Implications for Physical Activity in the Population With Low Back Pain

Low back pain is considered the most prevalent pain complaint affecting the general population, with a reported lifetime prevalence of up to 75%. It is a recognized societal problem from both a disablement and economic perspective, with costs exceeding that of coronary artery disease, respiratory infections, and diabetes. The traditional concept of low back pain having a favorable natural history paints an overly optimistic prognosis when considering recent epidemiological data. From a prognostic perspective, more than three quarters of individuals will have a recurrence of their symptoms within a year from the initial onset, and up to 40% report a permanent reduction in activity participation. Fear of movement and avoidance of physical activity participation have been associated with a less than desirable prognosis, often times leading to chronicity. Although numerous interventions with often contradictory findings have been described for the population with low back pain, a consensus of research has implicated the resumption and pursuit of appropriate physical activity as an efficacious intervention. This article reviews the current evidence pertaining to physical activity participation in the population with low back pain and provides recommendations for identifying individuals who may be at risk for chronicity resulting from fear and avoidance of activity.