Lower back pain is one of the most common and expensive medical conditions to affect people in the UK. It is estimated that 58-70% of the population suffer with regular back pain and the Chief Medical Officer (CMO) report of 2005 states that “around 80% of people in the UK experience symptoms of lower back pain at some point in their lives. Approximately 150 million working days are lost each year as a result of these afflictions.”
Non-specific lower back pain (NSLBP) is an umbrella term used to describe the sensation of localised pain and discomfort experienced below the ribs and above the hips when there are no symptoms of leg pain. NSLBP is considered to be a syndrome rather than a condition because the disability and symptoms present do so as a result of a wide-range of factors, rather than one single cause or entity.
The presence of NSLPB in office workers is rife. Commonly referred to as ‘white collar syndrome’, prolonged periods of sitting and poor desk postures are believed to be significant contributors.
Prolonged sitting increases the risk of lower back pain by 8% because the various spinal structures are unevenly loaded, particularly the inter-vertebral discs. When the same people move into a standing position for any significant period of time, 14% report a noticeable reduction in their symptoms.
It is extremely difficult to describe the actual source of NSLBP because around 85% cases of lower back pain are idiopathic- this means that the condition has no known cause. Any spinal structure that contains pain receptors (nociceptors) has the potential to cause lower back pain if it is irritated or stressed in any way. Given the fact that lower back pain is often referred pain, in which the area in which the pain is felt is not the site of the irritation, stimulus or inflammation. Nerves can be irritated at their root and yet the pain sensations are presented elsewhere. This is why identifying the specific cause of lower back pain is so difficult and at times impossible.
Managing Lower Back Pain
In most cases healthcare professionals recommend that patients implement self-care strategies to reduce their exposure to risk factors and participate in activities which promote spinal health. When episodes of NSLBP do present, patients can in most cases manage these symptoms independently through over the counter pain relief and/or anti-inflammatory medications. Moderate levels of physical activity and exercise may also prove to be therapeutic.
Up to 70% of patients with severe lower back pain will heal without treatment. Initial treatment of the condition, if required, aims to relieve symptoms of pain. Ibuprofen is commonly used for temporary relief ahead of aspirin, because it has anti-inflammatory properties. Acetaminophen has also been used for the same relief, but has proven better for patients suffering with intestinal issues. Non-Steroidal Anti-inflammatory Drugs (NSAIDs) will also be prescribed for the condition depending on the severity.
From an exercise perspective, general physical activity and a well-rounded exercise programme is likely to be the best approach for preventing and managing symptoms of lower back pain. Some suggest that performing specific exercises to target weak muscles, or lengthen short muscles is an effective strategy, there is however no credible research to support this approach. Instead, fitness instructors and personal trainers working with those with clients suffering from lower back pain should promote a varied and general exercise and activity approach, ensuring that movement is performed through a variety of planes, in multiple directions and regularly.
In the words of Professor Kim Burton at the University of Huddersfield “the evidence does not support the effectiveness of specific exercises as a treatment for back pain. That is not to say people with back pain should not be active or do specific exercises, or that the exercises are wrong/detrimental, it’s more about whether exercise professionals should be taught that specific exercises are appropriate to manage back pain.”
Generally speaking, those with active symptoms of lower back pain should:
• avoid high impact activities
• refrain from heavy lifting, jerking and jarring movements
• not perform double leg raises or straight leg sit-ups
• refrain from repeated twisting, rotating and bending
• avoid exercises that load or compress the axial skeleton
• avoid sustained or prolonged static postures
• rehearse engaging the abdominals regularly
• seek opportunities to improve posture
Fitness instructors and personal trainers wanting to work with clients suffering from lower back pain should ensure that they have the appropriate qualifications, REPs accreditation and insurance to do so. As a minimum, a Level 3 Diploma in Exercise Referral would be required although fitness professionals will ideally also hold a Level 4 Exercise Specialist qualification in the discipline of managing lower back pain.