The Show Up Fitness Podcast

Ep. 215 Back Pain: Case Examples FLEXION / EXTENSION INTOLERANT

• Chris Hitchko, CEO Show Up Fitness • Season 2 • Episode 215

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Battling low back discomfort doesn't have to mean the end of your training career or active lifestyle. This eye-opening episode tackles the pervasive problem of back pain—affecting a staggering 80% of the population—and reveals why cookie-cutter approaches fail while qualified trainers succeed.

Through compelling real-world case studies, you'll discover the crucial differences between merely certified trainers and truly qualified movement specialists. We break down the biopsychosocial model of pain assessment, showing how biological factors, psychological experiences, and social circumstances all influence recovery. You'll learn exactly how proper screening determines whether a client needs simple movement modifications or medical referral, and why positive language like "discomfort" instead of "pain" creates psychological shifts that facilitate healing.

The episode features detailed explanations of flexion intolerance versus extension intolerance, how to modify exercises for zero-irritation movement patterns, and the importance of establishing appropriate tissue capacity baselines before progressive overload. Most importantly, you'll understand why qualified trainers never simply say "do planks and bridges" or "never squat again"—fear-based approaches that dominate the industry but fail to address individual needs.

Whether you're a trainer looking to elevate your skills or someone suffering from persistent back issues, this episode offers hope, concrete strategies, and a methodical approach to recovery. We also highlight upcoming workshops in Denver (June 13-14) and Florida (June 27-28) for hands-on learning opportunities that can tran

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Speaker 1:

This is a very typical low back discomfort situation and we're going to get you out of this, my man. I guarantee it. We're going to be back squatting significant loads, we're going to be deadlifting, setting PRs, all that fun stuff. I plant the seed for hope because we will get there. Welcome to the Show Up Fitness Podcast, where great personal trainers are made. We are changing the fitness industry one qualified trainer at a time with our in-person and online personal training certification. If you want to become an elite personal trainer, head on over to showupfitnesscom. Also, make sure to check out my book how to Become a Successful Personal Trainer. Don't forget to subscribe, rate and review. Have a great day and keep showing up. Howdy y'all. Welcome back to the show Fitness Podcast.

Speaker 1:

Today we're going to address low back discomfort. 80% of the population has some type of discomfort in the low back. You probably have experienced it I have, and it sucks. But as a qualified trainer, you need to be able to properly screen and give a solution that is specific for that individual. We were just in Sacramento and we had a really neat case example. We go to Lifetime's part of our partnership because they want their trainers to be qualified and leveled up. That's why they work with the best certification out there. That's a show up in a CPT and you will be certified for life. But we also have our soft tissue, as well as nutrition certification, and what you will learn in this two-day workshop is how to assess and screen pain to see if it's in our lane and we can help that individual, or if we need to refer out. You should absolutely have a physical therapist and a registered dietitian on your team. That separates you from all of the certified textbook trainers out there, because they don't. If you were to go to a Facebook group and you see all the trainers bitching at how hard it is to turn your passion for fitness into career, ask them do you have a physical therapist and a registered dietitian in your network? That answer no. When was the last time you did a hands-on your network? That answer no. When was the last time you did a hands-on learning workshop? That answer no. No shit. You're not qualified because you don't have the competencies and the requisites to be qualified. That's what our industry needs more of qualified trainers. We're going to be in Denver, outside Parker, aurora, june 13th and 14th. We're going to be in Florida, coral Gables, june 27th and 28th, get to a seminar. It will change your trajectory as a personal trainer, but it's going to wipe away all of those ants, automatic negative thoughts. So this young hunk came up and I screened his back. What I didn't do was say just do a plank and do a bridge and don't run or don't do this ever again, because that's fear-based.

Speaker 1:

We take the biopsychosocial model approach, which is looking at that biology of that individual, their psychology and their experiences with the discomfort. When did it happen? How did it happen? We need to learn more. How did it happen? We need to learn more.

Speaker 1:

Eliminate red flags. Is it burning? Is it in the mid part of your abdominal region? It could be cancer, I don't know. But if a client were to report those symptoms I'm going to refer out. Is it numb? How long has it been numb for? Maybe you just sat on a train for 12 hours and client comes in the next day and they say they're experiencing some slight numbness. Well, yeah, that makes sense. Maybe we need to do like a little nerve glide, some sciatic stretches. That could potentially help. But that will be okay. That's within our scope. What's not within our scope is if there is numbness and shooting prolonged. When did it happen?

