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Training the Client with Chronic Pain: Flexibility & Core Assessments

10 Aug 2008

Putting together flexibility assessments for a client with chronic pain is similar to assessment design for all other clients. Fitness evaluations are based on goals with consideration of any individual medical issues. Regardless of the goal a client with chronic pain will have, depending on the severity of their symptoms, it would be best to tweak some traditional fitness assessments.

More often than not, flexibility will be an important, functional component to improve on when training a client with chronic pain. Some chronic, muscular pain can be intensified with tight muscles. Stretching out will not only help loosen up muscles, but can also help reduce, though not completely alleviate, muscle soreness. Traditional flexibility assessments for hamstring, back, neck, and shoulder flexibility will help in measuring progress, but in this case, qualitative approaches should be employed as well. Ask your client to be aware of any changes in how limber their muscles may feel and make note of it.

Stabilization is another fitness component of importance as it is the foundation to functional strength. Due to inactivity because of debilitating pain, most chronic pain clients will have a deconditioned core. A typical core stabilization and balance assessment often involves planks and balancing on a single leg. Single leg balances are appropriate for most exercisers with chronic pain, but a plank will most likely be too strenuous. A quadruped progression can be used as an alternative

For this modification, your client will be in a quadruped position with both knees and hands hip-width apart on a mat. Have them perform a cat stretch, alternating between arching and rounding the back. Instruct them to hold their back right in between the mid-way point of arching and rounding movements, which should leave them with a relatively straight back. Have them hold this stance while engaging their core. The time they will hold this pose will vary depending on client, but for starters, ask them to hold it until right before they start to fatigue. This can be anywhere from five seconds to minutes, so if you have a client that can reach the 2-minute mark pretty easily, then you can probably substitute planks when it’s time for re-evaluation! For clients that do start to fatigue seconds after holding the quadruped, be sure to ask what muscle groups were starting to fatigue and make note of any muscle tightness or weaknesses.

NEXT: Strength and Cardiovascular Fitness Assessments

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