Lower Back Pain

LOWER BACK PAIN

The focus of this blog is lower back pain, a very common condition. As well as resulting in pain and discomfort, it is one of the major causes of work absenteeism. A personal trainer should be aware of the causes and symptoms so that they can advise clients who have lower back pain about whether to exercise and how to exercise.

Lower back pain can fall into three different categories:

• Nerve root/radicular back pain
• Specific spinal pathology back pain
• Non-specific lower back pain

1. Nerve root pain, often referred to as a trapped nerve, is when the nerve exiting the spinal cord is being compressed by the vertebrae or a bulging disc. It is one of the less common causes of lower back pain, only representing one in 20 people with this condition.
2. Specific spinal pathology includes diseases such as osteoporosis and is caused by bone disorders. This is even less common: only found in one in 100 cases.
3. Non-specific lower back pain is the most common category, accounting for around 19 of every 20 people suffering from lower back pain. Most clients with back pain that are seen by a personal trainer will fall under this category. It is defined as pain and discomfort localised below the costal margin (the lowest part of the rib cage) and above the gluteal fold. It’s caused by mechanical problems rather than structural damage, usually stemming from disturbance of function, such as tight or weak muscles.

However, since lower back pain can be indicative of an underlying disease, if a health professional is working with a client with back pain and they haven’t recovered within six weeks, they should be advised to visit their GP to ensure that the problem is not a pathological issue.

Non-specific lower back pain is classed as acute if the person has been suffering with it for less than six weeks, sub-acute if it lasts six to 12 weeks and chronic if it lasts more than 12 weeks.

THE CAUSES OF NON-SPECIFIC LOWER BACK PAIN

This type of back pain is caused by over use, disuse, misuse or abuse of the back. A personal trainer may encounter clients with lower back pain resulting from any of these activities.

• Over use – this might be a manual worker or anyone who is constantly having to flex and extend at the spine, in particular repetitive movements.
• Disuse – is when a person is inactive and the musculature around the vertebrae is not strong enough to deal with everyday life.
• Misuse – is when someone is not using their back in the correct manner, for example lifting something and twisting at the same time.
• Abuse – is chronically overloading the muscle group, for example if someone lifts a weight that is too heavy for them.

PRESENTATION OF LOWER BACK PAIN

The signs and symptoms of lower back pain are often sudden, which can be indicative of an injury. A personal trainer may also work with clients who get back pain when they are raising a leg during exercise. They may also feel pain:

• at the start or end of the day
• after standing or sitting for long periods
• after coughing
• when repetitively bending

WHO IS AT RISK?

Fitness professionals should be aware of which clients are more susceptible to back pain. These include:

• Older clients As we age, we are more likely to have weaker muscles, tendons and ligaments, therefore the muscular structure around the vertebrae isn’t as strong and can more easily become damaged through everyday activities that put force through the back.
• Inactive people Those who aren’t active will have weaker back musculature.
• People with poor posture This includes tall people who stoop and gym goers who over train or follow poor training techniques.
• Overweight and obese people Extra weight tends to put additional force through the spine.

ADVICE FOR THOSE WITH NON-SPECIFIC LOWER BACK PAIN

The recommended approach is to remain active, avoid bed rest and take pain relieving medication and non-steroid based anti-inflammatories, although this should always be carried out under the supervision of a doctor or other suitable medical professional.

HEALTH AND FITNESS QUALIFICATIONS

When a health and fitness professional is dealing with a client with non-specific lower back pain, they will need a Level 3 Exercise Referral qualification as the client will be classed as Special Population case. The personal trainer should educate the client that keeping still is not always the best policy; indeed the condition can be improved and prevented by continuing to exercise.

The health professional should also ensure that they complete a Par Q form for the client, to analyse and assess the client’s level of fitness and previous training experience, any co morbidities, and the individual’s goals. From this information, the personal trainer will be able to devise a bespoke programme for the client, taking the condition and other factors into account.

As well as explaining to the client that non-specific lower back pain is caused by damage to musculature rather that to the spine itself, a fitness professional should advise of the benefits of exercise. These include:

• Faster recovery times
• Relieving the condition so it becomes less chronic
• Cutting down time off work and potential loss of earnings
• Improvements to their lifestyle and their ability to take part in recreational and family activities or to play sport

OTHER CONSIDERATIONS

If a client ever has difficulty in passing urine or has numbness around the genitals or in the legs, or a severe pain that gets worse over the weeks, the personal trainer should refer the client back to their GP.