Parameters of low back pain chronicity among athletes: associations with physical and mental stress

Objective: In the general population, physical and mental stress factors are linked to chronic low back pain (LBP). The aim of the present study was to examine this association among athletes

Die Rolle des Körperbildes bei Rückenschmerz

Rückenschmerzen sind ein multifaktorielles Geschehen und deren Ursachen für die Entstehung und Aufrechterhaltung äußerst individuell. In der vorliegenden Arbeit soll das Konzept des Körperbildes als möglicher weiterer Faktor diskutiert werden. Hierzu wurden in der ersten Studie Rückenschmerzpatienten und gesunde Kontrollpersonen hinsichtlich ihres Körperbildes verglichen. Es zeigte sich, dass chronische Rückenschmerzpatienten ein negativeres Körperbild aufweisen als Gesunde. In der zweiten Studie konnte dargelegt werden, dass Athleten ein positiveres Körperbild der $\textit {Körperlichen Effizienz}$ angaben als Nicht-Athleten. Zudem scheinen Patienten mit einer emotional positiv gefärbten Schmerzverarbeitung auch ein positiveres Körperbild zu haben. Die Befunde lassen auf eine hohe Relevanz des Körperbildes im Kontext von Rückenschmerzen schließen. Die Berücksichtigung des Körperbildes könnte somit ein vielversprechender Ansatz in der Behandlung von Rückenschmerzen sein

Full Title: Examining the Presence of Back Pain in Competitive Athletes: A Focus on Stress and Recovery

Context - Explanatory approaches for back pain (BP) in athletes focus on biomechanical factors while neglecting psychological perspectives. Psychological factors have gained importance in the prediction of injuries in athletes and BP in the general population, with stress and recovery emerging as central risk factors. However, scarce evidence exists regarding the role of these aspects for the prevalent burden of back pain (BP). Objective - To investigate the association between stress and recovery parameters and the presence of BP. Design - Cross-sectional design. Setting - The questionnaires were distributed after the training sessions. Participants - A total number 345 competitive athletes (Mage = 18.31, SDage = 5.40) was investigated. The classification of the athletes' competitive status was based on performance level. Interventions - Data were collected using questionnaires for the assessment of stress, recovery, and BP. Main outcome measures - We performed a multiple logistic regression to obtain Odds Ratios (OR) for stress and recovery parameters with regard to the outcome variable BP status. Results - For stress, the dimension Overall Stress (OR = 1.83, 95 % CI [1.30-2.59], p = .001) and the scale Physical Complaints(OR = 1.68, 95 % CI [1.25-2.25], p = .001) of the general version of the Recovery-Stress Questionnaire (RESTQ-Basic) resulted to be significantly associated with BP. None of the recovery-related scales displayed a statistically significant relationship with BP. Conclusion - The outcomes of this study imply a modest association between stress and the presence of BP in competitive athletes. Practitioners may take these findings into account regarding the conception of training and for monitoring purposes

Low back pain in athletes and non-athletes: a group comparison of basic pain parameters and impact on sports activity

Introduction: Low back pain (LBP) is a major health issue in athletes and non-athletes often accompanied by considerable restrictions in everyday functioning. Knowledge about differences between those groups regarding LBP parameters (intensity, duration, and disability) and their influence on daily life is still lacking. Hence, the present study aimed at the comparison of those LBP parameters between athletes and non-athletes and the impact of these factors on sports activity. Methods: LBP patients receiving prescribed sport- or physiotherapeutic treatment (N\ua0=\ua0264) completed a questionnaire battery to determine their LBP pain intensity, duration, chronification, disability, and changes in sports activity. The categorization into athletes and non-athletes was based on performance level. Uni- and multivariate analyses of (Co-) variance and nonparametric group comparisons were executed to analyze group differences. Results: Disability was lower in the athlete’s group, especially concerning work ability (p\ua

Recovery-stress patterns and low back pain: differences in pain intensity and disability

Recovery describes a restoring process influencing the health conditions of individuals but a potential link to low back pain (LBP) has not been scrutinized so far. Psychological strategies to deal with LBP have been considered within the biopsychosocial approach but substantial evidence regarding specific psychological underpinnings remains elusive. The current study aimed to compare individuals with different recovery-stress patterns (i.e. specific combinations of recovery/stress) regarding their pain and disability in the lower back.Cross-sectional data from 265 physically active individuals with non-specific LBP were collected via standardized questionnaires. The participants engaged in prescribed exercise therapy provided by a healthcare professional owing to their back burden. A k-means cluster analysis identified three clusters.Cluster 1 entailed individuals with high recovery and low stress values, Cluster 2 represented participants with medium scores on both dimensions and Cluster 3 included participants with low recovery and high stress values. The statistical analyses for pain intensity using analyses of covariance indicated significantly higher values for Cluster 3 compared with Clusters 1 and 2 for worst pain intensity (p\ua

