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Identification of potential triggers and risk factors for lower back pain can lead to education and prevention measures that reduce incidence and disability.

Affecting approximately 10% of the population worldwide, back pain results in a significant disease burden globally. A new study aimed to determine the potential triggers and risk factors, in an effort to provide evidence for development of effective prevention strategies for lower back pain. Subsequent prevention strategies may aim to reduce exposure to these factors and thereby prevent the onset of lower back pain.

Termed the ‘TRIGGERS’ study for lower back pain, the study specifically looked at physical factors such as heavy loads, awkward positioning, handling of objects far from the body, handling people or animals, unstable loading, slip, trip, or fall, and moderate or vigorous physical activity. Psychosocial factors that were also assessed included consumption of alcohol, distraction, and fatigue. The study was conducted in 300 primary care clinics in New South Wales, Australia, including a total of 999 patients over the age of 18, who presented with a new episode of acute back pain between October 2011 and November 2012. Participants were interviewed to determine the clinical characteristics of their back pain, in addition to information regarding prior exposure to a variety of potential triggers.

The researchers found that the greatest trigger (27.4%) was involving manual tasks using an awkward posture. Heavy loads was the next greatest trigger of lower back pain (17.9%), followed by fatigue and tiredness (11.8%). Each trigger showed a strong association with the onset of lower back pain. The researchers also reported a higher frequency of lower back pain onset occurring in the morning compared with other times of day.

Overall, the study demonstrates for the first time that modifiable physical and psychosocial risk factors increase the risk of onset of lower back pain. While these risk factors did increase the risk of back pain, the results did not change when accounting for physical activity, age, BMI, previous episodes of lower back pain, depression, and anxiety.

The authors suggest that future research should be aimed at developing prevention programs, taking into account the triggers identified in the current study. Education and modification of work-place procedures, for example, could be implemented to reduce the occurrence of lower back pain.


Steffens, D, Ferreira, ML, Latimer, J, Ferreira, PH, Koes, BW, Blyth, F, Li, Q, Maher, CG. “What Triggers an Episode of Acute Low Back Pain? A Case–Crossover Study” Arthritis Care & Research Volume 67, Issue 3, pages 403–410, March 2015.

Image courtesy of Ambro at FreeDigitalPhotos.net







Written by Deborah Tallarigo, PhD

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