The management of low back pain

Four out of five adults say they’ve suffered from low back pain at some point in their lives and the costs of managing this, both in terms of medical treatment and time-off sick, runs into billions of pounds. Julian Berriman investigates how exercise can help…

Low back pain prevalence and cost According to Health Executive figures (2005/2006), 3.7 million working days a year are lost through episodes of back pain. More than £1 billion of public money is spent by the health service each year on costs relating to back pain, with a further £565 million spent within the private sector (Maniadakis and Gray, 2000).

Yet most cases of back pain are non-specific and cannot be attributed to any serious pathology (according to Airaksinen et al, 2006, specific causes of low back pain are less than 15%) putting us, as fitness professionals, in a great position to help the remaining 85% manage the symptoms of this relatively benign condition.

A change in emphasis Several authors have concluded that in the treatment of on- going low back pain, there has been too much focus on pain as evidence of an injury or some structural/biomechanical fault with the spine (Waddell, 1993).

This can have a negative impact and lead individuals to adopt passive coping strategies – if someone is told there is something physically wrong with their back they may develop the belief that they need to avoid particular activities because these will further exacerbate their structural/biomechanical fault, and believe rest is a sensible option.

The way forward and the opportunities… Under the biopsychosocial model (relating to the health outcomes affected by biological, psychological, and social factors) decreasing pain levels will only help people avoid

16 TheThe REPS Journal 2009;00(Month):00-00 REPs Journal 2010;19(December):16-18