off record
Shaukat Ali Jawaid

Identifying the Triggers
for acute Low Back Pain


About 10% of the world population sometime in their life time is reported to experience low back pain. This is considered as the leading cause of disability according to the World Health Organization’s global Burden of Diseases report in 2010.  Acute low back pain is also reported to have greatest impact on global health as compared to many infectious and non-communicable diseases like malaria, diabetes as well as lung cancer. Despite all this very little progress has been made to identify effective preventive strategies for this extremely painful condition.

Physical and psychological factors are also reported to significantly increase the risk of onset of low back pain. Workers who are engaged in manual tasks which involve awkward positions will increase the risk of low back pain almost eight times according to a study by Daniel and colleagues published in Journal of American College of Rheumatology.1

This highlights the importance of health education, health promotion and understanding the risk factors. For this it is important to identify the triggers and then preventing those as most of them may be easily preventable through health education. Once someone suffers from an acute episode of low back pain, it tends to recur quite frequently hence, preventive measures alone can reduce and minimize the recurrence of this painful condition. Hard work or strenuous activity is not essential for a recurrent episode of low back pain but an awkward position during routine like changing of clothes, combing hairs, putting on socks could trigger an episode of low back pain. Heat therapy followed by back exercises does provide lot of comfort and relief in such situations. Hence, these patients should be advised to be careful while changing clothes and sit down while putting on socks rather than doing this in standing position. One also has to be careful while bending, refrain from lifting weight and avoiding any other awkward position.

The patients should be asked to identify which risk factors work as triggers and then be careful about those which will save them from not only pain but visit to the healthcare facilities. The Australian study reported by Journal of American College of Rheumatology1 also showed that they found, low back pain risk was highest between 7.00 AM and noon something which was not yet known.

In acute conditions, potent pain killers and muscle relaxants are extremely helpful but physiotherapy plays an extremely useful role. In fact physiotherapists are an important members of the healthcare team in the management of low back pain and other muscular problems. Rehabilitation Medicine has now emerged an as important discipline of medicine and health education remains a better option which is also quite cost effective. It has also been observed that those who suffer from low back pain, if they use hard flatbed instead of mattress, the recurrence of low back pain is prevented to a great extent but even then one has to be careful of the other modifiable triggers. Healthcare facilities in general and healthcare professionals in particular need to be fully involved in health education, developing new preventive programmes which could reduce the sufferings from this potentially disabling condition. Workers in the factories should have regular health education programmes where these aspects need to be highlighted as a preventive strategy.


  1. Daniel Steffens, Manuela L. Ferreira, Jane Latimer, Paulo H. Ferreira, Bart W. Koes, et al. What Triggers an Episode of Acute Low Back Pain: A case-crossover study? Arthritis Care and Research. Doi 10.1002/acr.22533.
© Professional Medical Publications. All rights reserved.