How to Assess Lumbar Function: Dean Somerset
As I noted earlier in the week, I’m flying down to Texas this weekend with my girlfriend to get away for a few days, and more importantly, to meet her dad (and step-mother) for the first time.
So, um, yeah, the cat’s out of the bag folks: I’m heading down to finally meet Mr. Isweartogodihavenevergottenpast1stbasewithyourdaughterOMGisthatagun this weekend.
Okay all kidding aside, I’m really looking forward to meeting her family. Lisa’s actually been to my hometown a handful times, and after close to a year and a half together, we figured it was high time I make a cameo appearance to meet some of her family as well.
We have a pretty sweet weekend planned: eating lots of dead animal flesh, attending my very first rodeo (no, I’m not wearing cowboy boots*), and just taking in everything Texas has to offer.
And while I have every confidence that Lisa’s dad will find me uncannily witty and charming, I’d be lying if I said I wasn’t just a liiiiiiiiiiiiiiitle bit nervous. Of course, the nerves are most likely due to the fact that I like flying about as much as I like passing a kidney stone.
I swear to god if this happens, I’m going to be pissed:
Nevertheless, since I’ll already be in the air when most of you are reading this, I asked my e-brotha from another motha, Dean Somerset (totally stole that from him), to fill in for me while I was gone. Dean’s a very smart dude, and, as luck would have it, has a very similar writing style to myself which I know many of you will appreciate. But lets be abundantly clear, I’m way hotter.
So, without further ado, I’ll let Dean take over from here.
See you next week. I think……..
How to Assess Lumbar Function
So Tony was gracious enough to let me do his job for him do a guest post for his blog today while he’s away lounging it up in sunny Texas. Want to know what I’m doing today?? Freezing my left one off in the middle of a -20F blast of angry Mother Earth hell in Edmonton, Alberta Canada. Who’s getting the shaft on this one? Only Tony could give you the REAL answer, folks. But here I am at any rate, ready to give you all what you’re salivating for: The tricks I use to assess lumbar function!! YEAAAAAAH BABY!!!
So to tell you a little about myself, I’ve been a trainer for the past seven years, and have worked myself into a nice little niche as a post-rehabilitation specialist. Over 90% of my clients are referred from medical sources to deal with injuries, post-surgical recovery, metabolic syndromes, you name it.
I used to be a competitive athlete back in the good old days of neon clothing and high-top fades, but I was more dumb than gifted, and resulted in a lot of injuries to my person. One was a major low back injury that caused me to dislocate my sacroiliac joint, herniated three discs, and tear a few muscles in the process. I still have trouble with the discs occasionally if I’m not careful, but I’m closing in on a 405 deadlift sometime in the next few weeks, so you could say I have a bit of a vested interest in the function of the low back and SI region. I also have a kick-ass blog, which you can check out HERE.
So let’s get down to business. When I have someone come into me with any type of non-disclosed mechanical low back pain, (meaning they have been checked out by their doctor, nothing found on their X-rays, and were found to essentially have a muscle imbalance or movement impairment) I follow a pretty set pattern in what I go through and look at.
Before we start moving around, though, I HAVE to ask them about lifestyle and nutrition, as those play as big a role in back health as anything. If they’re spending 20 hours a day in front of a computer, move as much as a glacier, and eat like a crackhead, there’s a lot of room to improve.
Note from TG: See!! He’s w whipper snapper this one. HA!
Water is the first thing I could recommend to anyone with any type of low back pain. Dehydration, even as little as 1%, can reduce the disc height to a stage of impairment, which can lead to degeneration and pain, so pound a litre or two and you’ll feel like a champ.
Next up, we look at basic posture in standing to see if anything jumps out as odd. We all know the basic bad postures like kyphotic, lordotic, scoliotic, forward head, and all that jazz, but it bears repeating. Kind of like free throws at the end of every practice, it’s best to just keep doing them, or else you’ll end up shooting like Shaq.
Once I figure out what their posture looks like, I take them through a couple of movement patterns testing the spine, hips and shoulders to find out not what tissues are impeded, but what MOVEMENT PATTERNS are impeded. The basic patterns I look at are as follows:
Spine flexion – touch the ground, essentially
Spine extension from prone
Lateral bend, plus lateral bend with flexion/extension
Hip flexion, abduction and external/internal rotation
Shoulder flexion, abduction, and external/internal rotation
When going through these patterns, I look for the quality of movement, as well as if there are any movements that cause any amount of pain, and have the person rate it on a 1-10 scale. From here, I can find out what movement patterns the client is weak in, which ones they are strong in, and which ones cause pain and should be avoided.
From here, I get the person to go through a corrective exercise or two in the desired movement pattern, and then check their quality and level of pain again to see if there was any change. If there was an immediate improvement, I am a God in their eyes, and they will give me their first born should I ask. I usually don’t.
Once I know I’m on the right track, I explain to them how long it will take to get stronger in the movement patterns that will decrease their pain and help correct the problem, and what they need to commit to in order to get those results. I’ll admit, there are occasionally people I can’t help because I can’t figure out where the problem is coming from, so I have to refer them on to someone else who would have a better idea.
I have a network of physios, chiropractors, sports med doctors, and allied health practitioners who I work with to help my clients out. If you’re a trainer and you don’t have a network like this, YOU WILL GO OUT OF BUSINESS!!!
Get out and meet a few people, tell them who you are and what you do, and they’ll probably send people to you and help you when your clients get an owie every now and then. Seriously, this is a common concept a lot of trainers don’t act on, and I’ve given seminars all over North America on the importance of having a medical referral network to increase your business.
If there are no trainers in your area who do this and you are the only one, you’re going to get more clients than they will, and eventually put them out of business because everyone is coming to you for advice and assistance, so get on it. I could do a few thousand pages on this topic alone, but maybe I’m exaggerating a little.
Of course, I’m simplifying the process a bit here, but that’s really the nuts and bolts of an assessment with me. Find what’s strong, what’s weak, what’s painful, and what needs work; test the hypothesis; reassess; re-test if necessary; get them all jacked up about training with you like they’re straight-lining a bottle of Mountain Dew into their left ventricle, and the rest is history.
Note from TG: That will do it for part I. In part II, which I’ll post early next week, Dean will take us through a real life case study using one of his own clients as an example. Stay tuned……
* Okay, maybe.
UPDATE: I totally am.