Study Design.Prospective, longitudinal case-crossover study.Objective.The aim of this study was to determine whether physical activities trigger flare-ups of pain during the course of acute low back pain (LBP).Summary of Background Data..There exist no evidence-based estimates for the transient risk of pain flare-ups associated with specific physical activities, during acute LBP.Methods.Participants with LBP of duration <3 months completed frequent, Internet-based serial assessments at both 3-and 7-day intervals for 6 weeks. At each assessment, participants reported whether they had engaged in specific physical activity exposures, or experienced stress or depression, during the past 24hours. Participants also reported whether they were currently experiencing a LBP flare-up, defined as "a period of increased pain lasting at least 2hours, when your pain intensity is distinctly worse than it has been recently." Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for associations between potential triggers during the past 24hours, and the risk of LBP flare-ups, using conditional logistic regression.Results.Of 48 participants followed longitudinally, 30 participants had both case ("flare") and control periods and contributed data to the case-crossover analysis. There were 81 flare periods and 247 control periods, an average of 11 periods per participant. Prolonged sitting (>6hours) was the only activity that was significantly associated with flare-ups(OR 4.4, 95% CI 2.0-9.7; P<0.001). Having either stress or depression was also significantly associated with greater risk of flare-ups (OR 2.5, 95% CI 1.0-6.0; P=0.04). In multivariable analyses, prolonged sitting (OR 4.2, 95% CI 1.9-9.1; P<0.001), physical therapy (PT) (OR 0.4, 95% CI 0.1-1.0; P=0.05), and stress/depression (OR 2.8, 95% CI 1.2-6.7; P=0.02) were independently and significantly associated with LBP flare-up risk.Conclusion.Among participants with acute LBP, prolonged sitting (>6hours) and stress or depression triggered LBP flare-ups. PT was a deterrent of flare-ups.Level of Evidence:

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Suri, P, Rainville, J. (James), de Schepper, E.I.T, Martha, J.F, Hartigan, C. (Carol), & Hunter, D.J. (2018). Do Physical Activities Trigger Flare-ups during an Acute Low Back Pain Episode?. Spine, 43(6), 427–433. doi:10.1097/BRS.0000000000002326