Customizing a personal training session for low back pain
Minutes before our virtual personal training session, my client texts me “I should have told you this sooner, but I did manage to tweak my back. If you have any stretches we could do to help that would be fab.”
Times like these are when the real work of personal training kicks in. The time I’d spent planning our session and the exercises I’d planned were no longer relevant. In the brief amount of time that I had prior to our session starting, I was only able to ask “Where?” and learn that it was her lower back. Bending and picking things up were difficult for her. At the same time, it had been two weeks since our last session and I knew she was feeling eager to get a productive cardio and strength training session in.
Suddenly the number of objectives for this session increased. Not in any particular order, they include:
delivering the cardio burst that she expects from her sessions so that she can feel good about herself and the work ahead of her (my client works from home).
Providing exercise modifications.
Providing stretches for the low back
Creating more mobility for normal, everyday movement patterns and
providing relief from the low back pain
In general, provide a safe, yet effective workout that will not exacerbate my client’s low back pain. Another challenge is simply that we are personal training virtually. I am limited visually but also audially because my client’s device microphone is poor quality that I can barely hear her. I frequently rely on just a a thumbs up or down to check in with her (this is where the most concise movement pattern explanations are helpful).
Throughout the whole virtual training session, I was on my toes… watching her form, trying to use as simple terms as possible to guide her through the exercise modifications. I read her body language and after our upper body strengthening part of the workout, offer her a new stretch that she’s never done before. Again, I am limited by what I can see (she’s easily 8 feet away from the camera) and have no audio cues to provide feedback. Asking her questions is pointless because the audio quality is so terrible.
Here’s what the workout ended up looking like:
Standing warmup
pelvic tilts forward and back (slow for 60 sec)
hip circles (ea direction 30 sec)
side to side lunges w/ hold (ea direction 30 sec)
feet wide, static stretch in forward fold (30 sec)
Weights
overhead press (30 sec)
alternating bicep curls (60 sec)
bicep curl to shoulder to OH press (60-90 sec)
slight forward hinge, chest flyes (60-90 sec)
chest fly tiny presses (60-90 sec)
football shuffles ATW 90 sec
stretch for back. kneeling on heels. Shift hips to one side (like sitting on one hip), chest to the other. Switch sides for 6x total
Abs
supine, feet planted. Curl to the right, isometric hold (30 sec) then small upper body curls (30 sec).
repeat other side
come center, rest head for bicycle switches
Repeat whole sequence 1x more
Cool down on floor laying down
knees to chest stretch (knee hugs)
knee circles
kneeling, pelvic tilts forward-back
After the session, I received this text…
“That was my favorite class we have done! I loved it. It stretched out my back and worked on everything. Plus I felt like I had it down correctly. Totally my fav. “
Knowing how to scale back a client session when pain is present, is in my opinion, where the real work of personal training happens -where professionalism, preparation, and creativity meet in the moment.