Daniel Steffens MECHANISMS OF LOW BACK PAIN Belo Horizonte 2015 Daniel Steffens MECHANISMS OF LOW BACK PAIN Tese apresentada ao Programa de Pósgraduação em Ciências da Reabilitação, da Escola de Educação Física, Fisioterapia e Terapia Ocupacional da Universidade Federal de Minas Gerais como requisito à obtenção do título de Doutor em Ciências da Reabilitação O rientadora: Profª. Drª. Leani SM Pereira Co -Orientador: Prof. Dr. Chris Maher Co -Orientadora: Profª. Drª. Jane Latimer Belo Horizonte 2015 S817 Steffens, Daniel 2015 Mechanisms of low back pain. [manuscrito]/.Daniel Steffens – 2015. 245f., enc.: il. Orientadora: Leani Souza Máximo Pereira Co-orientador: Chris Maher Co-orientadora: Jane Latimer Tese (doutorado) – Universidade Federal de Minas Gerais, Escola de Educação Física, Fisioterapia e Terapia Ocupacional. 1. Aptidão física - Teses. 2. Dor Lombar - Teses. 3. Incapacidade - Teses. I. Pereira, Leani Souza Máximo. II. Maher, Chris. III. Latimer, Jale. IV. Universidade Federal de Minas Gerais. Escola de Educação Física, Fisioterapia e Terapia Ocupacional. V. Título. CDU: 612.76 Ficha catalográfica elaborada pela equipe de bibliotecários da Biblioteca da Escola de Educação Física, Fisioterapia e Terapia Ocupacional da Universidade Federal de Minas Gerais. i Supervisors’ Statement As supervisors of Daniel Steffens’ doctoral work, we certify that we consider his thesis “Mechanisms of Low Back Pain” to be suitable for examination. Professor Leani de Souza Máximo Pereira Universidade Federal de Minas Gerais Date: 01.01.2015 Professor Christopher Maher The George Institute for Global Health Date: 01.01.2015 The University of Sydney Professor Jane Latimer The George Institute for Global Health Date: 01.01.2015 The University of Sydney ii Candidate’s Statement I, Daniel Steffens, hereby declare that this submission is my own work and that it contains no material previously published or written by another person except where acknowledged in the text. Nor does it contain material which has been accepted for the award of another degree. I, Daniel Steffens, understand that if I am awarded a higher degree for my thesis entitled “Mechanisms of low back pain” being lodged herewith for examination, the thesis will be lodged in the Universidade Federal de Minas Gerais and The University of Sydney libraries and be available immediately for use. I agree that the University Librarian (or in the case of a department, the Head of the Department) may supply a photocopy or microform of the thesis to an individual for research or study or to a library. Daniel Steffens Date: 01.01.2015 iii iv v Acknowledgments My thanks go firstly to my supervisors Prof Leani SM Pereira and Prof Chris G Maher and my co-supervisor Prof Jane Latimer. Leani, all this could not be possible without your persistence and dedication. Chris, you are the best supervisor I could have ever asked for. Your competence, dedication, patience and sense of humour made this journey much easier. You are truly an inspiration to all of us. Jane, your kindness and guidance allowed me to always see the light at the end of the tunnel. You were a great co-supervisor for which I have immense respect and admiration. I would like to acknowledge my appreciation to the Universidade Federal de Minas Gerais and The University of Sydney for establishing the Cotutelle agreement allowing me to pursue my studies. I would also like to thank the George Institute for Global Health for providing the modern infra-structure and support; and the Department of Physiotherapy from the Universidade Federal de Minas Gerais for their support. I am grateful to several people whose advice and support ensured that this thesis was completed. I am indebted to all my co-authors, who played a major role in the construction of each chapter of this thesis. In particular, I would like to thank Dr Mark Hancock for all his support, dedication, mentorship, transparency and willingness to help. You are one of the reasons I started my PhD. To all my friends and colleagues, it is impossible to imagine these four years without the BBQs, beers, laughs and advice. In particular, Zamba, Marcinha, Big Mike, Vinicius, Tarci, Bruno, Tie, Patricia, Gustavo, Marina, Amabile, Saad, Aron, Matt and Richard. You have made all the difference. To all my family, Mum, Dad, brothers and sister, you all have contributed to this. Mum, your unconditional support allowed me to choose my journey. Dad, I miss you and I wish you were here to share this moment with me. Your son will finally become a Doctor. You both were always there for me and I hope I have made you proud. Finally, to the love of my life. Paula, thank you for your support, encouragement and help at every single stage. This thesis is dedicated to you, the most important person in my life. vi Publications and Presentations Parts of the work presented in this thesis have been published and/or presented in the following forms: Publications Steffens D, Maher CG, Ferreira ML, Hancock MJ, Glass T, Latimer J. Clinicians’ views on factors that trigger a sudden onset of low back pain. European Spine Journal. 