lower-back-pain

A recent study done during 2019 1 by several specialists was conducted to uncover the relation of immediate and increasing back pain to exposures to seated postures. It’s a systematic review of studies that include objectively measured sitting time.

What was the Context?

Low back pain (LBP) is one of the most prominent causes of disability globally. The years spent living with a disability caused by LBP has increased to more than 50% in-between 1990 to 2015. For years, prolonged periods of sitting time are reported to be associated with LBP. 

Sitting too much because of your job has been suggested as a risk factor for LBP, however, data to support these claims are slightly unclear. One reason for this lack of data can be linked to the high prevalence of sitting and LBP in the general population. This in addition to the multifactorial nature of LBP itself.

The review study was published and done to carry out a systematic review of studies. It’s aimed to find out if sitting times measured objectively is connected to the swift increase of low back pain (LBP).

It’s measured objectively through a time trial that’s laboratory-controlled, wearable sensors, and direct observation. An increase in LBP is ascertained by the pain scale rating in individuals who are 18 years old and older.

What was the Methodology?

The review protocol was registered with the International Prospective Register of Systematic Reviews on October 19, 2017. The reporting format of the review followed the recommendations and guidelines of the Preferred Reporting Items of Systematic Reviews and Meta-analyses.

The researchers looked at four electronic databases. They were EMBASE, PubMed, SPORTDiscus, and Cumulative Index to Nursing and Allied Health Literature. All four were carefully examined from the beginning up to September 1, 2018. 

Studies used were cross-sectional studies and cohort, and randomized controlled trials. Sitting time was measured objectively, and it was matched with a measure of low back pain in adults. 

figure 1.2 LBP study

However, excluded studies are those with no control session and each done during a separate day. The full-text review, screening, data extraction, and the risk of bias assessment (Quality in Prognosis Studies) of included papers were independently completed by 2 reviewers. There was also a third reviewer present to take care of the disagreements.

What were the Results?

606 articles were pinpointed through the database searches. In addition, 3 articles were identified by reviewing a list of references or relevant papers, along with a hand search. Among these articles, the researchers removed 248 duplicates. 

Titles and abstracts of the 361 remaining articles were screened. For further review of eligibility, 75 full papers were accessed. The 65 articles were excluded. The 10 articles left and the data for 330 participants were included in this study.

All in all, a total of 609 articles have been identified. However, 361 titles and abstracts were screened. Afterward, 75 full-text articles were examined for being eligible. 10 articles fit the criteria for inclusion. 

Every one of them except for 1 reported that sitting time is associated with the immediate increase in lower back pain. 6 of the articles have reported clinically relevant pain levels.

One-half of the studies included were found to have low risks of bias. What remained was determined simply as having a moderate bias risk.

What Has Been Discussed?

The researchers found that sitting down for total durations ranging from 1 hour to 6.96 h/d for 5 days is connected to the immediate increases in LBP in people. 

It happens with and without a clinical history of LBP — both in the field and laboratory settings. Similar results can be found when the studies included only had a low risk of bias.

table 1 01

table 1 02

table 1 03

table 2

The consistency of the findings was high. Participants who have a history of LBP report high levels of pain intensity compared to asymptomatic controls. This was reported after an identical exposure to sitting in a laboratory setting. 

However, pain responses (even if they’re lower) were in both parties, with or without LBP. It is typically assumed that sitting aggravates the existing cases of LBP. But then they also found that sitting also provoked pain in individuals, even if they don’t have a history of lower back pain.

The strength of this review is that a systematic and comprehensive search strategy was used to identify potential articles that are related to the research question. The researchers particularly looked for articles that involved sitting over sedentary behavior. 

The study also has no limitation of time or language. It minimizes the chance of missing potential articles to include.

The objective measures of sitting time are linked to the immediately increased ratings of perceived LBP in adults, with and without a recent history of lower back pain. 

However, it continues to be unknown whether this increase has clinical implications. There’s also an absence of a conclusion in-between sitting and clinically relevant episodes of LBP that can be made.

And based on their findings, the researchers would recommend and suggest prospective studies in the future that would match the objectively measured exposures, which were analyzed objectively with temporally related measures of pain. It is done to determine if sitting time is a trigger of a clinical episode of LBP.

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