I hope I’m not alone when I say that I’ve had more than one client stand up with more low back pain than they started with. I reduced the frequency of this over the years, but it took a lot of fiddling and small changes. More importantly, I found that some clients would respond well to a change, while it would do nothing for others.
So, I kept expanding my toolbox! Here are my 8 tips for working with clients with low back pain:
I’ve got the pillow-under-the-abdomen trick in there (along with a playlet about how to explain it to the client), along with my favorite new toy: The unbelievably huge bolster for under the knees while the client is supine. Both prone and supine positions can exaggerate the normal lumbar lordosis; add in some pressure, and it can create an unpleasant environment for the low back. Both the abdomen pillow and the giganti-bolster bring the client into slight trunk flexion, which seems to be less provocative over the course of an hour.
Another big change was less emphasis on the QL region. I found that lots of pinpoint work on the quadratus lumborum, even if it felt good to the client while on the table, could have a rebound effect once they stood up. Once I started thinking more about the pelvis, I started having better outcomes.