New research shows back strains and sprains most likely in the morning

In China, at least 1 in 10 people will suffer from back pain in their life time, with new research indicating ways to prevent the condition.

Australian researchers have been surprised to find that sudden attacks of back pain are more likely to begin in the morning than later in the day.

The world first study, which ranks causes of back pain by degrees of risk, has also found that back pain is more likely to be caused when tired or distracted while performing a manual task.

Study leader, Associate Professor Manuela Ferreira of the George Institute for Global Health and The University of Sydney Medical School, said the study found that around 40% of sprains and strains occurred between 8 and 11am.

“We’re not sure why people are more likely to trigger an episode of back pain in the morning. It was unexpected.

“Spinal discs swell with fluid overnight, potentially leaving them more susceptible to stresses when loaded.”

According to the World Health Organisation, back pain in the number one cause of disability in the world, with 25% of the world’s population affected by back pain daily.

Back pain is also one of the 10 leading causes of disease burden globally. Despite this, back pain is the only listed cause where there have been minimal attempts to identifying effective prevention strategies.

In China, at least 1 in 10 people will suffer from back pain in their life time.

Associate Professor Ferreira said: “Most of us will have back pain at some point. This study shows that it’s not just long-term stresses on the back that lead to back pain.

“The results of this study are unique, demonstrating for the first time that even brief exposure to a range of physical and psychosocial factors can considerably increase the risk of back pain.

“Just as importantly, this study shows there are several things we can do to prevent back pain – it’s not just something we’re prone to because we have been lifting heavy loads or inactive for a long time. 

“The key message is that people should be careful when lifting: even brief exposure to heavy loads, awkward postures or being distracted can trigger an episode of back pain.” 

George Institute Musculoskeletal research leader Professor Chris Maher, a senior author on the paper, said previous back pain risk studies have only examined long-term exposure to causes such as smoking and inactivity. There was a distinct lack of research on whether short-term exposure to risk factors occurring before back pain.

Additionally, no research had ever assessed whether distraction or fatigue, identified as important factors for other musculoskeletal conditions, trigger back pain.

“Our results have identified factors that trigger back pain and, importantly, which ones are more dangerous. For example being fatigued triples the odds of developing immediate back pain, whereas distraction increases the odds by a factor of 25,” Professor Maher said. 

Back pain triggers include (ranked from most risky down):

  • Distraction during a task
  • Manual tasks involving awkward postures
  • Manual tasks involving people or animals
  • Manual tasks involving unstable or unbalanced objects
  • Manual tasks involving heavy loads
  • Moderate or vigorous physical activity

The study also busted popular myths: activities that were not found to trigger back pain included:

  • Alcohol consumption 
  • Sexual activity 

Professor Maher said these results add to our understanding of how to prevent back pain. 

“There are really three things people can do to reduce their risk of back pain. Firstly use your back wisely and we have shown here that even brief exposures can be harmful. Secondly adopt a healthy lifestyle: smoking, being overweight, prolonged sitting and/or and being physically inactive are bad for back health.  And lastly stress, either at home or work, seems to increase your chances of getting back pain. 

The study looked at 999 patients aged 18 years or older in New South Wales, and was published in Arthritis Care & Research.