Surprising News About Low Back Pain

February 20, 2015

Do you think heavy lifting with degenerative osteoarthritis is the major cause of low back pain? A new study designed to identify modifiable triggers finds relative youth, time of day, and perhaps lack of planning to be key factors.

Steffens D, Ferreira ML, Latimer J, et al., What triggers an episode of acute low back pain? A case-crossover study. Arthritis Care Res (Hoboken). 2015; Feb 9. doi: 10.1002/acr.22533. [Epub ahead of print]  

Low back pain is a notoriously common problem, but you may be surprised to [[{"type":"media","view_mode":"media_crop","fid":"32259","attributes":{"alt":"low back pain","class":"media-image media-image-right","id":"media_crop_4735970714153","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3414","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"width: 197px; height: 166px; margin: 2px; float: right;","title":"","typeof":"foaf:Image"}}]]learn who is most likely to turn up seeking care for it, and what brings it on.

Does your retired patient with osteoarthritis come to mind? Think again. The more likely candidate is a GenX-er who got up early after a long night out and bent over too quickly to heave that big basket of dirty laundry out of the way.

This case-crossover study of almost 1,000 new back-pain patients recruited from primary care clinics across Sydney, Australia, reveals low back pain to be far more common among 20-somethings, with more than five times greater risk, than among people in their 60s (odds ratios of almost 14 and 2.7, respectively).

Although low back pain is the most common reason people seek medical care, this is the first time researchers have studied exposure to transient, modifiable risk factors. Previous studies have not revealed consistent risk factors, the authors say, so these data provide clues to primary prevention.

The researchers phoned subjects within a week after their clinic visits and asked them to recall the date, time, and circumstances of back pain onset. This allowed the authors to assess exposure to 12 potential physical and psychosocial triggers of low back pain.

Although back pain is often blamed on heavy lifting, the questionnaire data showed that the most common trigger for acute low back pain is awkward posture during a manual task. In fact, awkward positioning makes people 8 times more likely to throw their back out when doing something, according to the study.

Among psychosocial triggers, being distracted makes people 25 times more likely to suffer acute low back pain, and fatigue triples the odds. Drinking alcohol or sexual activity had no effect.

Unexpectedly, the data showed greatest risk for low back pain due to awkward posture and unstable loading between 7 am and noon. Unfortunately, the study wasn’t powered to determine why this is so.

A week after onset, half the patients said they still had pain during the previous 24 hours, and almost 90% said that it was interfering with daily activities. Pain episodes lasted around 5 days. Patients had sought medical care after 2 days, on average.