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

Journal article


Oakes, H., DeVivo, M., Stephensen, D. and Mills, H. 2021. Managing flare-ups: The experience of a group of swimmers with persistent low back pain. Physiotherapy. 114 (S1), pp. E220-E221. https://doi.org/10.1016/j.physio.2021.12.208
AuthorsOakes, H., DeVivo, M., Stephensen, D. and Mills, H.
Abstract

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.

KeywordsLow back pain; Swimming; Flare-ups
Year2021
JournalPhysiotherapy
Journal citation114 (S1), pp. E220-E221
PublisherElsevier
ISSN0031-9406
Digital Object Identifier (DOI)https://doi.org/10.1016/j.physio.2021.12.208
Official URLhttps://doi.org/10.1016/j.physio.2021.12.208
Publication dates
Print01 Feb 2022
Publication process dates
Deposited03 Mar 2022
Output statusPublished
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De Vivo, M. and Mills, H. 2017. A mixed methods approach to advance the understanding of physical activity behaviour during pregnancy. Journal of Sports Sciences. 35 (S1), pp. 22-23. https://doi.org/10.1080/02640414.2017.1378421
Experiences of physical activity during pregnancy resulting from in vitro fertilisation: an interpretative phenomenological analysis
Walker, C., Mills, H. and Gilchrist, A. 2017. Experiences of physical activity during pregnancy resulting from in vitro fertilisation: an interpretative phenomenological analysis. Journal of Reproductive and Infant Psychology. https://doi.org/10.1080/02646838.2017.1313968
Why absence of evidence of risk is not the same as evidence for absence of risk
Mills, H., De Vivo, M. and Beedie, C. 2017. Why absence of evidence of risk is not the same as evidence for absence of risk. Canterbury Christ Church University.
“Already tired – do I need to be more tired?!” Eliciting the modal salient exercise beliefs of pregnant women in East Kent (United Kingdom).
De Vivo, M. and Mills, H. 2015. “Already tired – do I need to be more tired?!” Eliciting the modal salient exercise beliefs of pregnant women in East Kent (United Kingdom).
Clinical outcome measures for monitoring physical function in pediatric obesity: An integrative review
Mahaffey, R., Morrison, S.C., Stephensen, D. and Drechsler, W.I. 2016. Clinical outcome measures for monitoring physical function in pediatric obesity: An integrative review. Obesity. 24 (5), pp. 993-1017. https://doi.org/10.1002/oby.21468
Examining the effectiveness of the theory of planned behaviour in explaining exercise intention and behaviour during pregnancy: a meta-analysis
De Vivo, M., Hulbert, S., Mills, H. and Uphill, M. 2016. Examining the effectiveness of the theory of planned behaviour in explaining exercise intention and behaviour during pregnancy: a meta-analysis. Journal of Reproductive and Infant Psychology. https://doi.org/10.1080/02646838.2015.1118022
Public attitudes toward people with intellectual disabilities after viewing Olympic or Paralympic performance
Ferrara, K., Burns, J. and Mills, H. 2015. Public attitudes toward people with intellectual disabilities after viewing Olympic or Paralympic performance. Adapted Physical Activity Quarterly. 32 (1), pp. 19-33. https://doi.org/10.1123/apaq.2014-0136
“I could have gone off much harder”. Post-race counterfactual thinking in indoor rowers.
Dray, K., Uphill, M., Mills, H. and Southam, M. 2015. “I could have gone off much harder”. Post-race counterfactual thinking in indoor rowers.
Examining the effectiveness of the Theory of Planned Behaviour in predicting exercise intention and behaviour during pregnancy: Preliminary findings from a random effects meta-analysis
De Vivo, M., Hulbert, S., Mills, H. and Uphill, M. 2014. Examining the effectiveness of the Theory of Planned Behaviour in predicting exercise intention and behaviour during pregnancy: Preliminary findings from a random effects meta-analysis.
Exploring perceptions of success within an exercise referral scheme: a mixed method investigation
Mills, H., Crone, D., James, D. and Johnston, L. 2012. Exploring perceptions of success within an exercise referral scheme: a mixed method investigation. Evaluation Review. 36 (6), pp. 407-429. https://doi.org/10.1177/0193841X12474452
The potential power of the Paralympics - changing attitudes towards people with intellectual disabilities
Parrot, K., Burns, J., Mills, H. and Baker, P. 2012. The potential power of the Paralympics - changing attitudes towards people with intellectual disabilities.
'Even if you can’t skip, you have a skip in your step when you walk out of the gym': a study into patients' perceptions of an exercise referral scheme
Mills, H., Crone, D., Johnston, L. and James, D. 2007. 'Even if you can’t skip, you have a skip in your step when you walk out of the gym': a study into patients' perceptions of an exercise referral scheme.
Emotional intelligence: associations with emotions, emotion regulation and rowing performance
Uphill, M. and Mills, H. 2011. Emotional intelligence: associations with emotions, emotion regulation and rowing performance. British Journal of Sports Medicine. 45 (15). https://doi.org/10.1136/bjsports-2011-090606.36
Response to article: Effect of exercise referral schemes in primary care on physical activity and improving health outcomes: systematic review and meta-analysis
Crone, D., James, D., Mills, H. and Johnston, L. 2011. Response to article: Effect of exercise referral schemes in primary care on physical activity and improving health outcomes: systematic review and meta-analysis. British Medical Journal (BMJ). 2011 (343). https://doi.org/10.1136/bmj.d6462
Building Bridges - An innovative tool to capture small health behaviour changes; the development process
Mills, H., Uphill, M. and Weed, M. 2011. Building Bridges - An innovative tool to capture small health behaviour changes; the development process.
Factors associated with exercise referral scheme success
Mills, H. 2009. Factors associated with exercise referral scheme success.
'Even if you can't skip, you have a skip in your step when you walk out of the gym': a study into patients' perceptions of an exercise referral scheme
Mills, H., James, D., Chrone, D. and Johnston, L. 2007. 'Even if you can't skip, you have a skip in your step when you walk out of the gym': a study into patients' perceptions of an exercise referral scheme. Journal of Sports Sciences. 25 (S2), pp. 108-109.
A mixed method investigation into the perception and measurement of success in an exercise referral scheme
Mills, H., Crone, D., James, D. and Johnston, L. 2010. A mixed method investigation into the perception and measurement of success in an exercise referral scheme.
‘Like I say to my dad, it’s not you’re fat, it’s probably muscle’ – exploring young boys’ perceptions of the physical activity and health relationship
Mills, H. and Mendez, K. 2010. ‘Like I say to my dad, it’s not you’re fat, it’s probably muscle’ – exploring young boys’ perceptions of the physical activity and health relationship.
Public health and physical activity
Mills, H., Crone, D. and El Ansari, W. 2009. Public health and physical activity. in: Wilson, F. and Mabhala, M. (ed.) Key Concepts in Public Health Los Angeles SAGE Publications Ltd. pp. 202-206
Factors associated with physical activity referral completion and health outcomes
James, D., Mills, H., Crone, D., Johnston, L., Morris, C. and Gidlow, C. 2009. Factors associated with physical activity referral completion and health outcomes. Journal of Sports Sciences. 27 (10), pp. 1007-1017. https://doi.org/10.1080/02640410903214248