joints, and how many joints they attach to. Some just attach at one joint, some attach across multiple. So around this hip region, in lumbar spine region, think about how many muscles are in this front section here on the side, coming down to the hips that also come in your spine, and also on the back side. And a big one of those is going to be your so as that attaches at your spine down to the pelvis and into your femurs to very, very important muscle when we’re considering lower back pain, especially if somebody is sitting for quite some time. Think about the connective tissue of the muscles working together, what the connective tissues allow the muscles to do is going to contribute to how we hold our body in space as well and how they contribute to reaching pushing, pulling, lunging, squatting, lifting anything of that sort. So the so as if we’re in a seated position and our hips are flexed and we’re both forward, we’re shortening that muscle quite a bit. And over time, that tissue becomes less elastic and more plastic. So now if we consider just that one muscle on either side here that’s locking down. Anytime we go to extend. If our connective tissue and muscles aren’t allowing that naturally to occur, what will happen is your lower back muscles on the backside are going to cause that extension. And this tissue won’t necessarily decelerate, you’ll just get the concentric versus the eccentric. So over time that closing down to that space pulls us into more of that bias flexion. And so now anytime we go to move away from that flexion now we’re going to experience some kind of joint discomfort if the muscles and connective tissue are tacked down and kind of more velcro like less fluid, less viscosity in the tissue more just dehydrated, you can go much deeper into that muscular system. But just something to consider for now, the third part of that biological system, biological science is going to be the neuro logical system more so how are muscles connective tissue are talking to the nerves that go back up into the brain and essentially telling muscles to fire or to relax, to contract to flex, whatever you want to do, those proprioceptive is going to help to create that motion. So if you catch yourself in the fall, or if you reach for something, your body is going to inform your brain where you’re at in space so that you can make the next best move. Or you can contract the right muscle elongate the right muscle so that you get a more efficient movement. So that’s combined going to be a neuro musculoskeletal system combined into one full unit of courses, more systems acting upon our body. But we’ve got to see those three systems as one big system when we go to program so that as we coach and cue the athlete in front of us, we make sure that we’re getting a bigger picture of also what they’re sensing and feeling so that if they do have a pain or discomfort, is that okay, that they’re experiencing now as they’re building coordination? Or is this something that if they keep doing it, it’s going to create more pain, more aggravation that we now need to change or modify the exercise to make it more effective and get rid of lower back pain as opposed to just saying, Oh, we’re just not going to do kettlebell swings, we’re just not going to do squats. What if we can modify those exercises to contribute to better motion in the long term, better tension, better communication to our body and brain and even more so better stacking of our bones on top of each other. So we’ve got to look at physical, behavioral and Biological Sciences. It’s all a contributor to lower back pain so they can step back and go Alright, in this program, we’re going to make sure that we’re including things that build a better communication with gravity, build a better communication with ground reaction force build a better communication relationship with mass and momentum, while also considering our choices of movement, the paths of least resistance? And then also what are we telling ourselves in our mind about our movement, about our body about us growing older, as coaches, we must consider these things so that when we’re saying, Oh, no, you’re just getting older, we shift that to saying, hey, as you get older, you’re going to keep getting stronger and better, but we have to be in the present moment of what your body’s experiencing, and consider the long term results of what you’re doing currently in your training. And then of course, in that biological, like we talked about the neuro musculoskeletal system, how can we intentionally inform propria receptors? How can we intentionally feel tension and produce tension with points of contact with our feet, with our hands and our drivers like our hips and our head and our feet to facilitate better tension and better loading through the tissues so we can have better long term sustainable success and sustainable results that steer us away from lower back pain and into better function through our movement. We’re going to have another video going into modifications specifically for lower back pain in some of those global actions that you’ve done as a trainer with your clients like squats, lunges, pushes poles swings, this, that and the other. I’m going to show you some some easy modifications that will give you more insight into what may be creating the low back pain so that as you go to program for their future, you get them out of it, and they start to find that they have the strength within themselves and the empowerment within themselves to get them out of lower back pain as opposed to just having to blanket it with a lead, blanket it with rest and step away from the things they enjoy doing. follow one of these links and learn some more. Stay tuned for more diving deep into the mechanisms of musculoskeletal dysfunctions as we go further into the physical, behavioral and biological buckets. Enjoy
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