Speaker 1:

And for this case, individuals had low back pain for over five years. It's not a tissue issue. Now here another case example where a client goes and gets an MRI and they don't have any dysfunction quote unquote with the MRI. So where's the pain coming from? There are 23 intervertebral discs. You don't have one between C1 and C2. You don't have any in the sacrum and coccyx. Have one between C1 and C2. You don't have any in the sacrum and coccyx. Remember there are 33 bones in the spinal column, seven in the cervical, 12 in the thoracic, five in the lumbar, nine fused in the sacrum and coccyx.

Speaker 1:

So when I screen this individual, the first thing that we want to do is see if their flexion intolerance. That's touching your toes, with your knees slightly bent, putting your hands on those bony protuberances on your waist which are the PSIS, posterior superior iliac spine. Can you do hyperextension, looking up and bending backwards, lateral flexion which is going back and forth like doing oblique bends with weights? No, you're not going to get a bulky waist from doing those. Get out of here with that shenanigans. And then we're going to do a compression test. Most cases are going to be flexion intolerant and then one-sided lateral flexion intolerant. But that's not all. I would be a terrible trainer if I were just to say do a bunch of supermans, get on the ground and push up, because one time Dr Waterbury said that's what he did with one of his clients. Therefore, that's how you treat all back pain. That's not the case. We need to do a better job of screening to see what the likelihood irritation is coming from, and for this individual they were extension tolerant.

Speaker 1:

I just did an amazing, if not the single best call that I've ever done part of our platform. I did an assessment on a student who's been experiencing a lot of low back discomfort for the last five plus years. If you want that call, email info at showupfitnesscom. It's recorded, put into our platform and you can watch the hour assessment that I do and it was beautiful because you can see the discomfort that the individual had when he experienced discomfort during movement.

Speaker 1:

He's working with a physical therapist and we talk about how physical therapists are great, but some of them may be seeing 10, 20,. Therapists are great, but some of them may be seeing 10, 20, 30 patients a day, so they can't follow up. That's why you want to have them in your network so you can take workload off of their plate. When you let that therapist know I'm sure you've worked with a lot of trainers have no idea what the hell they're doing. They got their NASA, mace, issa, simple certification and then they try to cure back pain by just giving simple exercises. It's more complex than that.

Speaker 1:

We like to take the biopsychosocial model approach, and if you say that to a therapist, they're going to be like wow, you are sharp, I want to work with you. How do you know that stuff? That's what I learned when I was at USC, and so we are like-minded individuals, but when it comes to stuff out of our scope, we know when to refer out. And for both of these individuals the one that I worked with in Sacramento who is extension intolerant, and for the kid that I worked with, mr Luke, who is flexion intolerant I gave an exercise prescription that was specific to that individual.

Speaker 1:

I assess, I use positive vocabulary, and something that was really cool to hear is that he wants to squat and deadlift but he can't because it irritates him, and I said guess what, luke, I'm going to get you out of back pain, I guarantee it, and I'm also going to get you into squatting and deadlifting again. How does that sound? And he said immediately that sounds great, he wants that. So you have to go off of that hope. You need to give people hope Again within our scope. I'm not doing things that are going to make it worse. I'm not going to be doing inappropriate exercises in the beginning. Let's do a Jefferson curl with your body weight? No, that would be stupid.

Speaker 1:

Each case is different. But you start with a positive psychological experience for that individual. Give them hope. And if there was anything that I was uncertain of, I told him that I work with a physical therapist. We just brought one on at Show Up Fitness in Santa Monica from USC. I would refer out to him and I would work alongside of him. What can I do, what can I not do, what are the contraindications? And then I would take that information and implement it within the CCA. But for the time being I might require my client to work with a therapist for a couple of weeks and then come back to me. But for the most part it's going to be you see him once, you see me two times and it's an ongoing experience, but it's a positive experience.

Speaker 1:

So the therapist gave Luke some exercises, and I wasn't saying that they were wrong. But the unfortunate thing about our healthcare system is that professional wasn't able to see how he was doing the exercises and the exercises were irritating him at end range. So we needed to modify. And this individual being a dude, we're a bunch of idiots and I say that as a compliment, luke but we push through pain. How do I know? Because I did that. And when you push through it it just amplifies your nervous system, central amplification. The system is saying, hey, tiger, hold on. There's something a little off here. Maybe the capacity is too much, maybe we did too much too fast, maybe we need to take a little time off and I say a little time a day or so. But if you're constantly registering a four or a five plus discomfort and you push through it, you're not going to get that discomfort to go away.

Speaker 1:

And notice how I said discomfort throughout this call. I call it discomfort because it's not as intimidating as pain. Yeah, we use a scale zero to 10. It's not the best, but it works. And when I asked him, does that cause irritation? Sometimes he would go no, it's okay, he was lying to me. I want zero irritation. So when we do a side bend. Let's just say when you watch the video it'll make more sense. But if you were to go down 12 inches on the left side and there's irritation, well I need to go down 10 inches. Then On the right side you can go down 25 inches. Great, use that right side as medicine.

