What is the relationship between physical or sedentary activity and the development of low back pain over time?

The more time you spend on moderate to hard physical activity the less likely you are to have persistent, severe lower back pain. This can mean two things: Physical activity protects against developing severe back pain and/or people at risk of severe back pain have low physical activity because they have had back pain before. Therefore, clinicians should encourage patients with low back pain be highly active and help them find ways to be active.

The probability of a patient's low back pain developing into severe pain over the course of a year decreases by 2.8% for every minute the patient increases their physical activity level, especially if the intensity of the activity is moderate to high. Regular activity or sedentary activity probably has no influence on the development of low back pain. These findings are presented in a new study carried out by researchers from Australia and Denmark, including Alice Kongsted from the Chiropractic Knowledge Hub and the University of Southern Denmark, which supports recommendations for physical activity that are adapted to the individual patient.

The researchers base their conclusion on an analysis of data from 329 participants aged 18 or over from the Australian AUTBACK (Australian Twin low BACK pain) registry.

The researchers conducted the study because some previous studies have shown that differences in amount and intensity of physical activity affect low back pain differently. Other studies have shown that sedentary activity is associated with a threefold increase in the risk of having recurrent nonspecific low back pain.

Although this study indicates that more is better, it is important that patients know that even very short-term high-intensity activity has positive effects on health. A very large study from the UK has recently shown that just three short (1-2 minutes) "sprinting activities" during the day reduce mortality significantly1.

Meiyi Huo, Emma Ho, Alice Kongsted, Thomas Patterson, Paulo Ferreira. Association between physical activity, sedentary behaviour and the trajectory of low back pain, The Spine Journal (2023). https://doi.org/10.1016/j.spinee.2023.03.006

1 Stamatakis, E., Ahmadi, M. N., Gill, J. M. R., Thøgersen-Ntoumani, C., Gibala, M. J., Doherty, A., & Hamer, M. (2022). Association of wearable device-measured vigorous intermittent lifestyle physical activity with mortality. Nature Medicine, 28, 2521-2529. https://doi.org/10.1038/s41591-022-02100-x