Relationships Between Weight, Physical Activity, and Back Pain in Young Adult Women

The Relationship between Abdominal Diastasis and Lumbar Pain Pressure Threshold in Women Who Have Given Birth between the Ages of 30 and 45 Years-An Observational Pilot Study

Background and Objectives: Current evidence confirms that the magnitude of the inter-rectus distance (IRD) is associated with the severity of abdominal pain. Furthermore, evidence exists in the literature about the impact abdominal muscles have on low back pain, lumbopelvic pain, breathing and lumbar abdominal strength; however, no studies analysing the level of association between abdominal diastasis and lumbar pain pressure threshold (PPT) exist. The aim of this study was to analyse the level of association between the rectus abdominis distance and pain pressure threshold in the lumbar spinous processes in women who have given birth between the ages of 30 and 45 years. Secondly, it was to study the level of association between the time elapsed since the last delivery and low back pain in women who have given birth between 30 and 45 years of age. Material and Methods: This was a pilot observational study in which 21 females participated. The abdominal diastasis was measured by ultrasound, the pain pressure threshold was assessed by an algometer and the pain perception by the Mc Gill questionnaire. Results: There was no significant relationship between increased abdominal distance and increased lumbopelvic pain in women who gave birth between the ages of 30 and 45 years. However, there was a correlation between the time that had elapsed since the last delivery and low back pain. Conclusions: there was a correlation between the time that had elapsed since the last delivery and low back pain. Further studies analysing factors that may perpetuate the chronicity of symptoms, such as lifestyle and intrinsic factors, are needed.

Low Back Pain Prevalence among Distance Learning Students

Background: Low back pain as a symptom affects many individuals around the globe regardless of their economic status or sociodemographic characteristics. During the 2019 COVID-19 pandemic, students found themselves obligated to sit down for long periods of time. The aim of this current study is to investigate the impact of these prolonged periods of sitting down in front of computers on developing a new episode of low back pain. Methods and Materials: This research adopted an observational cross-section study design. Students who are currently enrolled or had experienced distance learning classes in the last 6 months were eligible to participate. An online-based questionnaire was developed by the investigators through reviewing the literature with relevant objectives. McNemar’s test was used to compare certain variables between two periods before and during online distance learning. We used paired t-tests to compare pain intensity before, during, and after online learning, while a chi-square test was used to investigate correlations between factors influencing low back pain. Results: A total of 84 students participated in the study—46 (54.8%) females and 38 (45.2%) males. Before online distance learning, only 42.9% of participants reported low back pain, while only 20% had a back injury. The mean pain scores before, during, and after online distance learning were (2.85 ± 2.16, 4.79 ± 2.6, and 4.76 ± 2.7), respectively. The pain scores before online learning were significantly lower than pain scores during and after online distance learning (p < 0.05), respectively. Conclusion: The study findings suggested that low back pain prevalence increased among students during the COVID-19 pandemic. Future research should study participants’ behavior during the online learning and assess the long-run impact of distance learning among high-school and undergraduate students.

Correlation among Routinary Physical Activity, Salivary Cortisol, and Chronic Neck Pain Severity in Office Workers: A Cross-Sectional Study

This study aimed to assess the correlation between different aspects of routinary physical activity with chronic neck pain severity indicators and salivary cortisol. This cross-sectional observational study included ninety-four office workers with non-specific chronic neck pain in the analyses. Pain related outcomes (pain intensity, pressure pain thresholds and disability), physical activity outcomes using the International Physical Activity Questionnaire, and salivary cortisol levels were evaluated. Pearson’s correlation analysis was used to investigate internal associations and regression models to explain and calculate which factors contribute to the variance of salivary cortisol and neck pain severity. Female sex (p < 0.01), sedentary behaviors (p < 0.05), and pain sensitivity (p < 0.05) were associated with greater cortisol levels (p < 0.05), but disability and pain intensity were not associated (p > 0.05). Worse disability, pain intensity, and pain pressure thresholds were also associated with lower routinary physical activity (p < 0.05). Regression models explained 20.6% of pain intensity (based on walking time to their workplace, age and pain sensitivity); 27.3% of disability (based on moderate physical activity at home, vigorous physical activity during leisure time and pain sensitivity); 54.2% of pain sensitivity (based on cycling time from home to their workplace, gender and vigorous activity during leisure time) and 38.2% of salivary cortisol concentration (based on systolic pressure, vigorous activity at work and both moderate and vigorous activity at home). Our results demonstrated the association between salivary cortisol concentration with moderate and vigorous physical activity, sitting time at work, and PPTs. However, salivary cortisol was not associated with disability or pain intensity.

