The search continues for a way to predict and prevent chronic low back pain (CLBP). One theory is that CLBP leads to physical deconditioning. Deconditioning means loss of strength, endurance, and aerobic capacity. Deconditioning is likely to result in more pain. But this theory has never been proven.

In this editorial, the authors comment on the first longitudinal study of patients with LBP. Longitudinal means they followed the patients over a longer period of time to see if deconditioning is really the end product of pain. In this case, the time period was a full year.

The study did not show that deconditioning occurs as a result of CLBP. But the editorial authors point out some ideas to consider before throwing the deconditioning theory out the window.

First, some of the patients might have received treatment during the year long study. They weren't told not to and they weren't asked what, if any, treatment they had. Treatment might have prevented deconditioning.

Second, it's hard to really get an accurate measurement of people’s activity level. They don't always remember what they did. Sometimes they become more active when they know they are being monitored.

It is possible the variables used to measure fitness aren't good tools for assessing deconditioning. Things like body weight, amount of body fat, and muscle strength may not really measure conditioning or deconditioning.

Previous studies have shown that reconditioning isn't as important as other interventions. Reducing fear and worry that comes with pain for some people is more effective in increasing physical activity. This study was a good first start. More research is needed about the role of activity level in CLBP.

Rob J. E. M. Smeets, and Harriët Wittink. The Deconditioning Paradigm for Chronic Low Back Pain Unmasked? [Editorital] In Pain. August 2007. Vol. 130. No. 3. Pp. 201-202.