COVID-19, Stress, Sleep, and Impacts on LBP

by | Feb 20, 2021 | I. Issues, III. Solutions, Low Back Pain, Medical Officers | 0 comments

A senior man sits up in bed and grabs his lower back. His face shows that he is uncomfortable and experiencing pain.

Lockdown measures that have been established to manage the ever-evolving COVID-19 pandemic have induced numerous changes across communities worldwide. In areas most affected by these societal changes, sleep quality has been noticeably impacted as a result of decreased mental and physical well-being (1). While some sleep disturbances are expected in individuals living through unprecedented times, connections between sleep quality and chronic lower back pain (LBP) have been well-established. Poor sleep and chronic LBP create positive feedback loops that perpetuate a vicious cycle of discomfort, leading to poorer overall quality of life, mood, function and higher pain catastrophizing (2). These positive feedback loops encapsulate the relationship between sleep and LBP- individuals that report lower sleep quality have lower neuroendocrine production of hormones that contribute to managing pain, outlook, and general temperament. All of these biological processes lead to increased LBP, exhaustion, and create difficulties in regulating sleep (3).

While vaccine distribution and overall community attitude towards combating COVID-19 has provided hope for ending lockdown measures in the near future, many individuals will continue enduring the passive stress created by long, uninterrupted periods working from home.  Increased time periods spent remotely working have led to prolonged sitting in a flexion posture that may worsen LBP as a result of increased intervertebral disk pressure. Motion segment angulation impacts spinal load significantly (4); increased sitting durations as a result of working from home have shown to significantly raise the risk of experiencing LBP. These physical stressors will continue triggering musculoskeletal pain while increasing the prominence of poor sleep quality. Furthermore, researchers recently  discovered that regardless of whether individuals were working virtually or in person, nonspecific LBP increased in the population. This trend can be traced back to event-induced stress and subsequent sleep problems created by the ongoing global pandemic (5). While the exact mechanisms that tie LBP and sleep problems remain a mystery, the direct correlation between quality of sleep and non-specific pain remain clear (6).

Decreased physical activity, social interaction, and quality of sleep all contribute to increased psychological and physical stress during lockdown (7). The ability of individuals to mediate stress and sleep problems relies heavily on their ability to interact with others or utilize outlets for physical activity, such as physical therapy, attending classes to improve joint flexibility, or accessing pools for low-impact cardio exercises (8). With these outlets unavailable, it’s challenging  for  the individual to find activities suited to increase their physical activity, resulting in higher stress, less sleep, and worsening LBP. As tension and exhaustion remain constant in our modern day-to-day lives (9), the duty to prioritize self-care becomes staggering.

Lack of accessible group exercise opportunities, general activity, and in-person professional guidance has left many individuals seeking LBP treatment lost in how to navigate their health. Experts suggest a range of treatment options for individuals looking to independently improve their quality of life with LBP. Key practices such as lumbar support utilization when working remotely, continuing to remain active at home, and practicing safe stretching techniques may all contribute to decreasing pain (10). 

  1. Blume, C., Schmidt, M. H., & Cajochen, C. (2020). Effects of the COVID-19 lockdown on human sleep and rest-activity rhythms. Current biology : CB, 30(14), R795–R797. https://doi.org/10.1016/j.cub.2020.06.021
  1. Gerhart, J. I., Burns, J. W., Post, K. M., Smith, D. A., Porter, L. S., Burgess, H. J., Schuster, E., Buvanendran, A., Fras, A. M., & Keefe, F. J. (2017). Relationships Between Sleep Quality and Pain-Related Factors for People with Chronic Low Back Pain: Tests of Reciprocal and Time of Day Effects. Annals of behavioral medicine : a publication of the Society of Behavioral Medicine, 51(3), 365–375. https://doi.org/10.1007/s12160-016-9860-2
  1. Finan, P. H., Goodin, B. R., & Smith, M. T. (2013). The association of sleep and pain: an update and a path forward. The journal of pain, 14(12), 1539–1552. https://doi.org/10.1016/j.jpain.2013.08.007
  2. Sato, K., Kikuchi, S., & Yonezawa, T. (1999). In vivo intradiscal pressure measurement in healthy individuals and in patients with ongoing back problems. Spine, 24(23), 2468–2474. https://doi.org/10.1097/00007632-199912010-00008 
  1. Toprak Celenay, S., Karaaslan, Y., Mete, O., & Ozer Kaya, D. (2020). Coronaphobia, musculoskeletal pain, and sleep quality in stay-at home and continued-working persons during the 3-month Covid-19 pandemic lockdown in Turkey. Chronobiology international, 37(12), 1778–1785. https://doi.org/10.1080/07420528.2020.1815759 
  1. Sribastav, S. S., Peiheng, H., Jun, L., Zemin, L., Fuxin, W., Jianru, W., Hui, L., Hua, W., & Zhaomin, Z. (2017). Interplay among pain intensity, sleep disturbance and emotion in patients with non-specific low back pain. PeerJ, 5, e3282. https://doi.org/10.7717/peerj.3282
  1. Beck, F., Léger, D., Fressard, L., Peretti-Watel, P., Verger, P., & Coconel Group (2021). Covid-19 health crisis and lockdown associated with high level of sleep complaints and hypnotic uptake at the population level. Journal of sleep research, 30(1), e13119. https://doi.org/10.1111/jsr.13119
  1. Kelley, G. A., & Kelley, K. S. (2017). Exercise and sleep: a systematic review of previous meta-analyses. Journal of evidence-based medicine, 10(1), 26–36. https://doi.org/10.1111/jebm.12236 
  1. Mucci, F., Mucci, N., Diolaiuti, F. (2020). Lockdown and isolation: psychological aspects of COVID-19 pandemic in the general population. Clinical Neuropsychiatry, 17 (2), 63-64.https://doi.org/10.36131/CN20200205 
  1. Koes, B. W., van Tulder, M. W., & Thomas, S. (2006). Diagnosis and treatment of low back pain. BMJ (Clinical research ed.), 332(7555), 1430–1434. https://doi.org/10.1136/bmj.332.7555.1430

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