Exercise and Low Back Pain: Is it safe?

Over all the years that I have been working in the fitness and massage therapy industries, I have discovered that there is one all too common complaint that far outweighs any other: low back pain. It has been estimated that 80 % of the population will experience an episode of low- back pain sometime in their lives. Of these, 5% will go on to develop chronic low back pain (LBP), which accounts for 10% of all chronic health conditions in the US and 25% of days lost from work. LBP has been labeled as the most expensive benign health condition in America. Sounds scary, doesn't it?

While the cause of low back pain is not always clear, four common causes have been identified: a herniated disc (rupture of the outer layers of fibers that surround the gelatinous portion of the disc); spondylolisthesis (forward sliding of the body of one vertebra on the vertebra below it); a trauma to the back (accident); and degenerative disc disease (progressive structural degeneration of the intervertebral disc). Lower- back problems are often associated with an imbalance of strength and flexibility of the lower back and abdominal muscle groups. Poor flexibility in the hamstrings and hip flexor muscles also has been linked to LBP.

The question that many have asked me is this: "Since I suffer from low back pain, is exercise safe for me?" Without question, the answer is yes. Training programs will most likely have to be tailored for the person who suffers from low back pain, but more often than not, cessation of exercise or refusal to begin exercise can often be worsen the condition. This is because nothing is being done to treat the condition, at least not on the physical level, which often causes the pain to worsen.

It has also been shown that excess body weight, smoking, and decreased physical activity are all strong risk factors for LBP. Therefore, a carefully structured training program along with other healthy lifestyle changes is a sure fire way to combat chronic LBP. It has also been shown that low endurance in the large muscle groups, particularly the back extensors, seems to put one at a greater risk for developing LBP. Aerobic training and exercise for the low back should be performed on a regular basis as a part of the treatment and prevention of LBP.

If someone is suffering from a bout of chronic or acute LBP, he or she should be cleared by a physician before starting an exercise program. In addition to aerobic and resistance training, basic core back exercises should be performed on a regular basis. It is important for people suffering from LBP to avoid unsupported forward flexion of the spine, as well as twisting at the waist with turned feet, lifting both legs simultaneously when in a prone or supine position (facing downward or upward), and rapid movements such as twisting or hyperextension of the spine. Quite often, LBP is a result of weak abdominal muscles combined with chronically tight erector muscles of the low back. In this instance, a training program that includes consistent abdominal strengthening as well as flexibility training for the lower back is recommended. And here are a few other things to keep in mind:

1) Proper form and technique are very important, especially for people with LBP. It is always a good idea to hire a trainer at least for a few sessions to ensure that you are doing the exercises correctly.
2) A neutral pelvis and erect torso should always be maintained.
3) Head- forward positions should always be avoided, as well as tilting the chin upward.
4) When leaning forward, lifting or lowering an object, always bend at the knees.
5) The belly button should always be drawn inward toward the spine during resistance training. This is called the "supported" position.
6) Avoid locking the knees.
7) An emphasis should be placed on incorporating strength and flexibility exercises for the hamstrings, hip flexors, low back muscles, and abdominals.
8) People with LBP should consult with a physician before starting an exercise program and also request specific recommendations for exercise.
9) For clients with chronically tight lower back muscles, heat and deep- tissue massage are recommended.

There is no question about it; LBP is a chronic problem that affects millions. But it does not have to own us. It is a treatable condition. Time and again, research has shown that exercise can be extremely beneficial in the treatment of LBP, so don't let it stop you from achieving your goals of health and fitness. You have the power. You have control. Don't let LBP control you!

Michael Elder has been working as a fitness professional in Chicago for the last thirteen years. He comes from a background in gymnastics and is certified as a personal trainer through the American Council on Exercise (ACE). He can be contacted directly through his website, www.MichaelElder.com.