“Health and fitness professionals are unlikely to achieve results with the low back pain sufferer unless they can both assess and deal with any psychosocial influences and the underlying reasons for them. “

As the health and fitness profession attempts to engage with the medial community and to be seen as a credible partner in addressing a variety of public health issues it will be key that we show that exercise and activity planning is underpinned by sensitive and appropriate communications or soft skills. In the area of low back pain management at least, an understanding of the biopsychosocial approach will be central to this.

Final note: Read the National Institute for Health and Clinical Excellence guidelines for the ‘Early management of persistent non-specific low back pain’ (2009) at www.nice.org.uk – which, places exercise within a biopsychosocial approach at the heart of low back pain management.

References: 1. Airaksinen O., Brox J.I., Cedraschi C., Hildebrandt J., Klaber- Moffett J., Kovacs F., Mannion A.F., Reis S., Staal J.B., Ursin H., Zanoli G.; On behalf of the COST B13 Working Group on Guidelines for Chronic Low Back Pain. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006 Mar;15 Suppl 2:S192-300

2. Loeser J. (1996). Back pain in the workplace II. Pain, 65:7-8 3. Maniadakis N. and Gray A. (2000). The economic burden of back pain in the UK. Pain, 84(1):95-103 4. Moseley G.L., Nicholas M.K., Hodges P.W. (2004). Does anticipation of back pain cause back trouble? Brain, 127:2339- 2347 5. Taylor D. and Rose M. (1997). Psychophysiological and psychological techniques for the treatment of low back pain. In: Adams N (ed) The psychophysiology of low back pain. Churchill Livingstone, New York 6. Waddell G. (199e). Biopsychosocial analysis of low back pain. Clinical Rheumatology, 6:523-557 7. Watson P.J. (2000). Psychosocial predictors of outcome from low back pain. In: Gifford L.S. (ed) Topical issues in Pain 2. Biopsychosocial assessment and management. Relationships and pain. CNS Press, Falmouth. P.85-109 8. Zusman M. (2004). Structure-orientated beliefs and disability due to back pain. In: Gifford L.S.(ed), Topical Issues in Pain 1. CNS Press, Falmouth. P.111-129.

THE AUTHOR

Julian is Director of Research and Development at Premier Training International and authored the Level 4 Certificate in Exercise for the Management of Low Back Pain first launched in

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18 Q2 October 2008. He is also a practising osteopath.

ANSWER THE FOLLOWING QUESTIONS ONLINE TO EARN CPD POINTS Please login to the members area of the REPs website to give your answers

Q1

The biopsychosocial approach: (a) Focuses on a structural fault with the spine (b) Supports a passive approach to low back pain management (c) Supports an internalised locus of control

An active approach to low back pain management would include: (a) Engaging in regular physical activity (b) Depending solely on physical therapy for resolution (c) Depending solely on pain relieving medications for resolution

Under the biopsychosocial approach which is considered more important: (a) Pain (b) The reaction of the individual to the pain (c) The structure causing pain

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