Presence of back pain prior total knee arthroplasty and its effects on short-term patient-reported outcome measures

PURPOSE

Back pain may both decrease patient satisfaction after TKA and confound outcome assessment in satisfied patients. Our primary objective was to determine whether preoperative back pain is associated with differences in postoperative patient-reported outcome measures (PROMs).

METHODS

We retrospectively reviewed 234 primary TKA patients who completed PROMs preoperatively and 12 weeks postoperatively, which included a back pain questionnaire, the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) and the Forgotten Joint Score-12 (FJS-12). Cohorts were defined based on the severity of preoperative back pain (none, mild, moderate and severe) and compared. Demographics were compared using ANOVA and Chi-square analysis. Univariate ANCOVA analysis was utilized to compare PROMs while accounting for significant demographic differences.

RESULTS

Both preoperative KOOS JR scores (none: 47.90, mild: 47.61, moderate: 44.61 and severe: 38.70; p = 0.013) and 12-week postoperative KOOS JR scores (none: 61.24, mild: 64.94, moderate: 57.48 and severe: 57.01; p = 0.012) had a statistically significant inverse relationship with regard to the intensity of preoperative back pain. Although FJS-12 scores at the 12-week postoperative period trended lower with increasing levels of preoperative back pain (p = 0.362), it did not reach statistical significance. Patients who reported severe back pain preoperatively achieved the largest delta improvement from baseline compared to those with lesser pain intensity (p = 0.003). Patients who had a 2-grade improvement in their back pain achieved significantly higher KOOS JR scores 12 weeks postoperatively compared to patients with either 1-grade or no improvement (63.53 vs. 55.98; p = 0.042). Both preoperative (47.99 vs. 41.11; p = 0.003) and 12-week postoperative (64.06 vs. 55.73; p < 0.001) KOOS JR scores were statistically higher for those who reported mild or no back pain pre-and postoperatively than those who reported moderate or severe back pain pre-and postoperatively.

CONCLUSION

Knee pain and back pain both exert negative effects on outcome instruments designed to measure pain and function. Although mean improvement from pre- to postoperative KOOS JR scores for patients with severe pre-existing back pain was higher than their counterparts, this statistical difference is likely not clinically significant. This implies that all patients may experience similar benefits from TKA despite the presence or absence of back pain. Attempts to measure TKA outcomes using PROMs should seek to control for lumbago and other sources of body pain. Level of Evidence IIIRetrospective Cohort Study.

Rates, costs and determinants of lumbar spine imaging in population-based women born in 1973-1978: Data from the Australian Longitudinal Study on Women's Health

Objective

There are concerns that lumbar spine imaging represents low value care. Our aim was to examine the use of lumbar spine imaging [radiography, computed tomography (CT), magnetic resonance imaging (MRI)] over 20 years, and costs and person-level characteristics of imaging in a large cohort of Australian women.

Methods

The Australian Longitudinal Study on Women’s Health (ALSWH) is a longitudinal population-based survey of women randomly selected from national health insurance scheme (Medicare) database. This study examined 13458 women born in 1973–1978 who consented to link their ALSWH and Medical Benefits Scheme records. Self-reported data on demographics, body mass index, depression, physical and mental health, and back pain were collected in each survey performed in 1996, 2000, 2003, 2006, 2009, 2012, and 2015. Data on lumbar spine imaging from 1996 to 2015 were obtained from the Medical Benefits Scheme database.

Results

38.9% of women underwent some form of lumbar spine imaging over 20 years. While radiography increased from 1996 to 2011 and decreased thereafter, CT and MRI continued to increase from 1996 to 2015. In women with self-reported back pain, depression and poorer physical health were associated with imaging, with no significant differences in types of imaging. Based on imaging rates in ALSWH, the estimated costs for Australian women aged 30–39 years were AU$51,735,649 over 2011–2015.

Conclusions

Lumbar spine imaging was common in population-based Australian women, with rates increasing over 20 years. Depression and poor physical health were associated with lumbar spine imaging. Raising awareness of this in clinicians is likely to result in significant cost savings if clinical guidelines are followed, with the potential of freeing resources for high value care and health outcomes.

