1. Low Back Pain Joe Sweeney

2. Overview Lower back anatomy Sign/symptoms and risk factors for low back pain Common lower back injuries Training individuals with lower back pain

3. Lower back Anatomy Lumbar Vertebrae, L1-L5 Intervertebral Discs Spinal Nerves

4. Lower Back Pain Facts Avoid prolonged bed rest and return to normal ADL (Exercise, 2004) Increase with age Low back pain in childhood typically proceeds into adulthood In most cases, want to avoid surgery Effects men and women the same (Low Back, 2015)

5. Lower Back Pain Facts Low back pain is most common workplace injury 80% of adults will have an episode of low back pain (Back Pain, 2015) 31 million Americans experience low back pain in a year Low back pain results in $50 Million dollars a year in medical expenses

7. Signs and Symptoms Pain can range in intensity, duration, and frequency Radiating pain Numbness Lower extremity weakness Decreased flexibility Difficulty sleeping Difficulty with weight-bearing activities or certain movements and positions (Ehrman,2013)

8. Risk Factors Obesity Smoking Genetics Age Sedentary lifestyle Heavy lifting and poor posture (Metcalf, 2015)

9. Acute vs Chronic Low Back Pain Acute  Pain lasts 4-12 weeks  Heals on its own  No lasting pain or impairment Chronic  Pain lasts more than 12 weeks (Low Back, 2015)  Pain is persistent

10. Acute vs Chronic

11. Common Low Back Injuries Muscle soreness Spinal stenosis Ankylosing spondylitis (Ehrman, 2013) Lumbar radiculopathy (Low Back, 2015) Sciatica Degenerative Disc Disease Herniated disc

12. Sciatica Sciatic Nerve What Sciatica does Can be caused by a herniated disc or spinal stenosis Piriformis syndrome (Piriformis, 2015)

13. Herniated Disc (Herniated Disc, 2014)

14. Degenerative Disc Disease (Nordqvist, 2014)(Bohinski, 2015)

15. Diagnosis and Exercise Testing Medical History Evaluation Physical Exam (Ehrman, 2013) ACSM recommends low back pain can be tested in the same way as healthy individuals. ACSM recommends if other comorbidities are present then testing should follow guidelines for that comorbidity.

16. Exercise Prescription: Cardiovascular Training No direct positive effect on low back pain ACSM guidelines should be followed Safe Cardiovascular Exercises: Walking, Swimming, Elliptical machines Avoid jogging, biking.

17. Exercise Prescription: Resistance Training Weak core muscles Avoid loading spine Good Exercises: crunches, side planks, BW good mornings, lunges, Lat pulldowns. NCHPAD -Age under 50 10-15 reps /day -Age above 50 8-12 Reps/ day for 2 or more days/week -Strengthening core -Stabilizing trunk

18. Exercise Prescription: Flexibility Balance of back flexion and extension stretches Include hip, hamstring, and quadriceps stretches as well

19. Case Study My client is a 48 year old male who lives a sedentary lifestyle and is a regular smoker. He has had occurrences of acute low back pain in the past. He has recently been experiencing constant and sharp pain in his lower back. The pain radiates down to his upper leg, and was brought on by doing continuous heavy lifting at his job.

20. Risk Stratification My client is at a moderate risk level because he is a male over 45 with 2 risk factors. The risk factors are a sedentary lifestyle and smoking.

21. Diagnosis Past history of back pain Lack of flexibility, sharp pain, and muscle weakness Herniated disc, which led to sciatica Prescribed ketoprofen (Low Back, 2015)

22. Exercise Testing: Cardiovascular Testing

23. Exercise Testing: Muscular Endurance and Flexibility

24. My Exercise Prescription: Cardiovascular Training DayExerciseTime MondayWalking on treadmill45 mins WednesdaySwimming exercises30 mins FridayElliptical machine30 mins SaturdayWalking on treadmill60 mins

25. My Exercise Prescription: Resistance Training DayExerciseRepsSets TuesdayLunges holding dumbells103 Body weight box step-ups123 Leg extension machine153 Calf raises153 Crunches103 ThursdayBench Press103 Lat Pulldowns103 Hammer curls153 Tricep close-grip bench press123 Side plankshold for 20 secs3

