Reducing back pain in your female training clients

By working with your client, and other allied health professionals, you can reduce her back pain and improve her quality of life, writes trainer and educator Clare Hozack.

Four out of five of us experience back problems at some time in our lives. While both men and women suffer back pain, it is a symptom of pelvic dysfunction and should be checked out by a women’s health physio. 

Pain, especially chronic pain, is more closely associated with emotion, particularly stress, than it is injury. Women are generally still taking the lion’s share of the work at home: around 21 hours more per week than men on average, according to the annual Hilda survey. More often than not, they will be juggling this with a job, and as such are often more stressed than their partners.

Mothers, in particular, are susceptible to both the pelvic dysfunction and stressful life, and need to be particularly careful when it comes to looking after their back health.

So, she’s ‘done’ her back (often changing the bed sheets!) and is suffering ‘acute’ pain. It’s sudden, sharp, and she’s panicked. If she experiences an episode of this pain during a training session, pelvic floor exercises can be used to help dull the immediate flare up. This is because they have an analgesic effect on back pain and down regulate (i.e. calm) the nervous system. Perception and thoughts can make the pain feel worse, so the exercises serve as both physical aid and mental distraction from focusing on the pain.

Mothers, in particular, are susceptible to both the pelvic dysfunction and stressful life, and need to be particularly careful when it comes to looking after their back health.

You should immediately refer her to a physiotherapist, preferably a women’s health physio who will look at her pelvis as well as her back. While she’s awaiting her physio appointment, she can try to alleviate the discomfort by relaxing her nervous system with lying kegel exercises, or lower back massage (lying and sitting). Click here to watch this demonstrated.

General back soreness

If she hasn’t ‘done’ her back, but it is simply sore, you can still help her to feel better. However, for the record, I am not recommending that she doesn’t go to see a doctor or physio. Better safe than sorry. These tips are to be actioned alongside what you would normally do if a client showed up to training with a sore back.

There is limited evidence that Whole Body Vibration relieves non-specific low back pain (that is low back pain without an obvious injury) more than traditional methods of training, like stability training, classic physiotherapy and routine daily activities (i.e. the popular option of ignoring it and carrying on). It is something that a client may wish to try if they have recurring pain. Again, they should consider checking with their doctor or physio beforehand.

When clients show up to a training session with a sore back, I make sure they keep moving, but refrain from stretching or aggravating their nerves (especially if they have sciatica or other nerve condition). In such instances, good movements include:

• Reaching across the body
• Vertical up down dog
• Ballet stretching

These should all be performed within a pain free range: no stretching, forcing, pulling or releasing! Click here to watch these demonstrated.

The stress test

If her back pain is chronic, and she’s tried everything only to be diagnosed with non-specific low back pain, then you need to address stress.

There’s a great pain program run by a group of doctors in the US called curable that focuses a lot on education, meditation and journaling to manage lifestyle stress.

There is also good research that shows lifting can reduce back pain and prevent recurrent back pain – but it can also trigger it flaring up, so, once again, clients and trainers should exercise caution before starting. For you, this means gradually increasing the weight that your client is lifting. Start her off with a low and slow 1kg rather than the 10kg she might look capable of.

Bigger picture, the idea is that your clients will lift heavy when her pain is non-existent, move down to unloaded movement when the soreness returns, and incrementally returns to lifting again when the pain is reduced. For example:

• Deadlift (no pain)
• Band dislocations (with pain)
• Light weights deadlift and stretch (slight pain)

Click here to watch these concepts demonstrated.

For some women, this will settle in to a predictable pattern with her menstrual cycle – lifting hard and heavy in her first two weeks, tapering down to nourishing movement through the last two weeks, and resting at some point in between. For others, you’ll literally have to work with her to ‘listen to her body’ and just do what she can on any given day.

Preventing back pain is about the balance of mobility, stability, strength, and lifestyle – it is possible for an imbalance in any one of these things to cause back pain. For this reason, if your client has seen a physio, she should try a chiro next. If she’s tried a chiro, try a myotherapist. If she’s tried a myotherapist, try a GP, a counsellor, an exercise physiologist.

Clients living with chronic back pain must be careful about getting stiff and less mobile. A regular stretching, mobility and aerobic program is recommended to mitigate this. Movement will not only lubricate your joints, but deliver nutrients, remove waste and maintain mobility.

Recommendations for regular movement include:

• Walking
• Lat stretch
• Swinging arms around body
• Jane Fonda-style side lunge with arm overhead reach

Click here to watch these demonstrated.

Good luck guiding your clients on their recovery journey. There are heaps of opportunities out there to turn her pain around, so work with her, and other allied health professionals, to reduce her back pain and improve her quality of life.

REFERENCES & FURTHER READING

• https://www.healthdirect.gov.au/back-pain
• https://my.clevelandclinic.org/health/diseases/14459-pelvic-floor-dysfunction
• https://pubmed.ncbi.nlm.nih.gov/23569140/
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5546756/
• https://pubmed.ncbi.nlm.nih.gov/32460819/
• https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/Back%20pain#self-management-of-back-pain
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4395719/
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4934575/
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4934575/

Clare Hozack

A former athlete and strength and conditioning coach, Clare applies this experience to her work training and educating pre- and post natal women to help them develop ‘next level’ fitness for parenting. A trainer with IntoYou studio on Sydney’s Northern Beaches, she is also the Australian and NZ Master Trainer for Burrell Education, which delivers a range of women’s health and pregnancy-related courses. You can download Burrell Education’s free Pre-Screening tools for pregnant women here and post natal women here.into-you.com.au / burrelleducation.com