Low back pain (LBP) is a leading cause of disability worldwide. A contributing factor to this public health crisis is the large gap that often exists between the treatment approaches that patients seek and current guideline recommendations. Exercise and physical activity are a prime example of this disconnect.
Evidence consistently shows that physical activity and exercise are fundamental to long-term recovery from LBP. However, many patients avoid engaging in activities that they fear will make their LBP worse. A new study, “Transient and Long-Term Risks of Common Physical Activities in People With Low Back Pain,”1 directly addressed this dichotomy by analyzing both the transient and longer-term risks of 10 everyday physical activities for adults with LBP.
Study Overview
This study included 416 adults who had a recent visit to a healthcare clinician for LBP. Using a “case-crossover” design, a method that treats each participant as their own control, real-time data were collected over a one-year period using smartphone surveys.
When a participant experienced a sudden worsening of pain, or “flare,” they were asked to report all the physical activities they had engaged in during the prior 24 hours. This design allowed the investigators to identify potential short-term pain triggers.
The long-term risk of physical activity was also assessed by measuring participants’ overall activity levels during the first eight weeks of the study and linking those findings to self-reported disability one year later.
Key Findings
Study authors found that each additional hour spent on activities including lifting more than 10 pounds, pushing or pulling, bending, twisting, and squatting was associated with a greater likelihood of a flare within the next 24 hours. However, there was no association between flares and standing, walking or climbing. Importantly, there was no association between physical activity and disability scores one year later, even in patients who had experienced flares in the short run.
Clinical Relevance
Movement and exercise are commonly recommended treatments for LBP. However, patients are sometimes reticent to try such approaches because they fear that physical activity will make their pain worse or damage their low back in some way. Findings from this study can help clinicians empower LBP patients to engage in active, evidence-based treatment approaches by acknowledging short-term fears while simultaneously reassuring patients that activity-induced flares are not associated with long-term harm.
Patients with LBP can be encouraged to engage in activities that are meaningful to them, work with their clinician to manage temporary symptoms, and make choices based on overall long-term health rather than fear of injury.
The results of this study help both clinicians and patients better understand the association between physical activity and LBP. Informed LBP management includes acknowledging and managing short-term flares while promoting sustained activity for overall health.
Reference
- Suri P, Timmons AKI, Korpak AM, et al. Transient and long-term risks of common physical activities in people with low back pain. JAMA Netw Open, 2025;8(12):e2547915. Free full text: https://tinyurl.com/4tvpk3r8.
