Triggers of Acute LBP

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Often as a culture, we have associated lifting heavy things and being in awkward positions as triggers of acute LBP. While these are important factors, the risk of them causing an initial episode of acute LBP is SIGNIFICANTLY increased when combined with psychosocial factors:

“transient exposure to stress and fatigue triples the odds of developing immediate back pain, whereas distraction increases the odds by a factor of 25” – https://www.ncbi.nlm.nih.gov/pubmed/25665074

Regard recurrent cLBP triggers, a recent study  looked at 6 physical factors factors that play a role in a ‘flare-up’ of LBP and compared them with stress and depression. They looked at the following physical factors:

1) lifting a heavy object (≥35 lbs.) between 1-5 times, or >5 times,

2) running/jogging,

3) vigorous, non-contact sports (i.e. tennis,swimming, cycling, etc.),

4) vigorous contact sports (i.e. football, hockey, soccer),

5) physical trauma such as a fall, motor vehicle accident, or other trauma,

6) prolonged sitting (>6 hours),

7) prolonged standing (>6 hours)

8) physical therapy (PT) for LBP.

Rather than heavy loads and intense activities as triggers of LBP ‘flare-ups’, instead they found “prolonged sitting (>6 hours) and stress or depression triggered LBP flare-ups.”. Good news for those of us in rehab, the data supported that “PT was a deterrent of flare-ups. ” – https://www.ncbi.nlm.nih.gov/m/pubmed/28700451/

Research Review Brief – Education vs. Symptom Based Modification for cLBP

Research Review Brief

An educational approach based on a non-injury model compared with individual symptom-based physical training in chronic LBP. A pragmatic, randomised trial with a one-year follow-up – Sorensen, et al.

Population

207 patients 18-60 years (52% female)with LBP for at least 4 out of the last 12 months with the last 14 days =/>4/10 on a VAS. If they had leg pain, the back pain had to be a worse complaint. All subjects made it through the study with no drop out in either groups (impressive!)

Treatment Groups

Group 1 (EDUC):  105 Subjects received an educational approach designed to improve confidence in the robustness of the spine and two movements: Seated flexion and rotation
Group 2: 102 Subjects received Symptom Classification Based Treatment – MDT(by certified MDT) Directional preference, Stabilization, or intensive dynamic exercise. IN ADDITION: group 2’s physical therapists could at their own discretion referred for pharmacology, manual therapy, or physician for injection to complement their symptom based plan

Outcome Measures

Pain, Activity Limitation, FABQ, Back Beliefs, physical activity, work ability, quality of life

Results

Primary Outcomes: Non-significant trend towards activity limitation being reduced mostly in the educational group although this could not be determined as clinically relevant.

Secondary outcomes: Improvement in fear-avoidance beliefs was better in the educational  group. All other variables were about equally influenced by the two treatments.

The median number of treatment sessions was 3 for the educational group and 6 for the physical training group.

Conclusion:

“We have demonstrated that, among patients with cLBP, the educational/cognitive intervention with few consultations was at least as effective as an individualized, multidisciplinary physical-training approach. ‘At least’ refers to the observed overall trend of more improvement in activity-limitation with EDUC. ”

“There was a statistically significant difference at 2 months in favor of EDUC in the proportion of people improving by a Minimal Important Change (MIC) in activity-limitation (5 or more points on the LBP Rating Scale).

“Post-hoc regression analysis showed a relationship between improved activity limitation and improvement in FABQ, and FABQ was more improved in the EDUC group at all three follow-ups, on balance these data appear to favour the EDUC approach.”

 

Full article Available Here.