26. My Exercise Prescription: Flexibility Training Hip Flexor Hamstring Piriformis Back ExtensionBack Flexion

27. Conclusion Take care of yourself! Spread awareness Proper lifting techniques and posture

28. References ACSM Issues New Recommendations on Quantity and Quality of Exercise. (2015). Retrieved November 7, 2015. from http://www.acsm.org/about-acsm/media-room/news-releases/2011/08/01/acsm-issues-new- recommendations-on-quantity-and-quality-of-exercise Are You Sitting Down? (Stretches for Hip Flexibility). (2015, February 23). Retrieved November 8, 2015, from http://victoryfitnesscenter.net/sitting-at-a-desk-you-need-these-stretches/ Back Pain Facts & Statistics. (2015). Retrieved November 9, 2015, from http://www.acatoday.org/level2_css.cfm?T1ID=13&T2ID=68 Blahd, W., & Riggs, J. (2014, June 4). Proper Lifting Technique. Retrieved November 9, 2015, from http://www.webmd.com/back-pain/proper-lifting-technique Bohinski, R. (n.d.). degenerative disc disease (spondylosis). Retrieved November 7, 2015. from http://www.mayfieldclinic.com/PE-DDD.htm#.Vj_Ran6rTIW Ehrman, J., Gordon, P., Visich, P., & Keteyian, S. (2013). Nonspecific Low Back Pain. In Clinical Exercise Physiology (Third ed., pp. 461-482). Champaign, Illinois: Human Kinetics. Exercises For SciaticaHamstring Stretching Exercises For Sciatica Pain Relief. (2014, October 30). Retrieved November 8, 2015, from http://exercisesforsciaticapuhnesh.blogspot.com/2014/10/hamstring- stretching-exercises-for.html Exercise Prescription for Healthy Populations with Special Considerations and Environmental Considerations. (2004). In L. Pescatello (Ed.), ACSM's Guidelines for Exercise Testing and Prescription (Ninth ed., pp. 211-214). Philadelphia, Pennsylvania: Wolters Kluwer Fitzgordon, J. (2015, June 1). Compressing The Lumbar Spine All Day Long. Retrieved November 7, 2015. from http://corewalking.com/compressing-the-lumbar-spine-all-day-long

29. References Green, J. (2015). Exercise Guidelines for Clients with Lower Back Pain : NCHPAD - Building Inclusive Communities. Retrieved November 8, 2015. from http://www.nchpad.org/887/5010/Exercise~Guidelines~for~Clients~with~Lower~Back~Pain Herniated Disc. (2014, July 1). Retrieved November 8, 2015. from http://www.aans.org/patient%20information/conditions%20and%20treatments/herniated%20disc.aspx Kosmahl, E. (2015). Orthopaedic: OBJECTIVE CLINICAL EVALUATION OF PHYSICAL IMPAIRMENT. Retrieved November 8, 2015. from http://www.scranton.edu/faculty/kosmahl/courses/ortho/lecturenotes/pages/obj-clin-evalu-w2.shtml Low Back Pain Fact Sheet. (2015, November 3). Retrieved November 7, 2015. from http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm Low Back Pain in Asheville. (2010, July 13). Retrieved November 7, 2015. from http://www.biltmoreparkchiropractic.com/tag/herniated-disc/ Metcalf, A. (2014, May 13). Back on Track – Understanding and Preventing Back Pain. Retrieved November 9, 2015, from https://www.fix.com/blog/avoiding-back-pain/ Nordqvist, C. (2014, September 26). What is degenerative disc disease? Retrieved November 7, 2015. from http://www.medicalnewstoday.com/articles/266630.php#what_is_degenerative_disc_disease Piriformis Syndrome. (2015, February 9). Retrieved November 8, 2015, from http://shawchiroandsport.com/piriformis-syndrome Quinn, E. (2015). The Bruce Treadmill Test Protocol. Retrieved November 8, 2015, from http://sportsmedicine.about.com/od/fitnessevalandassessment/a/Bruce_Protocol.htm Schierling, R. (2012). Disc Degeneration. Retrieved November 7, 2015. from http://www.spinaldecompressionmissouri.com/blog/tell-me-more-about-degenerative-discs Sciatica Exercises. (2011, January 20). Retrieved November 8, 2015, from http://spinalstenosis.org/blog/sciatica-exercises Von der Muhll, A. (2014). Getting cardio exercise--even when you have neck or back pain. Retrieved November 7, 2015. from http://www.santacruzacupunctureclinic.com/neck-pain/64 Witte, A. (2015). Treatment Options in Managing Chronic Low Back Pain. Retrieved November 9, 2015, from http://www.uspharmacist.com/continuing_education/ceviewtest/lessonid/107595/#tbl1