Many people I see in my physiotherapy clinics believe that the cold weather is causing a worsening of their back or joint pain. I have often wondered if there is any scientific evidence that would support this claim. So now it’s time to have a look.
I quickly found Finnish, Chinese and Australian trials looking at changes in lower back in relation to cold temperatures, changes in air pressure, or humidity. Acute versus chronic pain was measured, and changes were recorded using standardised, self-reporting patient questionnaires and physical examination.
The studies supporting the hypothesis:
The Finnish study asked 6591 participants aged 25 to 74 about cold-related musculoskeletal pain (CMP) and whether or not they found a temperature threshold (TT) at which pain emerged.
Of the participants 1892 (30%) experienced CMP, in at least one body site.
25.5 % of people reported a temperature threshold. 10% of those people reported TT at -2 °C, 50% at -14 °C ,whilst 90% at -23 °C
(Pienimäki et al 2000, 2014).
Pienimäki (2000) also published an analysis of epidemiological studies and case reports from 1991 to 1998.
This included a study by Chen et al. (1991) investigating low back pain (LBP) amongst other symptoms in 463 male cold store workers aged 21 to 45 in China.
Out of the 463 people, 296 employees were working in cold stores in temperatures between –15 to –25 ºC, and 167 people were in ice stores in –5 and + 5 ºC. The comparison was between them and 152 people who were working in normal temperatures.
The results showed that an average of 52.5% of cold store workers reported low back pain compared to 9.2% of the workers in normal temperatures.
This result was supported by Wang et al (1991) Reporting 46 % of 290 people in low temperatures complained of low back pain, compared with just 3 % of people working in normal temperatures.
Ding et al (1994) Also found that out of 220 people, pain increases were reported by 26% of low temperature workers compared to 10% of people working in normal temperatures.
A Swedish cross-sectional study based on a cohort of 134,754 male construction workers, including 16,496 office workers, showed a higher prevalence of neck and low back pain amongst manual workers versus office workers:
Manual Workers reporting neck pain = 24.3 % vs. lower back pain =8.6 %
Office Workers reporting neck pain = 16.5 % vs. lower back pain =6.2 %
These results supported the hypothesis that outdoor work in a cold environment may increase the risk of neck and low back pain (Burström et al 2013).
The spanner in the works
In contrast the most recent study from Australian researchers (Steffens et al 2016) did not find a link between temperature changes, humidity and an increase in musculoskeletal pain. However, higher wind speeds seemed to slightly increase pain.
The study comprised 993 inhabitants of Sydney with an average temperature of 16.7°C (range −0.7 to 37.5) and an average age of +/- 45 years.
Dr. Daniel Steffens from the George Institute for Global Health at the University of Sydney, Australia argues that despite many patients’ belief that weather impacts their pain symptoms, there is no robust research investigating weather and pain, due to the reliance of patient recall of the weather and symptoms.
He argues however that some evidence for other health conditions and further investigations of the influence of weather on fibromyalgia, rheumatoid arthritis, and osteoarthritis are needed.
It is also not clear if cold exposure increases the risk of back injuries such as intervertebral disk lesions or soft tissue sprains, caused by declined motor and musculoskeletal performance in cold environment (181 International Journal of Circumpolar Health, Health and performance in the cold, workshop, Oulu, 2000, Tuomo Pienimäki, MD, PhD) which would warrant further investigations.
Most studies found some association or a contributing role of cold exposure and low back and/or musculoskeletal pain but is seems mostly in temperatures well below zero and mostly taken in a working environment. The pain experience is subjective and self-reported, and does rely on the person recalling weather conditions and pain onsets. There could also be other factors contributing to the feeling of pain increase, for example physical and psycho social triggers. Looking into other areas of neuroscience, often a belief or expectation of pain, or feeling stressed and exhausted can amplify the pain experience.
Could the belief that weather affects musculoskeletal pain make a difference?
Senior Musculoskeletal Physiotherapist
Shine on the Green
Chen F, Li T, Huang H, Holmer I. A field study of cold effects among cold store workers in China. Arct Med Res 1991; 50: Suppl.6: 99-103.
Ding YF, Huang JZ, Xu Q et al. Health survey of cold store work. Ind Health Occup Dis 1994;20:294-297.
Dovrat E Katz-Leurer M, (2007) Cold exposure and low back pain in store workers in Israel
American Journal of Industrial Medicine, Vol 40,8 p 626-631
Pienimäki, Tuomo, (2000) Cold Exposure and musculoskeletal disorders and disease, A review, Health and performance in the cold, workshop, Regional Institute of Occupational Health, and Department of Sports Medicine, Oulu Deaconess Institute, Finland
Steffens D, Maher C, Li Q, Ferreira M, Pereira L, Koes B, Latimer J (2014) Weather does not affect back pain: Results from a case-crossover study. Arthritis Care & Research
Wang HC, Li TL, Chen F et al. A health survey of cold store workers. Occup Med 1991;18:71-73.