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Exercise for Chronic Low Back Pain

Advanced Fitness Instructors can help back pain sufferers to take back some control of their lives through a range of exercises that will increase fitness and the confidence to exercise further.

Ben Jane

on 26 November 2012

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Transcript of Exercise for Chronic Low Back Pain

Exercise for
Chronic Low Back Pain Core stability Biomechanics ADLs Psychosocial Screening techniques Anatomy motivation Screening Cardiovascular Resistance Lifestyle Guidelines 1. Exercise Daily
2. Tehnique is key
3. Exercise should not exacerbate back pain
4. Avoid spine bending after rising from bed
5. No set of exercises is ideal for all individuals
6. Be patient and stick with the programme Use the core to resist movement rather than create it. Further Reading http://www.nasm.org/uploadedFiles/1/CES_II/NASM_CES_LPHC.pdf www.benjanefitness.com Sports Therapy Rehab to
Performance Stage 1: Groove motion patterns
Stage 2: Build whole body & joint stability
Stage 3: Increase Endurance
Stage 4: Build Strength
Stage 5: Develop speed, power and agility UCP Marjon Back Gym 4 years, ~300 participants
6 weeks intensive group (8-18)
3-5 staff
Ongoing support & assessment
Education, walking, gym, sports therapy, pool, home-based exercises Pathophysiology What's going on? Red Flags Type of Exercise Water-based Walking speed
arm swing
nordic poles
rucksacs & rough ground Weight Loss
Rythmical Core stabilisation More reps, less weight to improve endurance General Guidelines Epidemiology Panjabi, 1992 ACTIVE CONTROL PASSIVE Nerves Muscles Bones Assessment Squat
Single leg stance
Passive single leg raise
Active single leg raise Why assess? see BHF toolkit for general advice CNSLBP...changes in the brain... Local Stabilisers See Red flags Low Back Pain Specific:
Known origin Non-Specific:
No Known origin Chronic: Progressive
> 3months &/or recurring Sub-acute: Sudden
6 weeks - 3months Acute: Sudden
< 6 weeks Sleeping Lifting Nutrition Static work postures – prolonged trunk flexion
Seated work postures
High spine rotation/movement velocity
Frequent lifting, pushing, pulling
Vibration exposure
Rapid Ballistic loading -Slips/falls
Repeated lumbar flexion
Time of day
Insufficient loading (decrease in strength) Risk Factors Myths All psychological if undiagnosed
Increase the flexibility
Strengthen the muscles
Lots of sit-ups Sitting is beneficial (Nutter, 1988) Diary-keeping Avoid Inactivity Don't hold the plank for longer than ~30s...change the exercise Hip Hinge >3300N!!! Multifidus Extensors Transverse
Abdominus Global Stabilisers Global Mobilisers Psoas Rectus
Abdominus Iliocostalis
Lumborum Latissimus Dorsi Gluteus
Medius 60-85% of people will have Back Pain at some point Over 80% report recurring incidence 80-90% recover in 6 weeks 5-15% develop Chronic Low Back Pain Highest prevalence amongst 40-60 year olds see Liddle & Bombardier for backs Thoracic pain
Fever and unexplained weight loss
Bladder or bowel dysfunction
History of cancer
Ill health or presence of other medical illness
Progressive neurological deficit
Disturbed gait, saddle anaesthesia
Age of onset <20 years or >55 years Yellow Flags ...pyschosocial factors indicative of potential long term disability:
A negative attitude that back pain is harmful or potentially severely disabling
Fear avoidance behaviour and reduced activity levels
An expectation that passive, rather than active, treatment will be beneficial
A tendency to depression, low morale, and social withdrawal
Social or financial problems Back specific function:
Generic health status:
Work disability:
Satisfaction with care/treatment outcome: Roland–Morris/Oswestry.
Body Pain Scale of SF-36/Chronic Pain Grade (optional).
days off work/work status/time to return to work.
Patient Satisfaction Scale Assessing Impact of Condition Functional/Diagnostic Assessments Chester Step Test
Grip Strength
Body Composition General Fitness Assessments Summary Confidence Building to overcome fear avoidance
Sound exercise principles
Maintain spinal alignment
Core Activation
Holistic Approach McGill, 2009 Single-leg squats? Front Squats Deadlifts from box or using dumbells Vary Stroke used
Avoid Breast stroke
Progressive aqua exercises Flexibility Hamstring/Hip Flexors
Upper Back
Whole body approach PARQ Afferent Efferent Repeated flexion necessary to cause herniation Thousands of cycles required Prolonged sitting increases risk Tend to occur in younger spines Location of herniation linked to dominant loading Avoiding Disc Herniation Twisting damages discs Train the core to resist movement prior to producing movement McGill's Big 3... Birddog
Side Plank
Adapted Curl Spondylolysis -
Spondylolisthesis -
Pars Interarticularis fracture -
Ankylosing Spondylitis -
Spinal Stenosis -
Scoliosis -
Disc Herniation - Social/ Environment Illness Behaviour Psychological ???? Attitudes & Beliefs Pain (McGill, 2007) (McGill, 2007) (McGill, 2007) Walking Posture
Function, fitness Backpacks
Fast Walking (Nutter, 1988, McGill, 2007) (Koes, 2006)
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