Impact of COVID-19Quarantine on Low Back Pain Intensity, Prevalence, and Associated Risk Factors among Adult Citizens Residing in Riyadh (Saudi Arabia): A Cross-Sectional Study

This study aimed to estimate the effect of the coronavirus disease 2019 (COVID-19) quarantine on low back pain (LBP) intensity, prevalence, and associated risk factors among adults in Riyadh (Saudi Arabia). A total of 463 adults (259 males and 204 females) aged between 18 and 64 years and residing in Riyadh (Saudi Arabia) participated in this cross-sectional study. A self-administered structured questionnaire composed of 20 questions regarding demographic characteristics, work- and academic-related aspects, physical activity (PA), daily habits and tasks, and pain-related aspects was used. The LBP point prevalence before the quarantine was 38.8%, and 43.8% after the quarantine. The LBP intensity significantly increased during the quarantine. The low back was also the most common musculoskeletal pain area. Furthermore, during the quarantine, a significantly higher LBP intensity was reported by those individuals who (a) were aged between 35 and 49 years old, (b) had a body mass index equal to or exceeding 30, (c) underwent higher levels of stress, (d) did not comply with the ergonomic recommendations, (e) were sitting for long periods, (f) did not practice enough physical activity (PA), and (g) underwent teleworking or distance learning. No significant differences were found between genders. The COVID-19 quarantine resulted in a significant increase in LBP intensity, point prevalence, and most associated risk factors.

Adaptive trunk sway velocities following repeated perturbations in subjects with and without low back pain

Faster trunk motions could be a strategy to prevent loss of balance and fall injuries due to unexpected perturbations. However, it is unclear how trunk sway velocities can be compensated during stepping in subjects with low back pain (LBP). The purpose of this study was to investigate lower limb reaction, swing, and step times, as well as trunk sway velocities at heel strike and toe-off, following repeated step perturbations between subjects with and without LBP. There were 30 subjects with LBP and 42 control subjects who were exposed to treadmill-induced perturbations at a velocity of 0.12 m/sec for 0.62 m. The treadmill-induced steps caused subjects to walk forward for 4.90 sec after the perturbation. The groups demonstrated significant interactions on the lower limb reaction times and on the number of repeated perturbations (F = 4.83, p = 0.03) due to a decreased step time at the first perturbation (t = 2.52, p = 0.01) in the LBP group. For the trunk sway velocities, the repeated perturbations demonstrated a significant interaction between groups (F = 4.65, p = 0.03). This adaptive trunk strategy for gait stability increased step times with repeated perturbations in the LBP group. The group interactions on the trunk sway velocities also indicated a possible somatosensory integration for step time adjustments to avoid potential fall hazards. This adaptive response with repeated step perturbations could result in compensatory trunk sway for gait stability.

Risk factors for episodes of back pain in emerging adults. A systematic review

BACKGROUND AND OBJECTIVE

The transition from adolescence to adulthood is a sensitive period in life for health outcomes, including back pain. The objective was to synthesize evidence on risk factors for new episodes of back pain in emerging adults (18-29 years).

METHODS

The protocol was registered in PROSPERO (CRD42016046635). We searched Medline; EMBASE; AMED and other databases up to September 2018 for prospective cohort studies that estimated the association between risk factor(s) and self-reported back pain. Risk factors could be measured before or during the age range 18-29 years, and back pain could be measured during or after this age range, with at least 12 months between assessments. Risk factors assessed in ≥3 studies were summarized. Risk of bias was assessed using a 6-item checklist.

RESULTS

Forty-nine studies were included with more than 150 different risk factors studied. Nine studies had low risk of bias, 26 had moderate and 14 had high risk of bias. Age, sex, height, body mass index (BMI), smoking, physical activity level, a history of back pain, job satisfaction and structural imaging findings were investigated in three or more studies. History of back pain was the only risk factor consistently associated with back pain after adjustment (nine studies).

CONCLUSION

There is moderate quality evidence that a history of back pain is a risk factor for back pain. There are inconsistent associations for age, sex, height, BMI, smoking and activity level. No associations were found between job satisfaction and structural imaging findings and back pain.

SIGNIFICANCE

Emerging adulthood is a transitional period of life with changes in life style, potentially influencing future musculoskeletal health. This systematic review included 49 articles evaluating more than 150 potential risk factors for back pain, one of the most prevalent musculoskeletal disorders. No consistent results were found for life style factors such as physical activity level or BMI, both highlighted as important risk factors in previous literature. Importantly, a previous episode of back pain was a consistent risk factor for a new episode of back pain across several studies, and further investigation of risk factors for the first back pain episode is needed.

