Active IQ Level 4 Certificate in Physical Activity and Lifestyle Strategies for Managing Low Back Pain (sample manual)

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Section 1: The classification and prevalence of low back pain Defining low back pain Section 1: The classification and prevalence of low back pain Low back pain (LBP) can be defined as pain, muscle tension or stiffness localised below the costal margin and above the inferior gluteal folds, with or without leg pain (sciatica) (van der Heijden et al, 1991). Low back pain is classified as acute when it persists for less than 12 weeks (Bigos et al, 1994). Some researchers have further sub-classified acute low back pain of less than 12 weeks’ duration into acute (
Section 1: The classification and prevalence of low back pain increase in activation of other muscles, including the external oblique, rectus abdominis and hamstrings (van Dieen et al, 2003; Silfies et al, 2005). This alteration in recruitment patterns can modify movement patterns and control of the spine and pelvis. This alters the load distribution through the spine, sacrum and pelvis causing an increased irritation to spinal structures leading to LBP (van Dieen et al, 2003; O’Sullivan, 2005). The pelvic floor muscles have also been shown to influence pelvic alignment and pelvic mechanics (Bendova et al, 2007). Evidence suggests that people experiencing pain in the sacroiliac joints (SIJ) of the low back have altered recruitment of the pelvic floor muscles (O’Sullivan et al, 2002). Other possible causative factors associated with functional movement and alignment have been identified in other parts of the body. For example, some evidence suggests that a lack of functional movement of the first metatarsophalangeal joint (MTP joint) affects hip and pelvic motion. This may lead to increased activation of the psoas muscle, altered pelvic positioning (anterior tilt) and increased hamstring activation through a stretch reflex. All of which can influence the pelvis, sacrum and lumbar spine and alter forces placed upon the low back (Dananberg, 1997). Hyperpronation of the feet has also been shown to increase the anterior rotation of the pelvis (Khamis and Yizhar, 2007). An anteriorly rotated pelvis is associated with increased lumbar spine lordosis (an arch in the low back), which can alter forces placed upon the discs, tissues and joints of the low back (Niosi and Oxland, 2004). It is therefore likely that altered movement and alignment of the foot can affect the joints of the hips and low back, placing increased mechanical load on these tissues, and possibly contribute to LBP. This necessitates observing a client’s movement and alignment prior to exercise interventions. Asymmetrical alignment and movement of the pelvis has been linked with low back pain. When the pelvis is asymmetrical in the frontal plane (lateral asymmetry), or the ilia are rotated in the transverse plane, it can alter the mechanics of the spine and pelvis. Individuals with an asymmetrical pelvis and LBP have shown a compensated movement pattern when sitting and standing; it has been suggested that movement quality and not range of motion may be a better indicator of altered function in this population (Al-Eisa et al, 2006). Psychosocial factors Psychosocial factors have recently become a major topic of discussion concerning low back pain. There are a growing number of studies that show an association between psychosocial factors and LBP (Linton, 2000; Schur et al, 2007; Leboeuf-Yde et al, 2008). Please refer to the discussion of the psychosocial components of LBP in unit 2. Figure 1.2 illustrates a simplified progression of a possible route to chronic back pain. Any of the steps shown can be re-configured and may be different based upon each individual. Genetic predisposition may lay the foundation for possible onset of an LBP episode, especially combined with mechanical loading beyond an individual’s capacity (assuming no structural abnormalities exist). This overload/pain can alter muscle recruitment and alignment (or result from altered recruitment and alignment). Alterations in recruitment and alignment can lead to abnormal movement patterns, perpetuate abnormal stress to the tissues of the spine, and prolong pain or lead to recurrent episodes of pain. Anxiety, depression, poor coping strategies and emotional issues can further affect the pain and healing cycle and sustain the recurrence of LBP. ALTERED muscle recruitment GENETIC predisposition MECHANICAL loading beyond capacity PSYCHOSOCIAL factors ACUTE/SUB ACUTE CHRONIC 12 | Copyright © 2017 Active IQ Ltd. Not for resale Figure 1.2 Example progression of non-specific low back pain
Page 1: Manual Level 4 Certificate in Physi
Page 5 and 6: Section 1: Factors that contribute
Page 7 and 8: Section 2: Anatomical and neurologi

Active IQ Level 4 Certificate in Physical Activity and Lifestyle Strategies for Managing Low Back Pain (sample manual)

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