The Role Of Psychosocial Stressors On Low Back Pain

The Role Of Psychosocial Stressors On Low Back Pain

Low back pain is one of the most common pains experienced by adults, with 7.5% of the global population estimated to be affected at any one time.(1) From making work more challenging to causing sleep disturbances, living with low back pain is difficult, being the leading cause worldwide of years lived with disability since 1990.(1) Given the frustrating and debilitating nature of low back pain that can interfere with the ability to perform simple household tasks, care for children and loved ones, exercise or work, there’s one common question that our physiotherapists are asked by our clients every day: what is causing my back pain?

Interestingly, many people find it difficult to identify a cause or pinpoint a specific event after which their low back pain began, describing the pain as appearing for no reason.(2) In these cases, we always include one specific potential causative factor as part of our assessment: stress.

The reality is that our modern lives are more stress-inducing than ever before. In fact, the 2021 Cigna wellbeing report has placed Hong Kong residents as the sixth most stressed population globally, with our overall well being index sitting below the global average when compared against the five well-being indices of physical, social, work-related, family and financial well-being.(3) Our community faces an array of psychosocial stressors every day, with lockdowns, social distancing requirements, working from home, schooling from home, closures leading to reductions in physical activity and social interactions that serve to boost our mental health, financial hardships, and much more. Further abroad, the media is constantly reporting grim statistics and unexpected global events that add to our stress each time that we pick up our smartphone or open our web browser.

With a strong connection between psychosocial stress and low back pain, recently we’ve seen an influx of clients with new low back pain symptoms, as well as a resurgence of patients with historical symptoms, or those that are experiencing an exacerbation of other musculoskeletal problems. Here’s a look into why and how we’re seeing this influx, the true impact of psychosocial stressors on your back, and what you can do from home to manage the effects on your body.

Why We Feel Stress

To understand the connection between stress and low back pain, it’s important to understand the very natural - and beneficial - process behind stress. Stress is the body’s reaction to certain situations or thoughts. Stress develops as a protective mechanism in your body, with chemical and physical reactions occurring that are designed to help protect you from harm. Specifically, the stress response involves the release of cortisol and adrenaline alongside an involuntary tightening of your muscles in the neck, shoulders, and down the spine at your back.

From an evolutionary perspective, stress prepares your body for ‘fight or flight’ - either fighting the perceived threat (‘stressor’), or quickly escaping from it. The difference in today’s world is that instead of stress being experienced in isolated incidents that produce an immediate result and resolution of the stressor, we are now experiencing stressors for prolonged periods of time - weeks, months or even years - something that the body is ill-equipped to handle.

How Stress Is Related To Low Back Pain

When we experience stress for prolonged periods or it is left unresolved, the muscle tension that the stress response produces can cause muscles in the low back to tighten, manifesting as additional strain on the body.(4) This tight musculature can potentially lead to low back pain. Stress also heightens the body’s pain sensitivity,(4) which can intensify the low back pain perceived. The mere presence of low back pain can also become a stressor itself,(5) creating a pain cycle that is difficult to break.

A study looking at the contributing factors to the development of new low back pain in nurses in Hong Kong found that being relatively new on a ward and having poor work relationships with colleagues, both of which can be significant cause of psychosocial stressors, are both independent predictors of new low back pain alongside bending frequently during work.(6) Another analysis of back pain from 43 low and middle-income countries found significant associations with back pain and depressive episodes (both brief and of longer length), a symptomatic psychosis diagnosis, anxiety, a person's stress sensitivity, sleep disturbances, and subsyndromal depression,(7) where someone possesses depressive symptoms but they do not meet the clinical criteria to be diagnosed with depression.

Aside from low back pain, other symptoms of stress on the body can lead to headaches, fatigue, digestive issues, hunched shoulders, grinding teeth, jaw pain, neck pain, shoulder pain, and more.

Preventing Stress-Related Low Back Pain

To help reduce your risk of stress-related low back pain, our tips in helping lower the level of stress on the body include:
  • Controlled breathing techniques - deep breathing techniques have been found to be capable of improving both mood and stress, with stress being measured by salivary cortisol levels and heart rate(8)
  • Progressive muscle relaxation - this technique involves tensing specific muscle groups and then releasing the tension to notice how your muscles feel when you relax them. Progressive muscle relaxation has shown an immediate linear trend towards physiological relaxation, along with guided imagery visualisation(9)
  • Exercise - acute bouts of aerobic exercises for a minimum period of 30 minutes have been found to significantly lower the blood pressure response to a psychosocial stressor.(10) Slow, calming exercises involving breath work like Tai Chi are also found to significantly improve psychological wellbeing while reducing stress, anxiety, depression, mood disturbances and improving self-esteem(11)
  • Mindfulness - mindfulness training, otherwise referred to as mindfulness-based stress reduction, is shown to help reduce stress by addressing maladaptive habitual self-views, (12)recognising and letting go of negative thoughts and feelings, and improving self-awareness(13)
  • Reduce social media use - there is a strong positive correlation between social media use and stress, as well as stress triggering social media use,(14) leading to a potential vicious cycle. This relationship is found to be stronger in some people than others, and is linked to how social media is used,(15) so it’s good to reflect on your relationship with social media and how it makes you feel after use.
  • Prioritise a healthy sleep routine - even slight sleep deprivation is shown to affect mood, memory and judgement.(16) Try setting healthy sleep habits such as having a defined bed time, allowing 8-9 hours total sleep per night, and avoiding looking at a screen two hours before you want to go to sleep or use a blue-light filter on your phone.(17)

Physiotherapy Treatment For Low Back Pain

While effective stress management must be a foundation of your care and prevention, once back pain develops, it’s important to get help to manage and relieve the symptoms using evidence-based physiotherapy treatment.

We start with a comprehensive assessment to understand both the physical effects and their severity on your back and body, and use this to form an individualised treatment plan. Alongside the hands-on therapies like mobilisation and massage performed by our experienced and knowledgeable physiotherapists, we’ll also address other common contributors of low back pain such as postural problems, workstations ergonomics, poor motor control, psychosocial stressors and more. Such holistic approaches to physio care for low back pain is shown to provide excellent results in pain reduction while improving muscle tone and mobility.(18) Education and advice for your unique circumstances is also an important part of our care, which is also proven to be effective in reducing both pain and disability for those with chronic low back pain.(19)

To book your appointment with our fantastic team, call us on +852 2801.4801 or book your appointment online.