Five articles on PainSci cite Steffens 2015: 1. The Complete Guide to Trigger Points & Myofascial Pain 2. Does Posture Matter? 3. Complete Guide to Low Back Pain 4. 6 Main Causes of Morning Back Pain 5. Don’t Worry About Lifting Technique
PainSci notes on Steffens 2015:
This fascinating experiment produced valuable data on potential triggers for episodes of acute low back pain.
Basically the researchers just a did a thorough and formal version of asking a lot of people — a thousand of them — what they were doing before their back pain started (as compared to other recent periods). They made an admirable effort to do this in a way that eliminated “recall bias,” but I am not completely confident they succeeded: people have strong ideas about what constitutes a risk factor for back pain, and people tend to perceive and remember what they want or expect to be true. Participants were asked to:
report exposure, including its time and duration, to each of the 12 putative triggers in the 96 hours preceding the onset of back pain. For example, for questions about manual tasks involving a heavy load would be as follows: so on the day of your back pain did you engage in any manual tasks involving a heavy load?
A lot of people are likely to remember it that way, because that’s what they already think causes back pain. The list of possibilities was also limited to classic putative risk factors, which means that if a risk factor isn’t a bit of a cliché, this study simply ignored it. I think that has real potential to confound the results here.
Nevertheless, there were strong signals and fascinating patterns here, and “the results of this study demonstrate for the first time that brief exposure to a range of physical and psychosocial factors can considerably increase the risk of an episode of acute back pain.” Here are some of the most notable findings:
- Being distracted was by far the biggest risk: patients were twenty-five times more likely to be distracted “during an activity or task” right before an episode of back pain than at other times in the preceding couple days.
- A distant second, “manual tasks” were risky — a broad category — but an “awkward posture” tops the list of more specific examples, and it was notably a greater risk factor than heavy/awkward lifting.
- Mornings are trouble! “Mornings were the most frequent time of day for back pain onset, with 35.2% of participants reporting pain onset between 7:00 AM and 10:00 AM. Only 3.7% of participants reported pain onset between mid- night and 5:00 AM, with a large increase in reports from 6:00 AM.”
- The risks of heavy lifting go down with age: “the odds associated with manual tasks involving heavy loads at age 60 years is more than 5 times smaller than at age 20 years.”
- Sexual intercourse and alcohol were not significant risk factors, with virtually no risk for sex.
original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
OBJECTIVE: To investigate a range of transient risk factors for an episode of sudden-onset, acute low back pain (LBP).
METHODS: This case-crossover study recruited 999 subjects with a new episode of acute LBP between October 2011 and November 2012 from 300 primary care clinics in Sydney, Australia. Each participant was asked to report exposure to 12 putative triggers over the 96 hours preceding the onset of back pain. Conditional logistic regression was used to estimate odds ratios (ORs) expressing the magnitude of increased risk with exposure to each trigger.
RESULTS: Exposure to a range of physical and psychosocial triggers significantly increased the risk of a new onset of LBP; ORs ranged from 2.7 (moderate or vigorous physical activity) to 25.0 (distracted during an activity or task). Age moderated the effect of exposure to heavy loads and sexual activity. The ORs for heavy loads for people ages 20, 40, or 60 years were 13.6, 6.0, and 2.7, respectively. The risk of developing back pain was greatest between 7:00 AM and noon.
CONCLUSION: Transient exposure to a number of modifiable physical and psychosocial triggers substantially increases risk for a new episode of LBP. Triggers previously evaluated in occupational injury studies, but never in LBP, have been shown to significantly increase risk. These results aid our understanding of the causes of LBP and can inform the development of new prevention approaches.
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- Photobiomodulation therapy is not better than placebo in patients with chronic nonspecific low back pain: a randomised placebo-controlled trial. Guimarães 2021 Pain.
- No effect of creatine monohydrate supplementation on inflammatory and cartilage degradation biomarkers in individuals with knee osteoarthritis. Cornish 2018 Nutr Res.
- The CANBACK trial: a randomised, controlled clinical trial of oral cannabidiol for people presenting to the emergency department with acute low back pain. Bebee 2021 Med J Aust.
- Relationships Between Sleep Quality and Pain-Related Factors for People with Chronic Low Back Pain: Tests of Reciprocal and Time of Day Effects. Gerhart 2017 Ann Behav Med.
- Modulation in the elastic properties of gastrocnemius muscle heads in individuals with plantar fasciitis and its relationship with pain. Zhou 2020 Sci Rep.