Lifestyle Medicine, Behavioural Modification and Self Care for Managing Low Back Pain

Original Editor - Stacy Schiurring based on the course by Ziya Altug

Top Contributors - Stacy Schiurring, Kim Jackson, Wanda van Niekerk, Lucinda hampton, Jess Bell and Aminat Abolade  

Introduction

Low back pain (LBP) can be a complex and complicated diagnosis to treat. When looking for root causes of LBP, the physiotherapist must at times look beyond physiological causes and consider how the client's behaviours and social supports could be contributing to their LBP. Often a contributing source to a person's LBP is an outside pressure beyond their direct healthcare requirements. These needs reinforce the use of biopsychosocial assessment approach for the treatment of chronic LBP. Preventative strategies and client education are an important parts of physiotherapy care, therapeutic interventions likely to reduce the chronicity of LBP may need to focus not only on biopsychosocial issues related to healthcare but also wider social and lifestyle factors that may perpetuate LBP disability.

Behaviour Modification

Research suggests that modifiable risk factors may play a role in the development of LBP. A 2016 study published in Orthopedics identified nicotine dependence, obesity, depressive disorders, and alcohol dependence as statistically significant risk factors for the diagnosis of LBP.

Substance dependence disorder

Substance Dependence Disorder: an addictive  disorder of compulsive drug use.  It is marked by a cluster of behavioural and physiological symptoms that indicate continual use use the substance despite significant related problems.

Consequences of substance abuse include: Source: lecture

1. Heart disease
2. Cancer
3. Stroke
4. Chronic obstructive lung disease
5. Cirrhosis
6. Familial, social, legal, and economic difficulties

A 2017 study by Skillgate et al. looked at the effect of healthy lifestyle behaviour on chronic low back or neck pain in adults.  The lifestyle factors studied included: participation in regular moderate or high intensity exercise, daily smoking, amount of alcohol intake/week, and consumption of a healthy diet which included fruit and vegetables.  The study found that persons who participated in three of four of these healthy lifestyle choices had protection from LBP in men and neck pain in women at a 4 year follow-up. The authors concluded the study with a recommendation for health lifestyle promotion and the need for further research into the effects of dietary components such as fish, whole grains, legumes, sweetened beverages, and sodium on the pathophysiology of pain.  

Skillgate E, Pico-Espinosa OJ, Hallqvist J, Bohman T, Holm LW. Healthy lifestyle behavior and risk of long duration troublesome neck pain or low back pain among men and women: results from the Stockholm public health cohort. Clinical epidemiology. 2017;9:491.

A 2010 meta-analysis of studies published in The American Journal of Medicine found:

●  Smoking might increase the risk of low back pain, and the association is strongest for chronic or disabling LBP.

●  Smoking might have stronger adverse effects on the lumbar spine in adolescents than adults.

●  Smoking cessation might reduce the risk of seeking care for low back pain and chronic low back pain. Further research is recommended between smoking prevention or cessation education and a reduced incidence or severity of LBP.  

Shiri R, Karppinen J, Leino-Arjas P, Solovieva S, Viikari-Juntura E. The association between smoking and low back pain: a meta-analysis. The American journal of medicine. 2010 Jan 1;123(1):87-e7.

A 2013 systematic review published in Manual Therapy identified that alcohol consumption is likely associated with complex and chronic LBP in persons with alcohol consumption dependence.  While further research is needed, this information can be used by physiotherapists as part of patient education for this population.

Ferreira PH, Pinheiro MB, Machado GC, Ferreira ML. Is alcohol intake associated with low back pain? A systematic review of observational studies. Manual therapy. 2013 Jun 1;18(3):183-90.

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