Evaluation of the short-term effects of recovery tools in the rehabilitation of chronic back pain: a feasibility study

Background: Recovery represents an individualised, psychological construct serving as a buffer for health complaints and back pain. Recovery might also help in reducing chronic back pain (CBP) but has not been examined within CBP rehabilitation. Aim: Testing the acute effects of recovery tools to reduce CBP and stress and to improve recovery. Methods: A longitudinal, quasi-randomised pilot study with 55 individuals on sick leave caused by CBP was conducted. The acute effects of a multimodal out-patient rehabilitation programme were evaluated, while recovery tools were conveyed within the intervention group. The control group received regular treatment. Validated psychometric questionnaires to measure CBP, stress and recovery were used. Results: Repeated measures ANOVA indicated significant reductions for Pain Intensity (p

Depression and suicidal ideation in high‐performance athletes suffering from low back pain: the role of stress and pain‐related thought suppression

Depression and suicidal ideation are important health problems in athletes suffering from pain. Dysfunctional pain cognitions, that is, pain-related thought suppression (PTS), may play an important role in their aetiology. Thought suppression was shown to increase depressive mood, particularly in highly stressed individuals. This cross-sectional study examines the relationship between PTS and stress on depression and suicidal ideation in athletes with pain.A total of 159 athletes with non-specific low back pain completed a set of questionnaires to measure PTS, depression and stress. Participants were split into groups with high and low stress, and high and low PTS. Two-way ANOVA calculated main effects for PTS, stress and a PTS*stress interaction, with depressive symptoms as dependent. Subsequently, distribution tests were calculated, investigating if the presence of clinically relevant depression and suicidal ideation is dependent of conditions of high/low PTS and stress.A main effect of stress demonstrated higher depression scores in highly stressed athletes. Further, a significant PTS*stress interaction showed elevated depression scores in athletes with high PTS and high stress. Distribution analysis revealed positive associations between PTS, stress and depression, with depression being most frequent among athletes with high PTS and high stress. Suicidal ideation was not significantly associated with PTS and only weakly correlated with stress.Our findings show that PTS is the most common pain response in athletes with pain. The results indicate a higher prevalence of depression and elevated depressive symptoms in athletes experiencing high stress, seemingly more pronounced when highly engaging in PTS.This study contributes to the understanding of depression in athletes with pain, suggesting stress and pain-related thought suppression to increase symptoms and prevalence of depression. As athletes often experience acute or chronic pain, understanding the impact of pain cognitions on health outcomes is an important step in the optimization of treatments

Body Image Relates to Exercise-Induced Antinociception and Mood Changes in Young Adults: A Randomized Longitudinal Exercise Intervention

Background: An important motivation for adolescents and young adults to engage in aerobic exercise (AE) is to improve fitness, body composition and physical appearance. These parameters have an impact on bodily perception as conceptualized by the ‘body image’ (BI) construct. AE is known to have positive effects on pain perception, mood, and body image (BI). However, no study has hitherto investigated their interrelationship within one study. Methods: Participants were randomly assigned to an intervention group (IG, n = 16, 6 months of AE) or a passive control group (CG, n = 10). Frankfurt Body-Concept Scales (FKKS), Positive and Negative Affect Scale (PANAS), State and Trait Anxiety Inventory, warmth and heat pain thresholds (WPT, HPT), pain tolerance, and graded exercise test data from baseline (T0) and the end of the intervention (T6) were analyzed using a paired t-test (p < 0.05). Results: A significant increase in the BI dimension ‘physical efficacy’ was identified from T0 to T6, which correlated positively with PANAS Positive Affect Scale and HPT. Conclusion: Data in young adults undergoing AE indicate that changes in the BI sub-category ‘physical efficacy’ are closely linked with changes in positive affect and antinociception. These novel findings suggest that BI plays a role in antinociception and positive affect

Psychological pain responses in athletes and non-athletes with low back pain: avoidance and endurance matter

