New Research Shows Body Image Can Influence Low Back Pain

Zachary Walston

Body image - how you see yourself in the mirror or your mind - can influence your mental wellbeing and diet. A poor body image can result in disordered eating and extreme exercise habits. While many athletes, particularly elite athletes at the collegiate and professional levels, have bodies most people would envy, they too have body image issues.

How is that possible?

It's all relative. Athletes compare themselves to fellow athletes. They may perceive their body being a limiting factor in athletic performance. They need to be 6% body fat instead of 8%. They need more muscle, despite already finding clothes shopping challenging. If they lose one more pound, they can finally break the 4-minute mile mark.

Being in shape and thin does not protect against body image issues.

What is not often discussed is how body image can affect pain and rehabilitation.

How Body Image is Related to Low Back Pain

When assessing the risks for LBP and treatment approaches, biomechanical factors often take center stage. Yet, the transition from acute to chronic pain is largely attributed to psychosocial factors.

The Avoidance-Endurance model of pain contends we respond to pain in one of four ways initially. Our cognition either responds with catastrophizing, thought suppression, focused distraction, or coping.

Catastrophizing leads to fear/anxiety and eventual avoidance of activity causing muscular insufficiencies. Thought suppression and focused distraction lead to endurance behaviors and muscle overload. Coping, however, allows for a flexible balance of avoidance and endurance, leading to the resolution of pain.

Body image is one of the factors that may determine which path an individual takes.

Perceptual aspects of body image include misperceptions of the painful body part (eg, “I can’t find it,” “It feels as though it has shrunk”). Cognitive–affective aspects of body image include negative evaluations of one’s own body with respect to self-acceptance (eg, “I have more physical deficits than others”), health (eg, “I often reach my physical limits”), and physical efficacy (eg, “I am strong”).

This study sought to compare the influence of body image on athletes and nonathletes with LBP.

The results suggest that the participants with eustress endurance response and adaptive response revealed a more positive body image compared with the participants with a fear-avoidance response and distress-endurance response. These findings were consistent for all 3 body image dimensions, such as physical efficacy, self-acceptance, and health. Furthermore, athletes have a more positive body image concerning physical efficacy.

This research suggests that body image can influence risks for developing low back pain. Body image issues may also impair rehabilitation.

While we need more research in the area, it is clear body image concerns should be addressed in all populations, even athletes with bodies perceived as great by the general population.

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I am a physical therapist, researcher, and educator whose mission is to challenge health misinformation. You will find articles about health, fitness, medical care, psychology, and professional development on my site. As the husband of a real estate agent, you will also find real estate and housing tips.

Atlanta, GA

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