How Gyms Can Help Members Relieve Back Pain

IHRSA clubs view back problems as an opportunity to improve lives and increase activity.

If you or someone you know has suffered from back pain, you have a very good idea of how disturbing and debilitating it can be.

Anyone who’s experienced serious episodes of this widespread condition would do anything to put an end to it and prevent it from ever happening again.

As with so many other physical or medical maladies—from muscular weakness, to obesity, to heart problems—exercise, appropriately prescribed and professionally provided, can have a significant positive impact on back pain.

Like the global inactivity epidemic, back pain is both a monumental concern and, for health clubs, a major opportunity to assist those in need.

Today, for some club operators and sales reps, one of the most important questions to ask a prospect is simply: “Do you ever suffer from back pain?”

Fitness Programming Acac Training Column

Stretching can help prevent lower back pain.

A Global Concern: 540 Million Victims of Back Pain

The number of people afflicted with back pain and the damage it can cause are hard to imagine, let alone quantify.

The Global Burden of Disease Institute for Health Metrics and Evaluation (IHME), at the University of Washington, in Seattle, reports that back pain affects an estimated 540 million people worldwide at any point in time. And the American Chiropractic Association (ACA), based in Arlington, VA, notes that some 31 million Americans suffer from low back pain (LBP).

The IHME concludes that it’s the single leading cause of disability worldwide.

“Eighty percent of the population will experience at least one episode of low back pain during their lifetime that limits their activity,” says Gregory Degnan, M.D., the medical director at acac Fitness & Wellness, in Charlottesville, VA. “Around 5% of this group will go on to develop chronic problems, which will affect their quality of life and job performance.”

The ACA points out that back issues are one of the most common causes of absenteeism, and the second-most common reason for visits to a doctor’s office. A 2010 study by the National Institutes of Health (NIH) pegged the incremental cost of back pain-related healthcare at as much as $300 billion each year.

“And the NIH estimates that, when the consequences—lost work hours and wages, and decreased productivity on the job—are factored in,” says Degnan, “they total between $560 and $635 billion a year.”

Exercise as a Solution?

LBP represents something of a quandary for clubs. On the one hand, exercise provides proven benefits, but, on the other, when people are hurting, they’re understandably reluctant to exercise.

“People become afraid to move, fearing that doing so will cause more pain,” Degnan says. “As a result, the body’s core stabilizers weaken, and it becomes a self-fulfilling prophecy. That’s what we call kinesiophobia—an extreme fear of movement.”

Nevertheless, there is a pervasive problem, and exercise really can help.

“And the NIH estimates that, when the consequences—lost work hours and wages, and decreased productivity on the job—are factored in, they total between $560 and $635 billion a year.”

Gregory Degnan, M.D., Medical Director

acac Fitness & Wellness - Charlottesville, VA

“Of all the ailments we hear about during a sales presentation, back pain is number one—more prevalent than heart disease,” says Alan Leach, the CEO and director of sales and marketing at West Wood Club, based in Dublin, Ireland.

Leach, like other operators and fitness practitioners, recognizes that many exercise and training programs can help prevent or treat LBP by encouraging better posture, a stronger core, and improved flexibility.

But in order to wed the ailment to the industry’s solution, providers first must understand the problem thoroughly.

Starting at the Source of Back Pain

What causes back pain?

A 2017 survey ascertained that 29% of those dealing with the condition believe that it’s caused by stress, says Jacque Crockford, the exercise physiology content manager at the American Council on Exercise (ACE) in San Diego. “Other perceived causes noted were weak muscles, not enough exercise, physical work, overweight, and sitting too much at work.”

There are a number of different types of back pain, including:

  • Musculoskeletal back pain (also called lumbago), without structural problems or nerve involvement;
  • Mechanical back pain, which is related to structural issues in the bony anatomy of the spine, such as, for example, arthritis and joint inflammation;
  • Nerve pain (radiculopathy), which has to do with bulging, herniated, or degenerative discs that can produce back pain, back and leg pain, or just leg pain;
  • Lumbar stenosis, a condition related to joint arthritis and degenerative discs in the back.

Back pain also is described as being either chronic or acute with respect to all of these subdivisions.

Applying What Fitness Industry Knows to Help

What sort of treatment is recommended?

Well, at the moment, there’s a lot of intelligent, well-informed, and well-intentioned discussion ... but no definitive conclusion.

“There’s been a big move towards using functional training and reconditioning to treat affected patients,” says Degnan. “However, there’s very little consensus in the literature about what works best.”

Treatment modalities, he explains, vary widely, and may include activity modification/bed rest; pharmaceuticals; traditional physical therapy; surgery; or, more recently, exercise programs aimed at generalized conditioning, flexibility, and core strengthening.