BACKGROUND: Dysfunctional psychological pain responses, namely fear-avoidance (FAR), including catastrophizing and helplessness, as well as endurance-related responses (ER), including thought suppression and overactivity, have been shown to be risk factors for persistent low back pain (LBP). Literature suggests that athletes may differ from non-athletes regarding psychological responses to pain. OBJECTIVES: This study set out to compare FAR and ER between athletes and non-athletes with LBP. It was hypothesized that athletes would report less frequent FAR and more frequent ER, and that both FAR and ER are associated with LBP intensity and disability. METHODS: The 173 athletes and 93 non-athletes cross-sectionally reported how frequently they employ FAR and ER on the Avoidance-Endurance Questionnaire (AEQ), as well as LBP intensity and disability on the Chronic Pain Grade Questionnaire (CPGS). MANOVA was applied to compare FAR and ER between athletes and non-athletes. Hierarchical multiple linear regression models were used to determine the unique associations between FAR and ER with LBP intensity and disability. RESULTS: Athletes reported lower frequencies of behavioural avoidance than non-athletes, but no other FAR variables differed between the groups. Frequencies of ER did not differ between athletes and non-athletes. Regression analysis indicated substantial associations of FAR with LBP intensity, as well as of FAR and ER with disability in athletes and non-athletes. CONCLUSIONS: The results of the present study suggest that athletes and non-athletes with LBP differ regarding behavioural avoidance, but overall, differences regarding pain responses are marginal. FAR and ER are both reported in athletes and non-athletes and contribute to disability in both groups. SIGNIFICANCE: Athletes train to endure pain in the course of athletic socialization, at least in the context of exercise. However, there is sparsity of knowledge about psychological pain responses in athletes with low back pain and whether they differ from those in non-athletes. The results of this comparative study suggest that endurance responses are more frequent than avoidance responses among athletes and non-athletes\ua0alike. However, both types of responses seem relevant to clinical pain management in athletes as well as non-athletes

Psychosocial interventions for back pain in elite sport

$\textbf {Psychosocial interventions}$ for back pain patients are well established elements of treatment regimens and numerous reviews support their effectiveness. Research is sparse regarding the specific case of elite athletes suffering from back pain(BP), and the effects of psychological treatments in this population. $\textbf {Therefore}$, based on a biopsychosocial paradigm, this article describes four intervention approaches with a specific orientation towards athletes’ 1) pain perception and pain management, 2) body experience and body concept, 3) motivation and self-regulation, and 4) stress management and recovery. $\textbf {For each of these four topics}$, a short overview of the key research and existing interventions is given. Based on the overviews of these four topics, specific treatments that have been developed by the authors are described. These treatments particularly aim 1) to gradually increase physical and social activity while reducing BP and disability, 2) to concentrate on positive aspects of body experience, 3) to enhance patients’ self-efficacy and intrinsic motivation for rehabilitation and 4) to promote and monitor individual recovery activities,and relaxation techniques. Evidence concerning the effects and feasibility of these developments is expected from current intervention studies. $\textbf {Future studies}$ are encouraged to examine whether the developed interventions are also effective when offered by trained physiotherapists or physicians in primary care.$\textbf {Psychosoziale Interventionen}$ haben sich im Rahmen der Behandlung von Rückenschmerzen als ein fester Bestandteil etabliert und eine Vielzahl von Literaturübersichten zeigt ihre Effektivität. In Bezug auf die speziellen Aspekte von Leistungssportlern und -sportlerinnen mit Rückenschmerzen und die Effektivität von psychosozialen Maßnahmen im Rahmen ihrer Behandlung ist die Forschungslage jedoch schwach. $\textbf {Daher beschreibt}$ der vorliegende Beitrag auf Basis eines biopsychosozialen Paradigmas vier Interventionsansätze mit spezifischer Ausrichtung auf 1) die Schmerzbewältigung und das Schmerzmanagement, 2) die Körpererfahrung und das Körperkonzept, 3) die Motivation und die Selbstregulation und 4) das Stressmanagement und die Erholung von Sportlern und Sportlerinnen. $\textbf {Für jede der vier Ausrichtungen}$ wird eine kurze Übersicht über die Forschung und bestehende Interventionsansätze gegeben. Basierend auf diesen Übersichten werden spezifische Interventionsansätze dargestellt, die von den Autorinnen und Autoren entwickelt wurden. Diese Interventionsansätze zielen insbesondere darauf ab 1) die körperliche und soziale Aktivität zu erhöhen während Schmerzen und Einschränkungen verringert werden, 2) die Konzentration auf positive Aspekte der Körpererfahrung zu lenken, 3) die Selbstwirksamkeitserwartung und intrinsische Motivation für die Rehabilitation zu erhöhen und 4) individuelle Erholungsmaßnahmen sowie Entspannungstechniken zu fördern und zu begleiten. Belege hinsichtlich der Effekte und Umsetzbarkeit dieser Interventionsansätze werden von aktuell laufenden Studien erwartet. Zukünftige Studiensollen darüber hinaus zeigen, ob die Interventionen auch effektiv sind, wenn sie durch ausgebildete Therapeutinnen und Therapeuten eingesetzt werden