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The Low Back Low Down: Pain Prevention

American Fitness, July, 2000 by Mary Yoke

Low back pain is a common problem, often estimated to afflict 80 percent of adults at some point in their lives. As fitness instructors, personal fitness trainers and fitness practitioners, it is inevitable that you will have participants and/or clients who suffer from lower back pain.

Did you know that:

* back problems are the second leading cause of all office visits to primary care physicians (after colds)?

* low back pain is the leading cause of disability in persons younger than 45?

* the highest prevalence of low back pain is in persons age 30 to 50?

* the annual cost including disability and lost productivity is approximately $50 billion?

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* the direct medical cost is $25 billion?

Perhaps even more importantly, are you aware that the majority of low back problems are preventable? Some back pain, of course, is caused by factors such as traumatic accidents, infection, malignancy (tumors) and congenital defects. This type of pain is generally not preventable (and is beyond our scope of practice). Most low back pain, however, is avoidable--if only people had the appropriate knowledge and skills. That's where you, the fitness professional, come in. You can play an important role in reducing America's health care costs through back pain prevention while enhancing the well-being of your students and/or clients.

Body Mechanics

A major factor in preventable low back pain is poor body mechanics-how an individual sits, stands, walks, sleeps, lifts and exercises as well as how he or she performs daily living activities. It is difficult to have proper body mechanics if important major muscles are weak and/or tight. Other risk factors for low back pain are loss of flexibility and muscle endurance, loss of torso stabilization, poor posture, excessive forward flexion and poor cardiovascular fitness. Loosely linked to the development of low back pain are high mental stress or inadequate coping mechanisms, obesity and smoking.

Neutral Spine

A key component necessary for understanding proper body mechanics is the concept of the neutral spine, or the spine that is in ideal alignment. Generally speaking, a neutral spine should be maintained throughout all daily activities, no matter what a person is doing. Is your spine neutral right now, at this moment, as you are reading this article? For ideal back care, we maintain a neutral spine as much as possible when standing, driving, sitting, sleeping, lifting, raking leaves, shoveling snow and, of course, when exercising! The obvious exception to this statement is that when performing specific torso exercises (such as for the rectus abdominis, obliques and erector spinae muscles), the spine will be flexed, extended or rotated and flexed, and, therefore, will no longer be in neutral. However, the spine remains neutral when performing almost all other muscle conditioning and flexibility exercises. For example, the hips and knees flex and extend in a squat, but the spine itself remains in ideal alignment (unchanged from the ideal alignment in the standing position) throughout. When performing a bent-over row for the latissimus dorsi, first place the spine in neutral and then begin to move the shoulder and elbow joints, maintaining a stable, ideally aligned spine throughout the set.

What is neutral alignment?

When the spine is in neutral alignment, it should have four curves: a lordotic (inward) curve in the cervical region, a kyphotic (outward) curve in the thoracic region, a lordotic curve in the lumbar spine and a kyphotic curve in the sacral spine. None of the curves are excessive; they are in a harmonious, balanced relationship to each other. (See Fig. 1.)

[Figure 1 ILLUSTRATION OMITTED]

When teaching prevention, work with your clients not only on proper standing alignment, but on correct seated posture as well. After all, most Americans are sedentary, spending hour after hour, week after week, month after month, and year after year sitting with their backs rounded and hunched over. The majority of their upper body weight is directed into the sacroiliac area. (See photo #1). Is it any wonder that the incidence of low back pain is so high?

[Photo 1 ILLUSTRATION OMITTED]

When seated in correct alignment, the upper body weight is directed onto the sitting bones, or ischial tuberosities of the pelvis, while the spine remains in neutral with its four natural curves intact and in proper relation to each other. Most people have difficulty sitting in correct alignment, partly because they are unaware of what constitutes good alignment, but also because their hamstrings are too tight and their torso muscles fatigue easily. All of these factors are correctable conditions. Additionally, many chairs are poorly designed, almost forcing us into bad posture. Using a small lumbar roll, or pillow, is very helpful in maintaining the proper lumbar lordosis, or inward lower back curve, when seated. When the lower back is properly supported, it is easier for the upper back curves to be in proper alignment, and it's more likely that upper body weight will be shifted onto the sitting bones, where it belongs (See photo #2). To practice low back pain prevention, teach your clients to modify their car seats, airplane seats, office chairs, easy chairs at home or any other place where they spend a lot of time sitting.

The Low Back Low Down: Pain Prevention

American Fitness, July, 2000 by Mary Yoke

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