General exercise is just as effective in treating LBP as the motor-control exercises that are often prescribed by medical professionals, concluded a study conducted recently by the National Strength and Conditioning Association (NSCA), based in Colorado Springs, CO. An article detailing the results, published in the NSCA Personal Training Quarterly, counsels that fitness providers shouldn’t hesitate to make use of general exercises tailored to an individual’s ability, medical profile, and personal goals.

But, Crockford cautions, any client who’s dealing with back pain should be cleared by a medical professional before embarking on an exercise program.

“Once they’ve been cleared by a physician or physical therapist, it then becomes appropriate for a certified professional to recommend exercises, such as light stretching, and core strengthening, including for the glutes,” she says. “Back issues come in many forms, so, when recommending exercises, make sure that they take the client’s current level of fitness and pain into account.

“If someone’s in pain, referring them to a medical professional is the correct first step.”

Understand Prevention Tactics

Fitness Programming Acac Training Yoga Column

Yoga positions can help relieve back pain.

How can members avoid back problems in the first place?

Degnan offers a sound prescription—they should maintain a proper body weight, work on the flexibility of their spine and hamstrings, strengthen their core, and employ the proper weight-lifting mechanics. “Unfortunately, there’s a common misconception that this means ‘strong abs,’ which leads to an over-emphasis on the classic abdominal exercises, many of which can, in fact, exacerbate the difficulties. Generalized core conditioning is much more productive than the common focus on the rectus,” he says.

“For example, plank position exercises are safer and more effective than crunches.

“It’s also important to focus on core contraction and stabilization during all resistance training exercises.” Depending on the type of LBP issue involved, glute strengthening and rotational exercises may be recommended, adds Crockford. Strengthening the core and glutes can improve back health by stabilizing the lumbar spine. “Also, by lengthening the hip flexor group, we can reduce the stress put on the attachment sites of these muscles, which is the low back,” she explains. “Conversely, exercises that may be contraindicated are hyperextension, rotation with forward flexion, or those with too much additional load.”

Practices such as meditation, tai chi, and yoga, which reduce stress and improve flexibility, have also been shown to ameliorate back issues.

IHRSA Clubs Respond with Programming

Fitness Programming West Wood Trainer Column

Carol Vilela, an injury specialist at West Wood Club, helps a client.

Individual IHRSA clubs approach LBP programming in a variety of ways. Stephen Capezzone, the CEO of Healthtrax International, based in Glastonbury, CT, prefers regular, one-on-one interactions with a fitness professional that are specific to the individual’s needs. “The members who work with a trainer regularly report having fewer problems and obtaining relief more quickly than those who try to correct things on their own,” he says.

“We employ proper stretching and exercises that strengthen the core,” says Gary Kendig, the COO of Healthtrax, “along with gentle yoga, Pilates, and aquatic fitness classes that, while addressing the issue of back pain, also help maintain overall conditioning and well-being.”

The right training protocol is critical, and so, too, is hiring the right fitness professional.

“In addition to selecting the finest candidates, based on their education, background, and industry experience, we also make use of a series of practical interviews,” Kendig says. “They include hypothetical case studies and role playing that often involves scenarios related to mobility, injuries, chronic pain, and post-op recovery.”

“The right training protocol is critical, and so, too, is hiring the right fitness professional.”

At Healthtrax, personal trainers receive additional instruction on postural assessment and stretching protocols. This helps them to identify pain triggers, and prepares them to develop a progression of exercises to create a foundation for pain-free activity.

At the West Wood Club, “All trainers are presented with scenarios at the interview/recruitment stage, and are asked to design a specific program for imaginary clients who have issues such as back pain,” Leach explains.

Fortunately, today, his clubs are attracting more qualified personnel. “Many trainers come to us with full sports science degrees, rather than just a three-month fitness instructor certificate,” he reports. “This high educational standard makes it easier for us to help members with back problems.”

Striving for thoroughness, the clubs utilize an on-boarding system that gives new members six free sessions of personal training. “This works really well,” says Leach. “The first session is a 45-minute pre-workout consultation, during which an in-depth medical history questionnaire is gone over in detail. Any new member who alerts us to back problems is immediately transferred to one of our sports scientists, who creates a customized program based on their back issues.”

Leach, one of the industry’s foremost experts on sales and marketing, notes that LBP doesn’t necessarily stop a prospect from joining, and, if the topic is handled properly, can actually prompt a person to do so.

“In my 30 years of selling fitness, the question ‘Do you suffer from any back problems?’ has been one of my most powerful and productive sales tools,” he says.

Leach, who conducts the sales training for all of the West Wood Club, now devotes a full day to “selling the medical problem.”

“If you can sit with a potential member and explain, professionally, how your programs can help relieve or cure this common problem, a sale is practically 100% guaranteed,” he says.

Related Articles & Publications