DO PHYSICAL ACTIVITIES TRIGGER FLARE-UPS DURING AN ACUTE LOW BACK PAIN EPISODE?: A LONGITUDINAL CASE-CROSSOVER FEASIBILITY STUDY.

BACKGROUND & OBJECTIVE

Many patients believe that their back pain ‘flare-ups’ are triggered by physical activities and/or are affected by the fear that performing these activities will lead to painful events. Personal beliefs about the triggers for back pain are important in activity participation and can often lead to the limitation of normal activities, and increased disability. This is not in line with current guidelines to remain as active as possible without limiting normal daily actions.

Clinicians also often recommend limiting activities to minimise the potential risk of ‘flare-up’, which may actually promote disability in the longer term. This may be due in part to a lack of evidence regarding the cause of ‘flare-ups’ especially of a physical cause. This paper looks to rectify this by studying the physical and psychological factors associated with back pain ‘flare-ups’ in the previous 24hr period via an online survey.

METHODS

This study employed a prospective longitudinal case crossover design. 48 participants were recruited with an average age of 49.8years with low back pain under 3 months duration. Back pain intensity was measured using an 11-point numerical rating scale (NRS). Functional limitations were measured using the Oswestry Disability Index (ODI) ranging between 0-100.

The participants completed online surveys 3 & 7 days after the initial consultation for 6 weeks. This surveyed the triggers for back pain over the 24hrs prior to a ‘flare-up’, including:

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), and 8) physical therapy (PT) for LBP.

Participants also reported on emotional triggers in the past 24 hours, including 1) stressful events, 2) depressed mood, and 3) either stress or depression.

RESULTS

437 surveys were completed by the participants with 328 being included in the final analysis at an average of 11 per participant. The only physical measure that corresponded with flare-ups was prolonged sitting for over 6 hours (OR 4.4, 95%

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