Dorsalgia: Back Pain and the Personal Training Client

Back pain, also known as dorsalgia, affects a considerable number of adults each year, ranking as the second most common complaint to physicians. Nearly 16 million adults — 8% — experience persistent or chronic back pain, curtailing many everyday activities. Over two million adults suffer permanent pain/disability. As the sixth most expensive medical condition in the United States, direct and indirect back-related healthcare costs can run over $12 billion per year.

Dorsalgia, one of the most common skeletal muscle syndromes, refers to pain in the back and includes sciatic pain but excludes discomfort relating to scoliosis or lordosis. This painful condition often develops with age, particularly affecting those with a variety of comorbid conditions.

Viewing the Back from Different Perspectives

Healthcare practitioners offer differing views on the origin of back problems as well as the optimal course of treatment. Orthopedic surgeons point to disc problems, whereas chiropractors focus on the alignment of the spinal column. Physical therapists tend to treat the muscles and tendons surrounding the spinal column, often applying electrostimulation or heat to the erector spinae/upper hip muscles, or try to stretch/strengthen the muscles to regain proper alignment for pain relief.

Risk Factors for Back Pain

The following have shown a preponderance for increasing the risk of dorsalgia:

• Deconditioning with Age ~  Sadly, this can begin to occur as early as one’s 30’s or 40’s, depending upon activity 
• Lack of Exercise ~  Leads to weakened back and/or abdominal muscles
• Excess Body Weight
• Comorbidities 
• Poor Body Mechanics/Posture
• Psychological Conditions ~  Depression, anxiety, and stress all pose a threat to tension/back pain; conversely, patients with long-term dorsalgia often develop the aforementioned symptoms 

Movement in Real Life

The field of ergonomics studies an individual’s efficiency in his or her working environment as well as Activities of Daily Living, or ADLs. To that end, professionals have long considered the back and its functions in the workplace. Many changes have been made to help alleviate or even thwart pain issues, including the “back belts” loosely worn by cashiers to provide additional support. 

Exercises for Strengthening and Stretching the Back

The back plays an integral role in the complex system which enables the body to move. This system includes hamstrings, gluteal, hip stabilizers, flexors, and abdominals. Overactive hamstrings and weak abdominals often pose the greatest threat to back injuries. When attempting to stretch or release the hamstrings, trainers can advise clients of the following: 

• Start with an SMR technique to calm down the neuromuscular activity
• Ease into the stretch slowly/refrain from bouncing the stretch
• Hold a mental visualization of isolating the tendons and muscles 
• Maintain the stretch at least 30 seconds 
• Allow the body to experience a “slight discomfort zone”, not a pain zone 

The lower back can stretch sideways, in a rotary fashion, and straight back/forward. While sitting on the floor or in a chair, bend trunk forward and grab the ankles, keeping elbows outside of the knees. Pull forward until you feel a gentle stretch if gravity alone isn’t enough, and slowly exhale.

While seated, reach one arm to the opposite knee (outer edge) and gently twist to the opposite side while looking over the shoulder; try to grab the back of the chair with the other arm and breathe out. 

The Glutes and Abs Challenge

Trainers often find the gluteal muscles a bit more difficult to stretch. While lying flat (or sitting), cross legs such that the right ankle bone rests on the left thigh. Place hands under the thigh/ankle position and slowly pull toward torso. Hold the stretch for at least 30 seconds. Repeat with the other leg. 

Often abdominals/obliques get involved in most back strengthening programs. If a trainer overemphasizes ab movements, they inadvertently neglect the hip flexors, also key components for back stability. Some variation of leg raises will target both the upper hip and lower abdominal regions. Try doing an exercise called the windmill: bend from the waist 90 degrees, with feet shoulder-width apart, and reach to each side with a full twist of the torso. 

Strategies for Back Pain Relief

If dorsalgia persists, individuals may have to examine aspects of their current lifestyles. The following may offer some back pain relief:

• Wear comfortable, low-heeled shoes, that preferably allow for movement in the toes.
• When standing for long periods, rest a foot on a low stool or raised surface. Also, try periodically bending backward with hands on hips.
• When driving long distances, place a pad or pillow behind the small of the back. Take rest breaks and walk around for a few minutes.
• “Back sleepers” can try placing a pillow underneath the knees; for “side sleepers”, experts encourage the fetal position.
• For extended computer work, have a chair that supports the lower back and allows for feet to plant fully on the floor.
• Swimming, walking, road/stationary cycling, Elliptical Trainer and moderate rowing may help to alleviate discomfort while strengthening the back.

Use It or Lose It

Muscle deconditioning, poor posture, and improper body mechanics all rank among the most common causes of chronic back pain. Muscle deconditioning occurs when back muscles lack the strength and stability to properly support the body and maintain alignment, leading to wear and tear over time.

In the short-term, modifying activities can facilitate healing. However, too little exercise (or overly “erring on the side of caution”) leads to muscle weakness and atrophy, rendering the back muscles unable to provide their usual level of support. This makes one prone to injury and pain. Movement remains the best treatment for any chronic back pain, including dorsalgia. 

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References

1. 1. U.S. Department of Health and Human Services. Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2002. Vital and Health Statistics Series 10, No. 222 [DHHS Publication No. (PHS) 2004-1550]. Hyattsville, MD, 2004.
   2. Nachemson A. Epidemiology and the economics of low back pain. In: Herkowitz HN, et al, eds. The Lumbar Spine, 3rd ed. Philadelphia: Lippincott, Williams & Wilkins, 2004:3–10.
   3. https://www.la-tour.ch/en/advices/what-difference-between-back-pain-cervicalgia-dorsalgia-low-back-pain-lumbago-and-sciatica#:~:text=The%20different%20types%20of%20back,pain%20in%20the%20lower%20back.
   4. https://pubmed.ncbi.nlm.nih.gov/30347825/
   5. https://pubmed.ncbi.nlm.nih.gov/33346438/
   6. https://pubmed.ncbi.nlm.nih.gov/15554142/
   7. https://www.mayoclinic.org/diseases-conditions/back-pain/symptoms-causes/syc-20369906
   8. https://www.healthpartners.com/blog/common-causes-of-chronic-back-pain/#:~:text=Muscle%20deconditioning,wear%20and%20tear%20over%20time.
   9. https://hpi.georgetown.edu/backpain/
   10. https://pubmed.ncbi.nlm.nih.gov/12117121/