5 Keys Fitness Professionals Must Remember When Training a Client with a Herniated Disc

I got a e-mail from Ben Coffman of Oklahoma City.  I thought you all would be interested in my reply.

SpineRick,

Could use your advice.

I am working with a women who has a severe herniated disk in her lower back.

Could you give me a few tips on what would be best for her in terms of back strengthening?

Thanks

Ben Coffman
Oklahoma City Weight Loss Expert
www.FitLifeOKC.com

 

Thanks for thinking of me and asking.

Here are my tips.

5 Keys Fitness Professionals Must Remember When Training a Client with a Herniated Disc

1)  Communicate with the Team

Make sure she is cleared to start an exercise program by her healthcare team and if the team has any recommendations on what she should do or not do.

2)  Find out what Positions Her Back Likes

Often times what clients will say is laying down is the best followed by standing and then sitting. This is all based on the level of load that is placed on the spine. With laying, there is the least amount of load. With standing, your legs act like shock absorbers and take up a fair bit of load. With sitting, the load moves into the spine more.  Even if she likes laying down the best, there is a lot you can do with bands and pullies to strengthen her back in that position.

3)  Leg Strength

Work on leg strength. If you can improve her leg strength, then her leg muscles will take on more load and less will be put onto the spine when she stands.  You may have to start with a ball squat which keeps the back upright.  This may not be a natural or fuctional position but it puts the least amount of stress on the spine.  In time you progress her to more of a normal squat movement.  Click here is you want to read my blog post on knee pain with squating.

4)  Limit Trunk Flexion

Movement that involves trunk flexion will increase the load of the back.  At the start you avoid it but with time you want to train different ranges of motion in trunk flexion.  As I mentioned in the last point, start with a ball squat.  Progress to a front ball squat and then a standing squat.

5)  Core Activation

I would work on a rehab level of core stability.  Often times with pain, the stabilizers of the back are inhibited due to pain.  It is important to re-activate them.  I go into great details in this in Core Stability for the Lower Back book .

Ben, I hope this helps.

I know I got rambling but I hope this helps.

Thanks so much for asking and thinking of me.

Take care bud.

P.S. – If you are a fitness or rehabilitation professional and would like to learn how to design exercise programs for clients with low back injuries, I would recommend attending Exericse Rehabilitation of the Lower Back course.  You can get more information at www.FitnessRehabEducation.com .

– Rick Kaselj

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3 Comments

  1. Hi Rick,

    As always, this is a great and informative post. It’s very timely for me, too, as my newest client has a herniated disk. First thing I did was pull out my copy of your “Core Stability of the Back” book to choose the first exercises I would show her! I also want to “second” your opinion about talking with our clients health care provider(s).

    Before taking this new client on, I requested to speak with her doctor (a chiropractor) to understand the situation better, and run through my proposed approach to see if it met w/the chiropractor’s approval.

    I think it’s in our client’s best interests that we talk with their health care team. But the best part is– I always learn something new when I communicate with allied health care practitioners–and that helps me become a better trainer!

    Best regards,

    Becky Williamson

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  2. Communicating with the medical professional managing this client is a given. Actually, the client with a disc herniation should not be seen without a medical clearance. If this client has radiating pain, weakness and/or numbness and tingling, she should not start a post rehab program without medical clearance. Yes, we find the client’s neutral in three positions, sitting, standing and supine. You may find the client will require a slight extension bias, or pre-positioning, to minimize pain. This is fine in the early stages. As spinal/core stabilization and activation activities are incorporated and the client’s inflammation decreases, we should see a normalizing of movement, improving stability and decreasing pain. Usually extension activities are favorable for clients with discogenic involvement. Limiting trunk flexion and sitting are a given. We bias these clients toward extension with all activities until symptoms centralize or are eliminated. I agree with limiting rotation in the early stages. Flexion and rotation are rough on a disc. Lower extremity strengthening is a key along with cardiovascular training with lumbar support to minimize pain in the early stages. This is a topic we deal with regularly. Activating the trunk musculature to improve core stability is essential for return to full function. Excellent topic.

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    Rick Kaselj Reply:

    Dr. Jones,

    Excellent points, thank you for adding to the post.

    Rick Kaselj
    http://www.ExercisesForInjuries.com

    [Reply]

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