Back pain and its risk factors in Brazilian adolescents: a longitudinal study

Owing to the lack of longitudinal studies in Latin American countries, we aimed to evaluate back pain and its risk factors in a 3-year longitudinal study of Brazilian adolescents. We analysed data of 525 adolescents (aged 11-16 years) attending primary school (fifth to eighth grade) in Brazil. The students were administered the self-reported Back Pain and Body Posture Evaluation Instrument (BackPEI) questionnaire in 2011 and at a follow-up evaluation that was conducted 3 years later (2014). Back pain was the outcome variable; the exposure variables included exercise, behavioural, hereditary and postural factors. Generalized estimating equations were used to perform a Poisson regression model with robust variance to evaluate the risk factors for back pain. The prevalence of back pain at baseline was 56% (n = 294); this increased significantly at the 3-year follow-up evaluation to 65.9% (n = 346). The frequency of experiencing back pain also significantly increased after 3 years in both boys (p = 0.002) and girls (p = 0.001). The prevalence of back pain increased significantly in adolescents up to the age of 13 years, stabilized in those aged 14 years and older and was higher among girls. A family history of back pain (in the parents), watching television for lengthy periods and carrying a backpack asymmetrically were predictors for back pain.

Diastasis of rectus abdominis muscles in low back pain patients

BACKGROUND

Abdominal muscles are important spinal stabilizers and its poor coordination, as seen in diastasis of rectus abdominis (DRA), may contribute to chronic low back pain (LBP). However, this has not yet been studied directly.

OBJECTIVES

To conduct a pilot study to examine the association between DRA and LBP.

METHODS

Using a digital caliper, standard clinical DRA measurement was performed in 55 participants with and 54 without chronic LBP.

RESULTS

Participants were on average 55 years old, 69 (63%) were women. Among the 16 participants with DRA, 11 (69%) had chronic LBP; among the 93 participants without DRA, 44 (47%) had LBP. Among men, 7 of 9 (77%) with DRA had LBP and 14 of 31 (45%) without DRA had LBP. Among women, 4 of 7 (57%) with DRA had LBP and 30 of 62 (48%) without DRA had LBP. BMI was the strongest correlate of DRA and may explain the relation between DRA and chronic LBP.

CONCLUSIONS

DRA and LBP may be interrelated, especially among men. This may be a function of greater BMI in individuals with chronic LBP. Understanding the association between DRA, LBP, and BMI may have important implications for treatment of LBP and for intervention.

Back pain in physically inactive students compared to physical education students with a high and average level of physical activity studying in Poland

BACKGROUND

The aim of the study was (1) to characterise back pain in physically inactive students as well as in trained (with a high level of physical activity) and untrained (with an average level of physical activity) physical education (PE) students and (2) to find out whether there exist differences regarding the declared incidence of back pain (within the last 12 months) between physically inactive students and PE students as well as between trained (with a high level of physical activity) and untrained (with an average level of physical activity) PE students.

METHODS

The study included 1321 1st-, 2nd- and 3rd-year students (full-time bachelor degree course) of Physical Education, Physiotherapy, Pedagogy as well as Tourism and Recreation from 4 universities in Poland. A questionnaire prepared by the authors was applied as a research tool. The 10-point Visual Analogue Scale (VAS) was used to assess pain intensity. Prior to the study, the reliability of the questionnaire was assessed by conducting it on the group of 20 participants twice with a shorter interval. No significant differences between the results obtained in the two surveys were revealed (p < 0.05).

RESULTS

In the group of 1311 study participants, 927 (70.7%) respondents declared having experienced back pain within the last 12 months. Physically inactive students declared back pain frequency similar to the frequency declared by their counterparts studying physical education (p > 0.05). Back pain was more common in the group of trained students than among untrained individuals (p < 0.05). Back pain was mainly located in the lumbar spine.

CONCLUSIONS

A frequent occurrence of back pain (70.7%) was noted in the examined groups of students. The percentage of students declaring back pain increased in the course of studies (p < 0.05) and, according to the students' declarations, it was located mainly in the lumbar spine. No significant differences regarding the incidence of back pain were found between physically inactive students and physical education students (p > 0.05). The trained students declared back pain more often than their untrained counterparts (p < 0.05).