Back pain avoiders might put themselves at risk for more injury, researchers warn
Aug. 6, 2007
By Andrea Gibson
Next time you shift your weight a little or decide to let the neighbor kid shovel the snow in order to avoid that uncomfortable feeling in your low back, think twice.
People who fear aggravating a backache will change the way they move to prevent more pain, a new study finds. But doing so may set the stage for further injury, researchers warn.
In a study published in the journal Spine, Ohio University researchers Jim Thomas and Christopher France examined 36 adults who recently had experienced lower back pain. They split them into two groups: one that confessed a high fear of aggravating the backache and another that was less afraid of re-injury.
The researchers asked participants in both groups to perform a series of three reaching tasks designed to simulate everyday activities such as bending to open a mailbox or leaning to ring a doorbell. Sensors attached to the study subjects recorded their muscle movements.
"I was a clinician for 15 years treating patients who suffered from back pain, and I wanted to know more," said lead researcher Thomas on his reasons for taking on the study in the first place. "Back pain is something so many people suffer from, why not examine it further?"
The study confirmed what researchers have long suspected: People with a high fear of back pain will twist, bend and make other unusual moves to try to avoid more aches. It might be OK to baby sore muscles for a while, but avoiding them for too long can cause them to weaken. When they're called into play unexpectedly -- such as lurching forward to grab a bag of falling groceries -- more injury can occur, said Thomas, an associate professor of physical therapy whose study is funded by a four-year, $1.5 million grant from the National Institutes of Health.
"It's like if you run every day, and then a friend invites you to a game of racquetball," Thomas said, noting that the sports use different muscle groups. "The next day you suddenly feel like you've been run over by a bus."
By joining with France, a professor of psychology, the researchers could link two areas of study that aren't typically related with hopes of improving the skills of clinicians in both fields.
"There are clinicians out there assessing patients' coordination and biomechanics without considering that there are some fear avoidance issues occurring," Thomas noted. "Likewise, there are psychologists observing fear avoidance, but not linking it to a patient's biomechanical movements."
The latest findings are part of a larger study that also is tracking 100 subjects in Athens and Columbus for a year after their recovery from a back pain injury. This second piece, which will wrap up in May 2008, seeks to confirm whether pain avoiders are indeed more likely to re-injure their backs. About half of the data has been collected to date in partnership with Ohio State University, Thomas said.
Researchers hope the study's findings will help physicians create new treatments for this common ailment.
"What appears to be an important finding is that recognizing fear in patients has to be incorporated into a physical therapist's interpretation of patients' movement assessments," Thomas said. "Movements clearly are being made based of people's perceptions of pain."
Eight out of 10 adults will suffer from back pain at some point in their lives. While many of the aches go away on their own, about half of those people will experience a recurrence of pain within the following year. Medical expenses and work absenteeism attributed to back pain disability are estimated at $20 billion to $40 billion per year in the United States, according to the researchers.