How would you modify functional training exercises for a client with chronic back pain?

All sessions should start with a warm-up, regardless of pain or not. A warm-up should help increase blood flow and warm-up muscles that are going the used during the session. Back pain can be caused by injury, tight hips, weak core muscle etc. For example if the cause of pain is due to tight hips it may be a good idea to spend extra time loosening up the hips. If back pain is due to weak core muscles, some core activation exercises may be a good warm-up. Consider not only what you client will be doing but also consider what they have been doing before the session. Have they been sitting at a desk for the past 8 hours? If so, so chest openers may be necessary to not injure the back. Remember everything in the body is connected.

Hijama (Cupping Therapy) and Chronic Lower Back Pain Pain Relief: Hijama helps in lower back pain by improving blood flow in the affected area and reducing inflammation. Muscle Relaxation: It can help relax tight muscles and reduce tension in your lower back. Improved Blood Flow: The therapy increases blood circulation, which may assist in healing and easing pain. Reduced Inflammation: Hijama might help lower inflammation in the back muscles. Detoxification: It is believed to help remove toxins from the body, which might contribute to pain relief. Better Movement: By relieving pain and tension, Hijama could improve your flexibility and mobility. Sunnah of the Holy Prophet of Islam (PBUH)

To begin physical exercise, consider engaging into a non-impact and non-weight bearing activity such as cycling with back support, or walking with 1% percent for about 5-10 minutes to get the core temperature up and better blood flow throughout the body.

A strong core is crucial. A strong core will help protect your spine and help reduce the load of movement on your back. A strong core is more than just a six pack. Focus on the deep muscles of the core such as the transverse abdominus, obliques, pevic floor muscles, glutes, etc. I usually use bracing exercises as some of my first core exercise with clients. A lot of people do not know how to brace, which can cause injury during exercise and everyday activities. Some of my favorite core exercises are glute bridges, table top leg presses, palloff press and a goblet hold. These exercises all seem easy from an eyes view, but when down properly they are challenging and the benefits are great.

Core strengthening is important, but the application of core exercises can be changed subjective to the client. For instance, here we would focus on engaging the core muscles via well designed machines which work the lower and upper body muscles. You may think how will it help, because stabilisation of the trunk is a key function of the core muscle.

Postural control is key to effective exercise and let’s simplify it. Exercise tempo refers to the speed of the movement. To make it applicable, when performing any exercise. Try to pause on each end of the movement and control the deceleration. For example- during a squat, pause at the top, then gently control the deceleration and pause at the bottom. Return to the top and pause for a brief second before going for another repetition.

Load is one of the variables that affects the training adaptations. But anyone suffering from chronic back pain, should monitor the load bearing carefully so it doesn’t overstress. Remember physical stress when monitored and given in a organised manger is pushes our bodies to become better, but if the dose is not monitored it can do more harm than good.

The position of an exercise is important. Moreover the position in which a weight is lifted is of far more value to the trainee. For instance, to lift anything considerably heavy off the floor neutral spine position, slight bending of the knee and hinging at the hips can help reduce stresses experienced by the spine.

Just like a warm-up should never be skipped nor should regular stretching (as long as it doesn't cause more pain.) If a client has chronic tight hips and that is the cause of back pain, extra focus should be put on keeping the hips loses. If a client is extremely light in the chest and rounded forward, focus on opening the chest to prevent back pain. You can have clients stretch after a dynamic workout, in between sets, at the end of a workout etc. Regular stretching can help prevent injury and reduce chronic pain.

Do not be afraid to refer a client out to a PT, Dr, etc. Some tightness in the back is one thing but chronic pain can be a sign of something more serious. Have a Physical therapist (that you trust) contact info that you can pass a long. A client will appreciate your concern even if it turns out to be nothing. I speak from experience! I had a client who was still in some pain weeks after she fell at home. While she was still able to do a lot she was uncomfortable. She took my advice to get it checked out and she had been dealing with a fractured spine! Imagine the damage that could have been done if I just kept training her and wrote off her pain!