Relationship between physical activity and disability in low back pain

By: Ryan Hickey, SPT (under direction of Joseph Brence, DPT)
Non-specific low back pain (LBP) has been researched and many have speculated correlations between physical activity and disability. Traditionally, it is assumed that patients who have LBP feel more disabled, report more restrictions within their daily life and as a result, are less physically active. It is important to note that disability and physical activity are not synonymous terms. The ICF states disability is an umbrella term that covers 3 aspects of health: body functions and structures, activity limitations, and participation restrictions. Physical activity is defined as the execution of a task or action by an individual. Simply, disability focuses on what people are unable to do, and physical activity focuses on what people are able to do.
Lin et al recently conducted a systematic review and meta-analysis to assess if a relationship exists between physical activity and disability in acute, sub-acute, and chronic non-specific LBP. Inclusion criteria required disability to be assessed by a self-report questionnaire (eg, Roland Morris Disability Questionnaire, Oswestry Disability Index) and physical activity to be assessed utilizing self reports forms (eg, Baecke Physical Activity Questionnaire, International Physical Activity Questionnaire), or movement instruments such as pedometers or accelerometers. The authors grouped patients into three categories: acute, sub-acute, and chronic. The acuity was based upon duration of LBP: acute (< 6 weeks), sub-acute (6 weeks – 3 months), and chronic (> 3 months).
The final sample size included 2,495 participants’ from eighteen articles that met the inclusion criteria. Seven studies provided data regarding acute or sub-acute LBP, and fourteen studies provided data regarding chronic LBP. The study concluded that there is weak and no significant relation between levels of physical activity and disability for individuals with acute/sub-acute non-specific LBP. However, a moderate and negative correlation exists between physical activity and disability for individuals with chronic LBP. Therefore, as chronicity increases, disability increases, and physical activity decreases. This result indicates individuals with chronic LBP and high levels of disability are likely to have low levels of physical activity.
The inverse relationship between physical activity and disability in individuals with chronic LBP leads to treatment options for this population (eg, enhance physical activity to reduce disability). A compliment to this treatment may be to monitor physical activity outside of treatment by using a pedometer or accelerometer. This adjunct would also allow for patients to visualize feedback and progress accordingly. Individuals who have acute LBP may report various levels of endurance behavior and avoidance resulting in varied levels of physical activity. This agrees with the analysis; lack of association between physical activity and disability for patient with acute LBP. Conversely, chronic LBP patients should avoid the avoidance endurance model which states patient react with avoidance behavior, meaning they will avoid activities because of fear of reinjury. This model approach will result in both a decrease in physical activity and increase in disability.
It is crucial to understand the relationships between physical activity and disability is different across subgroups of LBP. Another study found that the relationship between physical activity and the risk of chronic LBP forms a U-shaped distribution. Therefore, too little and too much activity presented increased risks of chronic LBP. Future research must be conducted to determine whether a low level of physical activity in acute/sub-acute LBP is a prognostic factor for persisting pain. For individuals with chronic LBP, providing interventions to increase their levels of physical activity is justified.
Lin CWC, McAuley JH et al. Relationship between physical activity and disability in low back pain: A systematic review and meta-analysis. Pain 2011: 152;607-613.

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  • Hello Forwardthinkingpt,
    I take your point, People should and must understand the nuance between exercise and physical activity. It will help them to adapt to a healthy lifestyle, thereby, attaining discipline and active living. Dr. David Bassett, Jr. PhD of University of Tennessee, Knoxville says, “Exercise is a specific form of physical activity. It is a planned, purposeful and performed with the intention of acquiring fitness or other health benefits.”
    Good Job!

    Podiatrist February 3, 2012 3:51 pm Reply
  • Interviewing and working with so many backpain people I don’t understand why science don’t get a proof and understand the major clue of backpain. The major clue of backpain to my opinion and experience is to much assymetric loading. Inacitvity means to a lot of people, lot’s of sitting, sitting is done mostly with a flexed lumbar spine. This has this catastrofic outcome we all see in daily life. The same you can say whilst some activities, for example gardening, or repeatingly flexing whilst lifting weights. Everyone knows hours of gardening (in a static flexed positioning) causes backpain. When the major part of loading is done before, a last flexion movement -like picking up the fallen soap under the shower- can be enough to produce another episode of acute backpain. Don’t change your bad habits and ultimately you become an recurrent and chonic backpain victim with disc degeneration or often operated on.
    So it is not only acitvity or inactivity that causes backpain and disability but it more depends on the sort of loading during the activty or inactivity how good or bad the effect is for your back. Loading and unloading in different postions not to long in extrem position or to high loading in extreme positons will keep the back most healty. In static position, the neutral, normal lordotic, Position is the less harmfull.

    koenoverdijk February 5, 2012 10:14 am Reply
  • I agree Koen! I think it’s easy to miss that point because I think movement is highly influenced by attitude. What I mean is, culture has a huge influence in how people use their bodies. For instance: On a trip to India in the 90’s I noticed that road construction work is done by women. I also noticed that these women spend long periods of time bending over in standing applying material down on the surface to become a paved road, by hand. I asked my brother in law, who is Indian and was with me, if he thought these women suffer form LBP. He decided to ask a few of them and the answer was a unanimous”NO”! I was not a PTA then and the question remained in my mind until I came to understand the concept of “hip-hinging”. These women were hip hinging as they performed their jobs. I think the quality and efficiency of movement, or “loading forces” is often neglected in considering whether a patient is doing too much. Same with posture when static.

    Mauricio Herrador February 5, 2012 3:40 pm Reply

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