PhD Magdalena Plandowska
Jozef Pilsudski University of Physical Education in Warsaw, Faculty of Physical Education and Health, Biala Podlaska, Poland

Corresponding author: magdalena.plandowska@awf.edu.pl

Abstract

While the effect of a low level of physical activity on the low back pain prevalence is becoming clear, the possible effect of a high level of physical activity in individuals with the low back pain has received less attention to date.

Objective of the study was to characterize the low back pain (within the last year) taking into account the level of physical activity (moderate and high level).

Methods and structure. This study included 94 subjects (62 with low back pain and 32 healthy persons). The subjects were divided into two subgroups, i.e. students with a moderate level of physical activity (MPA) and students with a high level of physical activity (HPA). An original questionnaire was used to assess the low back pain prevalence.

Results and conclusion. This research revealed that the low back pain affected a considerable group of subjects. The subjects with high level of physical activity declared low back pain more often than their peers with the low back pain. Guidelines for the management of the low back pain recommend to stay active and continue with usual activities. Athletes, coaches, physicians, and physiotherapists should be sensitized to the low back pain problem in athletes and seek to integrate prevention programs in daily training.

Keywords: low back pain, physical activity, physically active subjects, moderate level of physical activity, high level of physical activity.

Background. Studies revealed that physical activity is significant for preventing and treating back pain (BP), and the increase in the level of physical activity has become an important part of recommendations in the management of BP [1]. Physical activity exerts an impact on bone modelling, helps to prevent reducing muscular strength, and decreasing postural stability [2,3]. This applies to all people, especially individuals with low back pain (LBP). On the other hand, there is evidence that a high level of physical activity is hazardous on the lower back [4]. While the effect of a low level of physical activity on the LBP prevalence is becoming clear, the possible effect of a high level of physical activity in individuals with LBP has received less attention to date.

Objective of the study was to characterize LBP (within the last year) taking into account the level of physical activity (a moderate and a high level).

Research methods and structure.

Study subjects

This study enrolled 3rd-year students of a Bachelor course in Physical Education. Sixty-two persons with a history of LBP (mean height: 183.1 cm; mean body mass: 81.4 kg), and 32 healthy persons without LBP (mean height: 179.9 cm; mean body mass: 79.3 kg) were qualified for the study. Healthy persons had no history of LBP within the last year. Students with such spinal diseases which may cause BP as Scheuermann’s disease, spondylolysis, spondylolisthesis, rheumatic diseases, tumours, sarcomas, etc., were excluded from the study. The subjects were divided into two subgroups, i.e. (a) students with a moderate level of physical activity (MPA) and (b) students with a high level of physical activity (HPA). The inclusion criteria in the MPA group were as follows: a) attending physical education classes included in the curriculum within three years of studying (each student attends 798 h of sports classes); b) undergoing no sports training at the time of the research or in the past (within the last year); c) taking up leisure-time physical activity no more than once per week and no longer than 60 min. The inclusion criteria in the HPA group were as follows: a) attending physical education classes included in the curriculum; b) training a minimum of  90 min per day – 5 times per week, c) training experience – a minimum of 3 years. The HPA group included individuals who trained one of the following team sports: handball or volleyball.

All the subjects gave their written informed consent. The study was conducted in accordance with the Declaration of Helsinki, and the research was accepted by the Senate Scientific Research Ethics Commission (1/2019).

Questionnaire

A questionnaire was used to assess the LBP prevalence [5]. The first page of the questionnaire included an explanation of the study aim and instructions. The personal information section consisted of questions about age, body mass, and height. The first section of the questionnaire included questions regarding:

a) training (sport) – sports discipline, number of training days per week, number of training hours per day;

b) experiencing LBP within the last year (12 months). LBP was assessed using the following question: „Have you experienced low back pain for the last year (12 months)?”. The answer options were: „no”, „yes”. "Yes” was considered to denote the presence of LBP. Individuals who responded negatively to this question were asked not to answer the remaining questions.

Individuals who declared that they had experienced LBP in the period of the last year answered the question in the second part. The second part of the questionnaire included a question regarding the frequency of LBP, the situation in which LBP occurred or increased, and difficulties in everyday life caused by LBP.

