I spoke to a personal trainer last week about the concept of Core Stability and how to best train your core – in one stage in our conversation he said:
“I don’t do any lower level core training for my rehabilitation clients – I just use cables and lots of free weight exercises”
Now this statement – whilst it has a small level of truth – points out a serious problem in our understanding of core stability training – that you MUST train and condition the Inner Unit of the CORE before progressing to the outer unit muscles.
This error in rehabilitation program design leads to the situation one of our patients had – where to could squat 350 pounds for sets of 8 reps with no problem – but suffered from lower back pain when he bent over to brush his teeth – not an uncommon situation.
The biggest mistakes I made in my early Physiotherapy career was failing to appreciate the importance of lower level recruitment of the small stabilizers – as I believed that I could strengthen anything back into full function – and this applied equally to knees, and shoulders – as it did to back pain rehabilitation.
My second biggest mistake was that I also failed to appreciate the importance of restoring full range of motion to an injured area prior to commencing my strength training program – I have since learnt that many strengthening programs a wasted if you do not address the joint and muscle stiffness that comes from long term pain and dysfunction.
This is exactly why my team and I developed the “Better Back Program” – a system for back pain rehabilitation that takes patients through a four level process that involves these 4 stages:
Level 1 – Alignment / CV Fitness: flexibility, range of motion and general fitness.
Level 2 – Inner Unit / CV Fitness: inner core muscle control and general fitness.
Level 3 – Outer Unit CV Fitness: larger muscle groups,more advanced exercises and more specific fitness.
Level 4 – Maintenance / Athletic: more advanced program to allow return to sport and work situations.
You can see that the first two stages involve working on range of motion and small motor control – before we even commence any more advanced outer unit and athletic programs.
In all stages it is essential that the low back pain patient commences and maintains some element of cardiovascular conditioning whilst undergoing the BBP – this is to improve general oxygen delivery, set up new feedback pathways that may help to override previous pain pathways and increase the patients feeling of well being – all essential to good health.
The form of CV training undertaken is up to the individual patient and therapist – however it can involve cycling, treadmill or even swimming – as long as the patient enjoys it and gets an elevation in their heart rate.
Whilst the topic of Low Back Pain is broad and non specific in many cases – the use of a systematic approach to rehabilitation at least allows a baseline for patients and health professionals to work from – care needs to be taken when deciding to progress a patient to the next level as increasing training demand too soon is one of the most common reasons for program failure.
If you are serious about Core Stability training and back pain rehabilitation and want to find out more about the “Better Back Program” I have recorded a 2 hour video on this great program – and posted all training manuals – insode the members area of PhysioProfessor.
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