title: Recovery-stress patterns and low back pain: Differences in pain intensity and disability.
abstract: Recovery describes a restoring process influencing the health conditions of individuals but a potential link to low back pain (LBP) has not been scrutinized so far. Psychological strategies to deal with LBP have been considered within the biopsychosocial approach but substantial evidence regarding specific psychological underpinnings remains elusive. The current study aimed to compare individuals with different recovery-stress patterns (i.e. specific combinations of recovery/stress) regarding their pain and disability in the lower back.
  
  
  
  Cross-sectional data from 265 physically active individuals with non-specific LBP were collected via standardized questionnaires. The participants engaged in prescribed exercise therapy provided by a healthcare professional owing to their back burden. A k-means cluster analysis identified three clusters.
  
  
  
  Cluster 1 entailed individuals with high recovery and low stress values, Cluster 2 represented participants with medium scores on both dimensions and Cluster 3 included participants with low recovery and high stress values. The statistical analyses for pain intensity using analyses of covariance indicated significantly higher values for Cluster 3 compared with Clusters 1 and 2 for worst pain intensity (p < 0.001 and p = 0.003, respectively) and mean pain intensity (p < 0.001 and p = 0.001, respectively). The disability comparisons using non-parametric tests showed significantly higher LBP-related disability in Cluster 3 than Cluster 1 on two disability measures.
  
  
  
  The findings indicate an association between detrimental recovery-stress patterns and LBP. Examining the role of recovery has innovative practical relevance for LBP prevention and rehabilitation through the implementation of approaches to enhance recovery in relevant programmes.
authors.affiliation: Unit of Sport Psychology, Ruhr University, Bochum, Germany.
authors.forename: Jahan
authors.initials: J
authors.lastname: Heidari
authors.affiliation: Unit of Sport Psychology, Ruhr University, Bochum, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Mierswa
authors.affiliation: Department of Medical Psychology and Medical Sociology, Ruhr University, Bochum, Germany.
authors.forename: Monika
authors.initials: M
authors.lastname: Hasenbring
authors.affiliation: Department of Health & Social Psychology, German Sport University, Cologne, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Kleinert
authors.affiliation: Department of Medical Psychology and Medical Sociology, Ruhr University, Bochum, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Levenig
authors.affiliation: Department of Health & Social Psychology, German Sport University, Cologne, Germany.
authors.forename: Johanna
authors.initials: J
authors.lastname: Belz
authors.affiliation: Unit of Sport Psychology, Ruhr University, Bochum, Germany.|School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, QLD, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Kellmann
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000523:psychology* / Q000534:rehabilitation; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D013315:Stress, Psychological; D055815:Young Adult
keywords: cluster analysis; musculoskeletal; psychological; spine