2014; 23:512-519. Steffens D, Ferreira ML, Latimer J, Ferreira PH, Koes BK, Blyth F, Li Q, Maher CG. What triggers an episode of low back pain? A case-crossover study. Arthritis Care & Research. 2015; 67:403-410. Steffens D, Maher CG, Li Q, Ferreira ML, Pereira LSM, Koes BK, Latimer J. Effect of weather on back pain: results from a case-crossover study. Arthritis Care & Research. 2014; 66:1867-1872. Steffens D, Hancock MJ, Maher CG, Williams C, Jensen TS, Latimer J. Does magnetic resonance imaging predict future low back pain? A systematic review. European Journal of Pain. 2014; 18:755-765. Steffens D, Hancock MJ, Maher CG, Latimer J, Satchell R, Ferreira ML, Ferreira PH, Partington M, Bouvier AL. Prognosis of chronic low back pain in patients presenting to a private community-based group exercise program. European Spine Journal. 2014; 23: 113-119. Steffens D, Hancock MJ, Pereira LSM, Kent PM, Latimer J, Maher CG. Do magnetic resonance imaging findings identify patients with low back pain who respond better to particular interventions? A systematic review. Submitted for publication to European Journal of Pain on 28th October 2014. Steffens D, Maher CG, Ferreira ML, Hancock MJ, Pereira LSM, Williams CM, Latimer J. Influence of clinician characteristics and operational factors on recruitment of participants with low back pain: an observational study. Journal of Manipulative Physiological Therapeutics. 2014; 38:151-158. vii Steffens D, Ferreira ML, Maher CG, Latimer J, Koes BW, Blyth FM, Ferreira PH. Triggers for an episode of sudden onset low back pain: study protocol. BMC Musculoskeletal Disorders. 2012; 24:13-17. Presentations Steffens D, Ferreira ML, Latimer J, Ferreira PH, Koes BK, Blyth F, Li Q, Maher CG. What triggers an episode of low back pain? Results of a Case-crossover study. XIII International Back Pain Forum. Campos do Jordão, Brazil, 2014. Steffens D, Maher CG, Li Q, Ferreira ML, Pereira LSM, Koes BK, Latimer J. Could the weather trigger an episode of acute low back pain? A case cross-over study. XIII International Back Pain Forum. Campos do Jordão, Brazil, 2014. Steffens D, Ferreira ML, Latimer J, Ferreira PH, Koes BK, Blyth F, Li Q, Maher CG. What triggers an episode of low back pain? Results of a case-crossover study. Australian Pain Society, 34th Annual Meeting. Hobart, Australia, 2014. Steffens D, Hancock MJ, Maher CG, Williams C, Jensen TS, Latimer J. Does magnetic resonance imaging predict future low back pain? A systematic review. VIII Pain in Europe. Florence, Italy, 2013. Steffens D, Ferreira ML, Maher CG, Latimer J, Koes BW, Blyth FM, Ferreira PH. Does the method of training of recruiting clinicians influence recruitment to a low back pain case-crossover study. Primary Care Research on Back Pain - XII Odense International Forum. Odense, Denmark, 2012. Steffens D, Ferreira ML, Maher CG, Latimer J, Koes BW, Blyth F, Ferreira PH. Clinician’s views on triggers for sudden onset low back pain. Primary Care Research on Back Pain - XII Odense International Forum. Odense, Denmark, 2012. Steffens D, Hancock MJ, Satchill R, Ferreira ML, Ferreira PH, Maher CG, Partington M, Bouvier AL. Prognosis of patients with chronic low back pain presenting to a private functional group exercise program. Australian Physiotherapy Association Biennial Conference. Brisbane, Australia, 2011. viii Preface This thesis is part of a Cotutelle Agreement between the Universidade Federal de Minas Gerais and The University of Sydney made on 1 August 2011. This thesis is arranged in Ten Chapters, written so that each chapter can be read independently. The Universidade Federal de Minas Gerais and The University of Sydney allow for published papers arising from the candidature to be included in the thesis. Chapter One is an introduction to the thesis and provides an overview of the relevant low back pain literature with a specific focus on aspects related to the mechanisms of back pain. Chapter Two is an observational study conducted to describe short- and long-term factors that primary care clinicians consider important in triggering a sudden episode of acute low back pain. This study is presented as published in the European Spine Journal. Chapter Three is the protocol for the case-crossover study presented in Chapter Four. This protocol is presented as published in BMC Musculoskeletal Disorders. Chapter Four investigates the increase in risk of an episode of sudden onset, acute low back pain associated with transient exposure to a range of physical (e.g manual tasks, vigorous physical activity) and psychosocial factors (e.g. distraction/fatigue). The paper is presented in the format required by Arthritis Care & Research where it has been accepted for publication.