Movements Afoot’s Blog

by Lesley Powell

I want to talk about how to work with clients with low back pain.  These clients have already ruled out by the medical professional where exercise is contraindicated.

To start a client with low back pain,  my first goal is to observe their form as I teach the movement principles/fundamentals.

I am working first on teaching stabilization.

I am conservative about stretching until I know how they will react.  Some clients with too much stretching, their muscles go into spasm.  Sometimes the tight muscles are the ones trying to stabilize them. Without educating them about proper stabilization, the body does not know what to do.

Teaching the fundamentals, you can see how poor patterns will be reflective throughout the entire workout and their gait.  Fundamental education will create better awareness, control and injury prevention skills.

Differentiation of thigh bone

I always start with the thigh lift and the pelvic shift forward, a neutral bridge.

A lot of clients are not using the hip socket correctly.  The pelvis is unleveling to lift the leg.

• Is the pelvis stable when the leg is lifted?
• How is the ease in the femoral folds?
• If the pelvis is unstable, is it rotating and/or unleveling?

Bridging: Having a leg to Stand on. (upcoming a new podcast on proper bridging)

I always look at the neutral bridge with back clients.  Many clients are very weak in the legs and using the backs to compensate for leg weakness.

In the neutral bridge, the pelvis should shift forward over the feet.  The Bartenieff Fundamental, the pelvic shift forward is a perfect name for this action.

The highest place in the bridge should be the pelvis.
When the legs are weak, the back usually arches to push the body higher.

Back care clients are very weak in the deep muscles of the back.  Many are compensating with the superficial muscles of the back.  This can cause compression/pain in the back.  Simple extensions exercises of the upper spine and legs are essential skills to learn.  Can your client lift their upper spine and/or legs and then entire body pain free?  Are they shortening their backs to do any of these exercises.

By teaching your clients, the basics, you are also giving them tools to take home to practice.  Once they accomplished the basics, don’t forget about the Pilates mat exercises:

• Single leg circles
• Single leg kick
• Double leg kick
• Shoulder bridge

Stretching

Once I hurt my back seriously carrying a computer.  My back was in spasm for over a week.  I stay away from stretching the back.  I did a lot of stretching of my legs on the floor with a yoga strap.  Roll downs were too painful at that time.  Then my next goal was using downward dog to lengthen my back.  Even a client putting their hands on the barrel or a wall and doing a modified downward dog can be helpful.

It is essential to teach stabilization exercises.  Then intertwine these concepts with your workout using the machines.  For example, before doing pulling straps on the long box, here is a routine on the long box.

1. 3 upper spine extensions.  The Spine raises in line with the box.
2. 3 right leg lifts, 3 left.  Leg lift is in line with box.
3. 3 modified swans.  The spine and legs are in line with the box.
4. then, pullling the straps.

Below is a link to great exercises for back care.  Please feel free to share this link with your clients for their home practice.

Pilates Basics: Essentials for Back Care