Statistical analysis

The collected material was analysed with the use of Statistica 13.3 calculation software. The qualitative parameters were described using basic measurements of descriptive statistics for qualitative variables, i.e. percentage. Chi square test was used to identify significant differences in the percentage of LBP and healthy subjects at different levels of physical activity, and to compare the frequency of LBP taking into account the level of physical activity.

Results and discussion.

Prevalence and frequency of LBP

Out of 94 study subjects, 62 (66.0%) declared having experienced LBP within the last 12 months. LBP is more common among the subjects with a high level of physical activity (HPA) than among their peers with a moderate level of physical activity (MPA) (72.9% vs. 58.7%, respectively). However, this difference was not significant (p=0.15) (Table 1).

Table 1. The prevalence of LBP taking into account the level of physical activity

LBP – low back pain; MPA – moderate level of physical activity; HPA – high level of physical activity. Statistical significance was set at p<0.05.

The largest group is constituted by respondents who experienced pain rarely, i.e. 1–2 times per year (46.7%). While analysing the frequency of LBP with regard to the level of physical activity, it was noted that the subjects with HPA declared rare pain (1-2 times per year) often than the subjects with MPA (48.4% vs. 44.4%, respectively). Frequent and constant pain (more than 1-2 times per month) was also declared often by students with HPA (34.3% vs. 25.9%, for HPA and MPA, respectively). The difference was not statistically significant (p=0.48) (Table 2).

Table 2 The frequency of LBP taking into account the level of physical activity

LBP – low back pain; MPA – moderate level of physical activity; HPA – high level of physical activity. Statistical significance was set at p<0.05.

Circumstances in which LBP occurred or increased and difficulties in everyday life caused by LBP

The most common circumstances in which LBP occurred or increased included standing (41.9) and sitting (37.1). While analysing the circumstances taking into account the level of physical activity, it was noted that in such circumstances as standing (42.9), physical effort (40.0), and lifting heavy objects (31.4) LBP occurred and increased in the subjects with HPA more often than in the subjects with MPA (Table 3).

Table 3. Circumstances in which LBP occurred or increased and difficulties in everyday life caused by LBP

* The numbers do not add to 100% since the respondents were allowed to choose more than one answer.

LBP – low back pain; PA – physical activity; MPA – moderate level of physical activity; HPA – high level of physical activity.

Difficulties in everyday life associated with LBP were also analyzed. Over 20% of the respondents limited their physical activity, while 7.9% had to give up physical activity altogether due to LBP. The subjects with MPA often limited their physical activity and had to give up because of pain than the subjects with HPA. In 43.5% of the subjects, LBP intensified during physical activity, often among the subjects with HPA. Over 60% of the subjects reported that LBP made it difficult for them to sit for prolonged periods, while prolonged standing was difficult for nearly 50% (Table 3).

The incidence of LBP in athletes has been examined in other studies [6,7]. Studies revealed that similar to the general population, the prevalence of LBP among athletes is high (between 10% to 67%) and LBP seems to be a problem in some sports. LBP occurred more often in sports and competitions which require substantial (especially axial) spinal loads, require a flexed position of the back, and frequent back twisting movements [6]. However, we need to be very cautious before blaming a high level of physical activity – or one particular form of exercise - for the onset or deterioration of LBP. While a high level of physical activity has been associated with an increased risk of self-reported LBP, a moderate level of physical activity protects persons with LBP from returning and chronic pain [4].

Conclusions. This research revealed that LBP affected a considerable group of subjects. The subjects with HPA declared LBP more often than their peers with MPA. Guidelines for the management of LBP recommend remaining active. While  ‘keep  active’  might  seem  an  odd  recommendation  for  athletes  with  LBP,  inactivity for an athlete with LBP can increase their chance of getting injured, which ultimately results in further inactivity and potentially more pain. Emphasizing physical activity as a means to treating LBP remains an appropriate message. Additionally, athletes, coaches, physicians, and physiotherapists should be sensitized to LBP problem in athletes and seek to integrate prevention programs in daily training.

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