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Transient Low Back Pain Development During Standing Predicts Future Clinical Low Back Pain in Previously Asymptomatic Individuals

Nelson-Wong, Erika, DPT, PhD*; Callaghan, Jack P., PhD

doi: 10.1097/BRS.0000000000000191

Study Design. Longitudinal, observational.

Objective. To determine if development of transient low back pain (LBP) during prolonged standing in individuals without prior history of LBP predicts future clinical LBP development at higher rates than in individuals who do not develop LBP during prolonged standing.

Summary of Background Data. Prolonged standing has been found to induce transient LBP in 40% to 70% of previously asymptomatic individuals. Individuals who develop pain during standing have been found to have altered neuromuscular profiles prior to the standing exposure compared with their pain free counterparts; therefore, it has been hypothesized that these individuals may have higher risk for LBP disorders.

Methods. Previously asymptomatic participants who had completed a biomechanical study investigating LBP development during standing and response to exercise intervention completed annual surveys regarding LBP status for a period of 3 years. χ2 analyses were performed to determine group differences in LBP incidence rates. Accuracy statistics were calculated for ability of LBP development during standing to predict future LBP.

Results. Participants who developed transient LBP during standing had significantly higher rates of clinical LBP during the 3-year follow-up period (35.3% vs. 23.1%) and were 3 times more likely to experience an episode of clinical LBP during the first 24 months than their non-pain developing counterparts.

Conclusion. Transient LBP development during prolonged standing is a positive predictive factor for future clinical LBP in previously asymptomatic individuals. Individuals who experience transient LBP during standing may be considered a “preclinical” group who are at increased risk for future LBP disorders.

Level of Evidence: N/A

Previously asymptomatic individuals reporting low back pain (LBP) during standing (PD) were followed for 3 years to determine if higher clinical LBP rates would be found compared with non-pain reporting counterparts (NPD). The PD group had significantly higher rates of LBP requiring professional health care during the 3 years than the NPD group.

*School of Physical Therapy, Regis University, Denver, CO; and

Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON.

Address correspondence and reprint requests to Erika Nelson-Wong, DPT, PhD, 3333 Regis Blvd. G-4, School of Physical Therapy, Regis University, Denver, CO 80221 303-964-5484; E-mail:

Acknowledgment date: August 20, 2013. Revision date: December 4, 2013. Acceptance date: December 13, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Dr. Nelson-Wong was supported through PODS I and PODS II Doctoral Scholarships through the Foundation for Physical Therapy, American Physical Therapy Association; Dr. Callaghan holds the Canada Research Chair in Spine Biomechanics and Injury Prevention, and is supported through the Natural Science and Engineering Research Council of Canada (NSERC).

No relevant financial activities outside the submitted work.

© 2014 by Lippincott Williams & Wilkins