Inciting events associated with lumbar disc herniation
PainSci commentary on Suri 2010: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.
What do people think triggered their back pain? In this study of 154 people who had back pain and associated intervertebral disc herniations, a few dozen “inciting events” were reported for about 40% of them, and only about 9% of those were involved any kind of lifting.
It also didn’t matter what the trigger was: there was no link between any known trigger and the severity of the case. Not even heavy lifting triggers!
And most cases, over 60%, had no trigger at all: “spontaneous” herniations. Not only can disc herniations can just happen, for no apparent reason, that’s actually how it usually goes.
Here are the 31 back pain triggers identified by at least one of about sixty people:
- Non-lifting physical activities
- Specific movements
- Bending
- Leaning
- Misstepping
- Reaching
- Slipping without falling
- Twisting
- Walking
- Activities of Daily Life
- Closing doors
- Dressing
- Household tasks (vacuuming, washing car)
- Making the bed
- Shoveling snow
- Transferring in/out of bed
- Transferring in/out of car
- Yard work and maintenance (flooring, tilling, roofing)
- Sports and Recreation
- Golf
- Gym exercise
- squatting
- Hockey
- Skiing
- Tennis
- Specific movements
- Heavy Lifting
- Moving furniture
- Transferring a patient
- Very heavy loads >75 Ibs
- Light Lifting
- Light loads (ladder, box)
- Very light lifting (box of tissue paper)
- Non-exertional occurrences
- Coughing
- Prolonged sitting
- Sneezing
- Physical trauma
- Falling
- Motor vehicle accident
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.
BACKGROUND CONTEXT: No prior study has investigated the frequency of patient-identified inciting events in lumbar disc herniation (LDH) or their clinical significance.
PURPOSE: To examine the clinical frequency of patient-identified inciting events in LDH, and to identify associations between the presence of inciting events and the severity of the clinical presentation.
STUDY DESIGN/SETTING: Cross-sectional analysis of data from a cohort study with prospective recruitment, with retrospective data collection on inciting events. The setting was a hospital-based specialty spine clinic.
PATIENT SAMPLE: One hundred fifty-four adults with lumbosacral radicular pain and LDH confirmed by magnetic resonance imaging.
OUTCOME MEASURES: Self-report measures of disability measured by the Oswestry Disability Index (ODI), the visual analog scale (VAS) for leg pain, and the VAS for back pain.
METHODS: Dependent variables included the presence of a patient-identified inciting event, which were categorized as spontaneous onset, nonlifting physical activity, heavy lifting >35 lbs), light lifting (<35 lbs), nonexertional occurrence, or physical trauma. We examined the association of an inciting event, or a lifting-related event, with each outcome, first using univariate analyses, and second using multivariate modeling, accounting for important adjustment variables.
RESULTS: Sixty-two percent of LDH did not have a specific patient-identified event associated with onset of symptoms. Nonlifting activities were the most common inciting event, comprising 26% of all LDH. Heavy lifting (6.5%), light lifting (2%), nonexertional occurrences (2%), and physical trauma (1.3%) accounted for relatively small proportions of all LDH. Patient-identified inciting events were not significantly associated with a more severe clinical presentation in crude analyses. Spontaneous LDH was significantly associated with higher baseline ODI scores in multivariate analysis, although the magnitude of this effect was small. There were no significant associations (p< or =.05) between the presence of a lifting-associated event and the outcomes of ODI, VAS leg pain, or VAS back pain.
CONCLUSIONS: The majority of LDH occurred without specific inciting events. A history of an inciting event was not significantly associated with a more severe clinical presentation. There was no significant association between the occurrence of a lifting-related event and the severity of the clinical presentation. This information may be useful in the counseling of patients recovering from acute LDH.
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:
- Inciting events associated with lumbar disc herniation. Suri 2010 Spine J.
- Prediction of an extruded fragment in lumbar disc patients from clinical presentations. Pople 1994 Spine (Phila Pa 1976).
- Characteristics of patients with low back and leg pain seeking treatment in primary care: baseline results from the ATLAS cohort study. Konstantinou 2015 BMC Musculoskelet Disord.
- Effectiveness and cost-effectiveness of universal school-based mindfulness training compared with normal school provision in reducing risk of mental health problems and promoting well-being in adolescence: the MYRIAD cluster randomised controlled trial. Kuyken 2022 Evid Based Ment Health.
- No long-term effects after a three-week open-label placebo treatment for chronic low back pain: a three-year follow-up of a randomized controlled trial. Kleine-Borgmann 2022 Pain.