Low back pain

Low back pain (LBP) is pain, muscle tension or stiffness below the rib margin and above the gluteal folds, with or without pain radiating into the leg.^{1Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 416.} Reported lifetime prevalence reaches 84%, and about 20% of cases become chronic.^{1Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 416.} More than 85% of cases are nonspecific, with no known structural cause.^{1Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 416.} ACSM classifies LBP as acute under 6 weeks, subacute from 6 to 12 weeks and chronic beyond 12 weeks.^{1Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 416.}

Diagnosis and treatment fall outside most exercise professionals’ scope of practice and require a licensed health care provider.^{2Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 423.} When LBP signals another serious condition, such as cancer, plan exercise with the health care team managing it.^{3Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 420.}

In practice

• Keep clients active within pain limits and avoid bed rest.^{4Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 417.} Encourage an early return to normal activity even while some pain remains.^{3Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 420.}
• Walking is a starting point.^{2Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 423.} ACSM suggests a symptom zone of 3 to 5 out of 10 pain, or 9 to 14 on the Borg RPE scale.^{2Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 423.}
• Limit exercises that spread pain into the legs.^{5Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 424.}
• Progressive aerobic and resistance training reduce chronic LBP pain about equally.^{2Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 423.} Evidence doesn’t favor one approach, so let client preference and practitioner expertise guide exercise choice.^{6Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 425.}

Activity during acute flare-ups

IPTA advises trainers to stop all exercises during an acute flare-up and require a brief rest.^{7International Personal Trainer Academy, Certified Personal Trainer Textbook, p. 455.} ACSM recommends ordinary activity within pain limits and no bed rest.^{4Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 417.} It does allow that avoiding exercise for the first few days after an acute, severe episode may be best.^{8Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 422.}