Speaker 1:

Move without pain, consistently, with flexion right above his knees it was fine, but below his knees it wasn't. So we need to incorporate a lot of pro-movement, zero irritation exercises, such as touching your toes to the point where there's no discomfort. There was a little bit of discomfort with extension as well, but it was primarily flexion based. We did a compression test, zero discomfort. So then I had him show me all of the exercises, and a lot of therapists may incorporate stretching. Nothing wrong with stretching if it works for the individual. But a lot of therapists will just give blanket exercises for prolonged periods of time, and there was a couple that really irritated him, and so the therapist, rightfully so. He sees a lot of patients. Maybe he was having a bad day, I don't know. I'm not saying therapists suck, not at all. I'm saying our medical system needs more qualified medical professionals such as us as qualified trainers. But unfortunately social media and all the smoke and mirrors online gives us a bad rep.

Speaker 1:

So if you really want to be different, level yourself up. Go through a soft tissue course, learning the screens and what exercises are appropriate based on the individual's movement. So we then did a couple of exercises that caught zero discomfort and, being a young kid, nice and strong, he was more capable of, say, a 60-year-old who's been battling this for 20 years and doesn't have the sufficient stability to do just a simple elbows plank. So we progressed that into a hands behind the back plank plank. So we progressed that into a hands behind the back plank and we added some rotation. When we did a side plank, we did a bridge and then a modified hip 90-90, because he was doing a hip 90-90 with a reach and thoracic rotation and he said the stretch he felt, but it didn't necessarily make it feel better. It's kind of like popping your neck or your back it feels better momentarily, but then you have to keep on doing it. What is the definition of insanity? Doing the same shit over and over again, expecting different results? So we modified the movements that were appropriate for him with zero discomfort.

Speaker 1:

During the call I said you will probably have an episode where you get a little flare perfectly normal. But I'm very confident, based on this 30 to 45 minute review and assessment, that's not going to be the case. This is a very typical low back discomfort situation and we're going to get you out of this, my man. I guarantee it. We're going to be back squatting significant loads, we're going to be deadlifting, setting PRs, all that fun stuff. I plant the seed for hope because we will get there.

Speaker 1:

I can, jefferson, deadlift my body weight. Hell. When I was in Sacramento I did 245 Zurcher deadlift off the ground. At the time I hurt my back 10 years ago. If I would have done that I probably would have died Kidding, but it would have been so excruciating because I had a guard. No way I can do that. But through working with experts, pro movement, progressive overload, knowing my scope and progressions, I was able to conquer it and get to that point, as I know you will be able to conquer it and get to that point, as I know you will be able to.

Speaker 1:

So we're going to do these three exercises one time a day for two to three rounds, six to eight repetitions using the screen. That was negative. So the flexion above the knees, lateral flexion on the right side, modified on the left side. We're going to use those for a lot of repetitions. So you have a morning routine. You do it one time and then check in with me tomorrow, film it. If there's anything that you have questions on, reach back out to me. But tomorrow let's see how you're doing and I'm very confident tomorrow he's going to be doing better.

Speaker 1:

I also suggested to put pillow under his legs and sometimes an anterior tilt can cause discomfort, as it did with him. We screened that, so we did an anterior tilt, a posterior tilt. Posterior is fine, anterior wasn't. So when we sleep, sometimes we can be in a position that we're unaware of because we're sleeping and it can just irritate that area. In Sacramento a posterior tilt affected the individual. So trainers today or influencers today on social media I'm the low back specialist to do these exercises. Hence knees over toes, guys, the same thing with that. We're not screening to make it specific to that organism. Bio-psycho-social model approach is significantly superior because you're looking at the individual, you're giving them hope and it's going to work, knowing how to screen within our scope to eliminate those nasty situations that could be present Cancers and tumors and who knows what else.

Speaker 1:

I'm not a doctor but I can screen to know when I can help you the most efficiently and when I need to refer out. So the whole interaction for this roughly hour assessment was just really neat because you could see the irritation when it would present itself. So we modified and then there was a solution. So if I were to work with him regularly I would still do the CCA, but I would do body weight stuff for the time being. Typically you'll find modified pushups being okay, planking being okay, trx squats Squats didn't irritate him, so you can progress into body weight squats but you don't want to do too much too fast. Body weight squats but you don't want to do too much too fast. You do a bunch of single arm rows, walking lunges with weight, unilateral overhead pressing which is stabilizing the spine on one side of which he has that irritation. Could you incorporate some quadratus lumborum release techniques? Sure, but we wouldn't do it for his case because it was specific to his spine. Ql discomfort is going to be on the lateral side and it's away from the spine discomfort and through guided experience you'll be able to determine which one it is.

