Managing flare-ups: The experience of a group of swimmers with persistent low back pain

Purpose: Low back pain (LBP) is often a recurrent and fluctuating condition, therefore developing a flare-up plan could be a valuable self-management tool. The NICE guidelines recommend that people are provided with information and advice to enable them to self-manage LBP, however specific flare-up advice is not included in the guidelines. Flare-ups are an under researched area despite having a significant impact on pain intensity, disability, mood, work, and social life. It is known that some people find it hard to self-manage LBP and that others rarely need to seek care; therefore, learning from the experience of the latter could help the former. The study objective was to understand how a group of swimmers with persistent LBP manage flare-ups.

Methods: 14 swimmers were interviewed for a study exploring the experience of using swimming to manage persistent LBP; one of the questions in the interview guide asked about how they managed flare-ups. The interview transcripts were analysed using thematic analysis; the information relating to flare-ups was reported separately for the purpose of this study.

Results: Both pool and outdoor swimmers participated in this study. They had suffered with LBP from between 3 and 45 years and they were not under the care of a health professional. The following four themes were developed during the analysis. (1) Short-term passive coping strategies; initially the swimmers would ease off and rest, but not for longer than 48–72 h, they would listen to their body, be more careful and adjust their usual routine. Some used analgesic medication, ice and/or heat. (2) Short-term active coping strategies: they spoke about stretching, keeping mobile and functioning. Some adapted their usual swimming routine, but not all and swimming was part of their flare-up plan. (3) Appraisal of flare-up: some of the swimmers wanted to understand why the flare-up had happened, they spoke about prevention of flare-ups and learning from experience. (4) Developing resilience: the words used by this group suggested that they had developed resilience, they did not want to give up and had a positive mindset. Their flare-up plan had evolved over the years and they had confidence in their plan.

Conclusion(s): The findings contrast with a recent qualitative study, which found that passive coping strategies were used more frequently, and active strategies were rarely utilised. In this study the swimmers used a range of short-term passive and active coping methods. Their flare-up plan had evolved with time so that they were using less passive and more active strategies. They were able to appraise and learn from flare-ups and this process may have helped develop their coping skills and resilience. Further work is recommended involving people with LBP who can self-manage flare-ups, enabling development of flare-up guidelines and to establish the optimal timeframe for the use of passive coping strategies.

Impact: Empowering people with time specific advice about rest, medication, ice, heat, stretches and exercise, such as swimming, to use during flare-ups could reduce the strain on health services. This study provides some initial guidance for physiotherapists and direction for future research.