Low back pain is not
considered a life-threatening disorder, though
many of the clients I trained in the past
lamented that they sometimes thought of death as
preferable to the excruciating and often
debilitating pain associated with low back pain.
You may be one of the many certified personal
fitness trainers that practice what you preach
and keep yourself in great shape. If so, you
have my congratulations, but fortunately for
you, you cannot fully appreciate the intensity
of the pain that causes people to become
physically inactive, creating a vicious cycle
leading to loss of functional capacity and
increased risk of major diseases such as
obesity, metabolic syndromes, cardiovascular and
cardio-respiratory diseases, osteoporosis,
and more. Eventually, the low back pain victim
pays a tremendous cost, not only physically and
financially, but also mentally, emotionally,
psychologically, and socially.
Exercise and
nutrition prescriptions are the best ways to
prevent low back pain. Unfortunately, life is
what happens when you are making other plans, and
many dedicated fitness enthusiasts have suffered
devastating injuries and diseases brought about
by circumstance beyond their control.
I had to
rehabilitate virtually every joint in my body
after being hit by a drunk driver. It was the
driver's 5th D.U.I., but even the
fact that he was caught did nothing to diminish
the pain I went through getting back in shape.
You may want to double check your "compassion meter" when you are dealing with clients with low
back pain, or any other painful dysfunction, and
try to develop some understanding of the
physical, mental, and emotional torment they
might be experiencing.
Once your client
receives medical clearance to exercise, start
with aerobic exercise. Research indicates that
aerobic exercise training hastens recovery after
a low back pain episode (LBP). Obesity,
particularly abdominal obesity, contributes to LBP by shifting the center of gravity and
increasing stress on the spine. If you are
thinking that losing some of the fat mass would
be helpful, you are correct! Educating your
clients on nutrition and healthy eating is
extremely helpful, but your client must focus on
losing FAT and hopefully maintaining or
preferably INCREASING MUSCLE.
Increasing muscle mass is essential to support
the spine to prevent, reduce or eliminate LBP.
Recommended aerobic
exercises are weight supported, non-impact
activities such as walking or cycling. Many LBP
sufferers may find recumbent bikes the most
comfortable. Contraindicated aerobic exercises
would be any impact type activities such as
jogging, running, rowing, stepping, etc. Impact
forces are measure in “G's” (Gravitational
Force). Depending on your client’s gait, stride
length, weight, economy of movement, and other
factors, “G’s” on any particular exercise mode
will vary. Approximations of the G’s on walking
are 1.1 – 1.4 G’s; jogging: 4.4; running: 7.7 or
more. If your LBP client is also physically
inactive and/or obese, the G’s from walking may
exceed their comfort zone, making the recumbent
bike or aqua exercise a better choice to
initiate their exercise program. Stepping or
step aerobic type activities can exceed 2 G’s
depending on the client and should not be used
in any initial LBP program.
LBP programs will
require safe and effective rehabilitation of the
injury, disability and/or dysfunction. Muscular
strength, muscular endurance, and flexibility to
increase joint ROM especially in the back, hips
and hamstrings will be critical components of
your rehabilitation program. All IFPA Certified
Personal Fitness Trainers are required to be
fastidious on the proper form and technique of
all exercise and fitness training.
Rehabilitation programs require the highest
level of attention to detail in all aspects of
fitness and exercise training. Performed
correctly, exercise can remedy much of what ails
your clients. Performed incorrectly, exercise
can greatly exacerbate back injuries.
Inappropriate exercises, exercise prescription,
exercise management, and/or improper technique
can have devastating consequences for your
client and your career. Stability exercises to
strengthen the spine stabilizers are an
essential part of the LBP program, but must be
performed correctly, safely, and effectively to
be of any benefit.
Exercise capacity
will not be directly altered by LBP, but it may
be impossible to accurately assess any of the 10
components of fitness, including aerobic
endurance, if exercise tolerance is limited by
pain. The IFPA recommends that a person
experiencing LBP not be tested for a least 4
weeks after the onset of pain, and an extensive
muscular warm-up before testing (15-20 minutes
of low intensity, non-impact aerobic exercise,
and gentle stretching of the affected area).
Assessment should include measures of joint
range of motion (ROM), muscular strength,
muscular endurance, flexibility, and aerobic
endurance, provided this can be accomplished
without pain. Because, lack of flexibility in the
back, hips, and hamstrings contributes to LBP,
assessment should include ROM of these muscle
groups. Maximal strength testing is
contraindicated during the acute phase after an
injury and may be contraindicated at any time
pain occurs. Remember IFPA Personal Fitness
Training rule #1: DO NO HARM! Use caution to
avoid hyperextension or twisting of the spine.
This article is in
two parts. Next week, part two, will consider
the exercise prescription for LBP. If you are
interested in a more in-depth study of the
exercise management for LBP or the numerous
other disorders that create the many special
population groups that are currently looking for
professional personal fitness trainers that have
the knowledge, skills, and abilities to safely and
effectively manage personal fitness training
sessions specific to their particular needs,
then please read the announcement below for the
release of the new IFPA Exercise Management
Certification Course.
I would also like to
take this opportunity to say hello to all of the
new friends of the IFPA from China. I felt
honored and privileged to share my knowledge of
sports medicine and exercise and nutrition
prescription with the many doctors and health
care professionals of China at the recent
American Academy of Anti-Aging Medicine
Conference in Hangzhou, China. I greatly
appreciated your kind words and compliments! I
am also grateful for your wonderful hospitality
in your beautiful city. I look forward to seeing
many of you again, next week in Las Vegas at the
American Academy of Anti-Aging Medicine
Conference (A4M), held at the Venetian. I will
be presenting the American College of Anti-Aging
Sports Medicine Professionals (ACASP) workshop
on December 5 & 6 for the A4M Conference
(December 5 – 10).
Best regards,
Jim Bell, PhD
CEO
James
T. Bell, PhD is the
founder and president of the International Fitness
Professionals Association, IFPA.
More
Books from Jim Bell, PhD
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