Please cite this article as: Heidari, J., Mierswa, T., Kleinert, J., Ott, I., Levenig, C., Hasenbring, M., Kellmann, M., Parameters of low back pain chronicity among athletes: Associations with physical and mental stress,

Back pain (BP), a prominent problem for competitive athletes, is a primary reason for limitations in athletic performance and daily life restrictions. As studies on the relationship between psychological variables and BP in athletes are scarce, the aim of this study was to investigate stress and depression in competitive athletes with BP. In a cross-sectional design, data of 154 competitive athletes (51% female; M= 18.81 years, SD= 5.05 years) were collected, assessing Performance stress, Socio-emotional stress, Risk for depression and Psychological well-being and the two BP parameters BP Intensity and Disability. Two multiple linear regressions were conducted to predict (1) BP Intensity and (2) Disability from Performance stress, Socio-emotional stress, Risk for depression and Psychological well-being. Multiple linear regressions demonstrated that Performance stress (β = .21, p = .01) was the only significant predictor of BP Intensity (F= 6.68, p = .01, R = .05), whilst Risk for depression (β = .24, p = .01) was the only significant predictor of Disability (F= 8.46, p = .01, R = .06). Neither gender nor age explained a significant amount of variance in the models. Study results showed that, as in the general population, the variables stress and depression are related to BP in competitive athletes. In particular, BP intensity was found to be associated with stress and BP-related disability was associated with depression, whereas age and gender showed no association with the BP parameters. A longitudinal investigation is warranted to determine the direction of the observed relationships.

Background Dysfunctional psychological pain responses, namely fear‐avoidance (FAR), including catastrophizing and helplessness, as well as endurance‐related responses (ER), including thought suppression and overactivity, have been shown to be risk factors for persistent low back pain (LBP). Literature suggests that athletes may differ from non‐athletes regarding psychological responses to pain. Objectives This study set out to compare FAR and ER between athletes and non‐athletes with LBP. It was hypothesized that athletes would report less frequent FAR and more frequent ER, and that both FAR and ER are associated with LBP intensity and disability. Methods The 173 athletes and 93 non‐athletes cross‐sectionally reported how frequently they employ FAR and ER on the Avoidance‐Endurance Questionnaire (AEQ), as well as LBP intensity and disability on the Chronic Pain Grade Questionnaire (CPGS). MANOVA was applied to compare FAR and ER between athletes and non‐athletes. Hierarchical multiple linear regression models were used to determine the unique associations between FAR and ER with LBP intensity and disability. Results Athletes reported lower frequencies of behavioural avoidance than non‐athletes, but no other FAR variables differed between the groups. Frequencies of ER did not differ between athletes and non‐athletes. Regression analysis indicated substantial associations of FAR with LBP intensity, as well as of FAR and ER with disability in athletes and non‐athletes. Conclusions The results of the present study suggest that athletes and non‐athletes with LBP differ regarding behavioural avoidance, but overall, differences regarding pain responses are marginal. FAR and ER are both reported in athletes and non‐athletes and contribute to disability in both groups. Significance Athletes train to endure pain in the course of athletic socialization, at least in the context of exercise. However, there is sparsity of knowledge about psychological pain responses in athletes with low back pain and whether they differ from those in non‐athletes. The results of this comparative study suggest that endurance responses are more frequent than avoidance responses among athletes and non‐athletes alike. However, both types of responses seem relevant to clinical pain management in athletes as well as non‐athletes.

The findings indicate an association between detrimental recovery-stress patterns and LBP. Examining the role of recovery has innovative practical relevance for LBP prevention and rehabilitation through the implementation of approaches to enhance recovery in relevant programmes.

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