Physical activity and low back pain: A U-shaped relation?

Abstract

Being physically active is often suggested to be important in the prevention and management of low back pain. This simple view does not take into account that the relation between the level of activity and back pain may be a U-shaped curve - i.e. both inactivity and excessive activities (back-unhealthy activity) present an increased risk for back pain. We explored the U-shaped association between physical activity and chronic low back pain (3 months duration) by analyzing cross-sectional data from the Dutch population-based Musculoskeletal Complaints and Consequences Cohort study (DMC(3), 1998) of a sex-age stratified sample of 25 years and older (n=3364). Type of activity (daily routine, leisure time and sport activity), intensity of and time spent on these activities, and back exertion of sport activities were taken into account. Physical activity was not associated with chronic low back pain (CLBP) when studied by the dimension of activity, by the intensity or by the duration of physical activity. Only engaging in sport activity was associated with less CLBP (OR 0.78: 95% CI 0.66-0.93). The extremes of the total physical activity pattern were associated with CLBP. A moderate increased risk for CLBP was found for both participants with a sedentary lifestyle (OR 1.31: 95% CI 1.08-1.58) and for those being involved in physical strenuous activities (OR 1.22: 95% CI 1.00-1.49). This was especially true for women (sedentary: OR 1.44: 95% CI 1.10-1.83; physically active: OR 1.36: 95% CI 1.04-1.78). This study provides some evidence that the relation between physical activity and CLBP is U-shaped.

Physical activity and low back pain: a systematic review of recent literature

“…For women, the same finding was found for sports on a regular basis [52] and high intensity training [51]. In general, engaging in sport activities is not associated with back problems [6,79] although specific sport activities may be detrimental to the spine [80]. After all, participating in regular sporting activities is considered an indicator of a healthy lifestyle.…”

“…An important aspect in all the studies on physical activity during leisure time and sports was that the operationalisation of physical activity in the studies differed and was, in general, not very specific. The positive association of physical exercises and sports with LBP might be interpreted as a result of the accumulation of the total of exercise and sports, as part of a continuum of activity levels with different consequences for LBP [6]. This accumulation might be especially true in healthy subjects.…”

“…Studies focusing on the relation between back pain and physical activity (such as occupational, recreational and sports-related activities) have produced results that are compatible with a U-shaped model, addressing the detrimental effect of both sedentary behaviour and strenuous levels of physical activity [4][5][6]. Biomechanical loading seems to be the most important occupational factor predicting both recurrent low back pain citations were retrieved and examined.…”

Until it hurts? Epidemiology of musculoskeletal pain in youth sports

“…Additionally, whether or not a non-linear dose-response relationship exists was uncertain. There may be a U-shaped curve, i.e., both too little and too much physical activity may increase the risk of musculoskeletal pain 20) . To optimize the safety and benefits of physical activity and organized sports for adolescents, understanding the shape of the dose-response curve is important.…”

Nivel de actividad física y grado de discapacidad en pacientes con dolor lumbar crónico

“…Mientras que algunos autores argumentan que la actividad física moderada o intensa, tanto en hombres como en mujeres, representa un factor de riesgo para la ocurrencia de DLC (24,25), otros consideran que, comparado con sujetos sedentarios, estos niveles de actividad constituyen un factor protector (4,26,27). Al mismo tiempo, mientras que algunos autores no han logrado demostrar diferencias en el nivel de actividad física entre pacientes con DLC y sujetos sanos (28), otros como Miranda (29) y Heneweer (30), han puesto en evidencia la existencia de una relación entre el nivel de actividad física y el riesgo de padecer DLC. Para este último autor, esta relación describe una distribución en la que tanto bajos como altos niveles de actividad física aumentan el riesgo de padecer la enfermedad.…”