World first study shows back strains and sprains most likely in the morning

Sudden attacks of back pain are more likely to begin in the morning than later in the day, Australian researchers have unexpectedly found.

Back pain is also more likely to be triggered when fatigued or tired or when distracted while performing a manual task.

This world first study of immediate back pain ranks causes of back pain by degree of risk.

Back pain is the third most common health condition managed by GPs in Australia, with treatment costs totalling $4.8 billion a year.

Study leader Associate Professor Manuela Ferreira, of the George Institute for Global Health and Sydney Medical School, The University of Sydney, said around 40% of sprains and strains in the study occurred from 8-11am.

“We’re not sure why people are more likely to trigger an episode of back pain in the morning. It was unexpected.

“Spinal discs swell with fluid overnight, potentially leaving them more susceptible to stresses when loaded.”

Each day back pain affects approximately 25% of the world’s population, and is one of the 10 leading causes of disease burden globally. Back pain is, however, unique amongst this list of 10 diseases because there has been little or no progress in identifying effective prevention strategies.

Associate Professor Ferreira said: “Most of us will have back pain at some point. This study shows that it’s not just long-term stresses on the back that lead to back pain.

“The results of this study are unique, demonstrating for the first time that even brief exposure to a range of physical and psychosocial factors can considerably increase the risk of back pain.

“Just as importantly, this study shows there are several things we can do to prevent back pain – it’s not just something we’re prone to because we have been lifting heavy loads or inactive for a long time.

“The key message is that people should be careful when lifting: even brief exposure to heavy loads, awkward postures or being distracted can trigger an episode of back pain.”

George Institute Musculoskeletal research leader Professor Chris Maher, a senior author on the paper, said previous back pain risk studies have only examined long-term exposure to factors such as smoking and inactivity. Investigations on short-term exposure to transient risk factors occurring immediately before back pain were lacking.

Additionally, no research had ever evaluated whether distraction or fatigue, identified as important factors for other musculoskeletal conditions, trigger back pain.

“Our results have identified factors that trigger back pain and, importantly, which ones are more dangerous. For example being fatigued triples the odds of developing immediate back pain, whereas distraction increases the odds by a factor of 25,” Professor Maher said.

Back pain triggers included (ranked from most risky down):

  1. Distraction during a task
  2. Manual tasks involving awkward postures
  3. Manual tasks involving objects not close to the body
  4. Manual tasks involving people or animals
  5. Manual tasks involving unstable or unbalanced objects
  6. Manual tasks involving heavy loads
  7. Moderate or vigorous physical activity
  8. Fatigue/tiredness

The study also busted popular myths: activities that were not found to trigger back pain included:

  1. Alcohol consumption
  2. Sexual activity

Professor Maher said these results add to our understanding of how to prevent back pain.

“There are really three things people can do to reduce their risk of back pain. Firstly use your back wisely and we have shown here that even brief exposures can be harmful. Secondly adopt a healthy lifestyle: smoking, being overweight, prolonged sitting and/or and being physically inactive are bad for back health.  And lastly stress, either at home or work, seems to increase your chances of getting back pain.

The study looked at 999 patients aged 18 years or older in New South Wales, and was published in Arthritis Care & Research.



Maya Kay, Communications Manager Australia,
The George Institute for Global Health
P: +61 424 195 878