Speaker 1:

I have a client who I work with regularly Katie. I got her from an Equinox trainer because he had her do some stupid ass power cleans into front squats which are not appropriate for her and she hurt her back. So she came to the professional me and we helped her overcome that. I've been training with her for over three years four years now, I want to say maybe even five. She worked with some other trainers but she's been with us the entire time because she feels comfortable and safe working with qualified trainers. And she came in because she had some lateral discomfort. She's been doing a lot of running at Orange Theory and through some testing I was able to determine it's not her low back like Luke was experiencing, or the kid in Sacramento. This was QL specific. So doing a release on the QL significantly helped her so she can move within the workout. Significantly helped her so she can move within the workout.

Speaker 1:

Strengthen that tissue by doing side planks with your feet staggered. When they're stacked it's more glute med. So both have their role within the organism you're trying to work with. So you're going to be able to distinguish between. Is it flexion, is it extension, is it compression? If it's compression, like it was in Sacramento, then we probably want to eliminate goblet squats, back squats, overhead pressing for the time being.

Speaker 1:

But you keep your exercise vocabulary small. It's a digestible menu for the time being, because tomorrow I want you to feel better, because then we're going to incorporate VFI, volume, frequency and intensity. We're not going three, four exercises, five, eight, 10 reps to 10 exercises. 10 reps that's too much. Just like if someone wants to bench 315, I'm on the road to 315 right now. Adam and I in Sacramento got after 275. We're getting stronger. By the end of the year I will be doing 315. I guarantee it. We'll see, but we are progressing. You don't go from the bar for 10 reps to the next week putting on 225. That would be inappropriate. There's going to probably be an injury because it's too much, too fast. That's the whole tissue capacity we want to figure out.

Speaker 1:

When does it get irritated? And as a trainer he's on his feet eight to ten hours a day and he goes down and picks stuff up and he will push through because he doesn't want to show weakness to his clients. And I get, but he had those ants, automatic negative thoughts and that plays into his low back discomfort. What about stuff going on at home, significant others, finances. Maybe he's a drinker, maybe he's a smoker. We're not sleeping very well. There's so many things that go into making your pain more unpleasant.

Speaker 1:

So the assessment process isn't just exercises, it's learning. It's a discovery phase to see what's appropriate, and then we slowly progress. And I told them maybe we'll incorporate some low back releases. It may help, but for now I want you just to do these exercises, report back to me tomorrow and then, if we're doing better, we're going to start progressing by doing more reps. So he did the front plank with an arm behind his back for eight per side. If there's no irritation tomorrow and it's getting better or even staying the same, we would go up to 10 reps. I don't want to be doing things that are going to irritate him, but we need to find that capacity. So if you were to do a front plank and say, 20 seconds in he starts feeling discomfort Awesome, that's really great data. I want you to do three sets of 12 seconds. Then we build on it.

Speaker 1:

Low back pain can be debilitating. It can be very frustrating. People have committed suicide. They've become addicted to opiates because it's so frustrating and a lot of times we're given no hope. So what you can do is level yourself up by learning more about these screens and the appropriate exercise selection based on what you find during those screens.

Speaker 1:

If you want to level yourself up and become a qualified personal trainer, get the soft tissue mobilization technique certification that we offer. You're going to learn how to assess how to implement the right exercise, not only for low back, but also knee pain, shoulder pain, elbow discomfort, foot discomfort. It levels you up as a trainer so you can charge more. You're going to be more confident but, most importantly, you're going to get medical professionals on your team, and that's what separates you from this saturated market of certified trainers, because you're not a simple certified trainer. You are a qualified movement expert with a great team. But you got to level yourself up, master anatomy and link up with the right professionals. Get to a seminar. We're going to be in Denver in June 13th and 14th. We'll be in Miami 27th 28th.

Speaker 1:

If you would like the complete month program for someone who has low back discomfort, with a checklist of the appropriate exercises for progressions, regressions and things we may need to eliminate for now, email info at showupfitnesscom. We will send you that program as well as the video that we do within the platform for Luke and his low back discomfort. Let us know the podcast that you're enjoying, topics that you'd like to learn more about and how we can help you level up so you can turn your passion for fitness into career. This isn't a side job or a side gig. This is something that is super fulfilling when you help people get out of pain, get the results, perform better, look better naked. That's what qualified trainers can do. That's what we do at Show Up Fitness. Have a great day y'all. Remember big biceps are better than small ones. Keep showing up.