This research paper examines the role of patient-identified inciting events in the clinical presentation of lumbar disk herniation. The study aimed to investigate the frequency of patient-identified inciting events and their association with the severity of the clinical presentation.
Think of an inciting event as the moment you feel your back “go out”. This may or may not be followed up with mobility limitations, decrements in strength, radiating pain, and loss or limitations to normal daily functions.
The majority (62%) of lumbar disk herniation cases did not have a specific patient-identified inciting event associated with the onset of symptoms.
Of the 38% of cases where an inciting event was reported, non-lifting physical activities such as simple movements, activities of daily living, and sports activities were the most common, accounting for over one-quarter of all cases. Heavy lifting (6.5%), light lifting (2%), non-exertional occurrences (2%) and physical trauma (1.3%) accounted for relatively small proportions.
The presence of an inciting event was not significantly associated with greater disability, leg pain, or back pain. In fact, when adjusting for potential confounding factors, spontaneous lumbar disk herniation (without an inciting event) was significantly associated with higher disability scores, though the magnitude of this effect was small and likely not clinically meaningful.
There was no significant association between the occurrence of a lifting-related inciting event and the severity of the clinical presentation, even after adjusting for covariates.
Research Conclusion
The authors conclude that the majority of lumbar disk herniations occur without specific inciting events, and the presence of an inciting event does not appear to be associated with increased symptom severity. These findings challenge the notion that vigilant avoidance of activities is necessary to prevent disk herniation, and may be useful in counseling patients with radicular symptoms due to disk herniation.
There is a general narrative that resistance training can cause disk herniations, and the reality is, it can. This study highlights the fact that over 91% of lumbar disk herniations, at least in this population, were related to something other than lifting weights. Resistance training increases capacity and the ability for the body to handle more physical demands, making activities of daily life, more manageable.
In fact, this meta-analysis of eight articles found that 12-16 weeks of posterior chain resistance training had a significantly greater effect than general exercise on pain, level of disability, and muscular strength. This randomized controlled trial found that resistance training, with or without core training, reduced levels of lower back pain, functional disability, stress and creatine kinase (inflammatory marker) levels, and increased the strength the trunk flexors and extensors.
A cool next step for this study would be to explore these findings in different populations: trained vs untrained, body composition and socioeconomic status differences, occupational influences, as well as the role of cumulative stress (work, family, exercise, health status, etc.)