Low back pain is the leading cause of disability globally. In 2020, according to the World Health Organization (WHO), it impacted around one in 13 people, equating to 619 million people. This is an increase of 60 per cent from 1990 and cases are expected to rise to an estimated 843 million by 2050.
Low back pain (LBP) affects life quality and is associated with co-morbidities and higher mortality risks. Individuals experiencing chronic LBP, especially older people, are more likely to experience poverty, prematurely exit the workforce and accumulate less wealth for retirement. Older people are also more likely to experience adverse events from interventions.
Economic drag
An estimated £4.17 billion is lost in the UK each year as a result of absenteeism. According to Health and Safety at Work 2022, 27 per cent is a result of musculoskeletal problems. This is a situation where the health and fitness industry can be part of the solution. Wellbeing consultant, Oliver Patrick, says: “Musculoskeletal problems are largely a disease of being sedentary. Improving cardiovascular fitness, movement quality and muscle mass would immediately make an impact on the health of the workforce.”
Stephen Price, managing director of SP&Co Group agrees: “Along with the rise in lifestyle-related disease and in mental wellbeing challenges, the significant rise of musculoskeletal issues, pose a really worrying threat to the already stagnant workforce. Although there are bigger policy plays, the health and fitness industry has an incredible opportunity to play a significant role in workforce wellbeing.
“The medical community are crying out for support in this area, to be able to demedicalise patients that simply shouldn’t be patients and help communities derisk,” he says. “Fitness operators should be playing a major role in supporting the NHS and thereby the health of a nation.”
Motion is lotion
The first intervention gyms can make is by keeping the muscles around the lower back strong. Often muscle weakness is a significant contributor to lower back pain, but research suggests that even a short exercise intervention can yield marked improvements in strength.
Dr Gillian Hatfield, associate professor in kinesiology at Canada’s University of Fraser Valley, led research into the impact of eight-weeks participation in the Les Mills Core programme. The study found those taking part in bi-weekly gym classes of Les Mills Core for eight weeks saw plank endurance increase by 45 per cent, extensor endurance by 35 per cent and abdominal strength by 14 per cent.
“The fact that people with pre-existing lower back pain saw significant benefits from the core workouts is important,” says Hatfield. “People experiencing lower back pain are often prescribed painkillers and told to rest up but, in most cases, motion is lotion. Reducing sedentary time helps improve the endurance of lower back muscles and the increased blood flow and mobility can help reduce pain and stiffness.”
Les Mills head of research, Bryce Hastings, says sedentary lifestyles and long periods of sitting are closely linked with back pain and the muscles activated during core training play a vital role in preventing this. “Even people who get the recommended amount of physical activity can also spend a lot of time being sedentary,” he says.
“When we’re sitting, our postural muscles can get weaker and become less able to support us. If we stay in a slouched position for long periods, our back muscles stretch and prolonged stretching can prevent muscles from firing when we need them to, leading to injury and pain.”
Supporting the NHS
UK Active’s MSK (musculoskeletal) Health Hubs initiative was launched in 2022. Designed and provided in collaboration with Good Boost, Orthopaedic Research UK, ESCAPE-pain and Arthritis Action there are now more than 100 operational sites across the UK.
Chair of UK Active, Mike Farrar, says the MSK programme could significantly reduce the burden on the NHS and keep patients out of hospital and surgery. “This is a fantastic opportunity for gyms and leisure centres to diversify their offer and reach many more people who can benefit from their expertise and services. Given the right conditions and support, we could scale this programme nationwide, which would have a transformative impact on our nation’s health, wellbeing and the economy.”
UK Active is also involved with another pilot in partnership with London hospital, Guy’s and St Thomas’s to give physiotherapy patients treatment in three London leisure centres run by Southwark Leisure, Brixton Recreation and Active Lambeth.
Around 25,000 patients are expected to benefit from the initiative which is funded by the hospital charity. Half of those attending are suffering from lower back pain, for which regular exercise is the key to recovery. The majority of the others need to improve their fitness and muscle strength, due to underlying conditions, such as injuries, arthritis or fibromyalgia.
Patients benefit from access to the expertise of the hospital’s physio team, combined with a much wider range of equipment and space than that on offer in the hospital’s gyms.
Winning partnership
This initiative is allowing physios to see three patients at a time, is cutting wait times and enabling patients to benefit from a social element, which has been shown to improve attendance.
The pilot at Castle Leisure Centre, in Elephant and Castle, is approaching its first anniversary and an average of 150 to 200 patients are now seen weekly.
It is hoped that holding sessions at local gyms will give people the confidence to become members after the programme. As further encouragement they are allowed to use the other facilities – including the pool, sauna and streamrooms – for free when they attend appointments and are given a discounted membership on completion.
Jenny Heal, clinical lead musculoskeletal physiotherapist, hopes this initiative can be rolled out more widely across the Trust: “It’s important to empower patients to be responsible for their own health. By making it easier for them to access physiotherapy close to home, we’re providing support which should lead to a better quality of life, and reduce the burden on the NHS.”
