Last week I spent a little time looking at activity regulation, and especially looking at over-activity or persistence, rather than the usual under-activity or avoidance pattern. I was reading an in press paper by Hans Heneweer, Luc Vanhees and Susan Picavet, looking at a proposed ‘U-shaped’ relationship between activity and the development of low back pain. In this paper they suggest, using a cross-sectional and correlational design, that both high levels of activity and low levels of activity tend to lead to back pain, while moderate levels of activity protect against it.
I don’t want to go into detail about the study itself, but I do want to ponder about age and general activity level expectations that we might have. In this study, Heneweer et al. suggest that 4 hours a day of heavy physical activity may be associated with an increased risk of low back pain - but I’m curious, does this hold for fit young bucks of 20? Would we (or should we) have the same expectation from a 60 year old?
I’ve often wondered about the expectations that middle-aged labourers have to maintain or persist in their heavy and demanding work. Do they ever think about a time when they won’t be able to keep going? Or is there some sort of expectation that they should be able to persist with heavy work until they retire? And in a compensation environment, where they receive payment and treatment for developing ‘work-related back pain’, how much is due to ‘accident’ and how much is simply natural change over time?
I wonder why people have a belief that they shouldn’t have to make accommodations over time to account for age, mood, life stage or whatever. I know there are some older people who maintain an exceptional level of physical activity, but is this normal or typical?
I do think it might be helpful for researchers to explore how flexible people are about their activity levels. Maybe one factor that could influence disability due to back pain is whether an individual can regulate how much he or she does on any given day. So, on a day when things have been fairly physical demanding, the person may decide to do a little less, while on a day when activities have been more sedentary, the person may decide to go play some tennis or do something more active.
If there is one thing I have personally learned from having a postconcussion syndrome, it’s that I need to be flexible in terms of what I expect from myself. Sometimes it’s a good thing to stop and relax, do something less demanding; other times it feels good to extend myself, to focus and concentrate. The hard thing is deciding which is the better option at any one time! And perhaps that’s the key to developing low back pain - given that it’s a multifactorial entity, I doubt that a simple relationship between activity and back pain alone will explain everything. It’s probably got a lot more to do with perceived fatigue, enjoyment of the activity itself, background mood and other psychosocial factors than simply physical demand.
Maybe this complex set of factors is why helping someone manage back pain can be so challenging. Every day involves making decisions about the right level of activity to undertake at the time. Something some people do with ease, while others are more rule-governed and rigid. I’d love to know whether this is the case!
Heneweer, H., Vanhees, L., & Picavet, H. (2009). Physical activity and low back pain: A U-shaped relation? Pain DOI: 10.1016/j.pain.2008.12.033