Lower Back Pain
Obesity Increases the Risk of Lower Back Pain: Studies Confirm This Resoundingly
In a recent article posted on a Reuters affiliated news site, (1) the conclusion that “people who exercise at least one hour per week have a lower risk of troublesome back, neck and shoulder pain” is touted as not very “surprising”. After all, common sense would dictate that this were the case. Despite this, however, there are still studies written by major scientific outlets that do not agree. Many contradictory studies suggest that there is no evidence in current thinking that obesity has anything to do with lower back pain, apart from in the highest extremes of the disease, in which case lower back pain (LBP) is almost always attributed to something else. (2) However, and many of these studies do admit this deficiency in the research conducted, not all factors associated with obesity are studied together and it’s fair to say that no single factor can be responsible for a higher body mass index (BMI) resulting in obesity. The lifestyle choices and medical covariates often associated with obesity as a cause include but are not limited to “low occupational status, sedentary lifestyle and psychological distress.” (3)
Evidence supports obesity influences existence of lower back pain
Despite the inconclusive studies and the research that concludes inconclusive links, there are also many studies which do profess some correlation between obesity and LBP. For example, the Reuters article cited above discusses at length a study conducted by Dr. Paul Mork at the Norwegian University of Science and Technology, who followed a population of 30,000 and more adults participating in a large Norwegian health study. The study, which commenced in the 1980s and lasted 11 years, recorded the BMI of participants at the outset, the frequency at which they conducted exercise and then tracked their lifestyle for the duration of the study. According to the Reuters write-up, the participants were divided into four categories based on their frequency of exercise and a further four categories based on their BMi. Then the researchers further investigated what percentage of the participants developed chronic shoulder, neck and lower back pain.
The Norwegian study came to some pretty resounding conclusions: “men who were exercising 2 hours or more per week at the start of the study were 25 percent less likely to have lower back pain 11 years later, and 20 percent less like (sic) to have neck or shoulder pain, compared [to] men who didn’t exercise at all” (4). Further factors cited in the Norwegian study indicated that contributors such as weight in both men and women significantly “affected the risk of chronic pain later on.” Furthermore, independently, Dr. Adam Goode from Duke University in Durham, North Carolina also confirmed that “quality of life, disability and health care resources” are all affected by the “substantial influence” of chronic neck and back pain (5).
Mechanical load issues and fat hormones responsible
A similar study conducted using young people from Finland concluded that “both low back pain (LBP) and obesity are common public health problems” and that although the precise “mechanisms underlying the association between obesity and LBP are not fully known (...), [obesity] may increase the risk of LBP, for example, because of lumbar disc disorders, through mechanical load.” (6) In fact, this study and several others suggest that mechanical load issues may in fact be the culprit causing obesity issues via “low-grade systemic inflammation.” (7) What this means is that leptin, adipokines and some cytokines (all substances produced during body-fat accumulation) may actually stimulate “the synthesis of pro-inflammatory [toxins] that are directly linked to pain modulation.” (8) A related study on animals showed that the substance leptin “may increase pain sensitivity.” (9) The conclusion from this information is simply that the substances created in your body by body-fat accumulation increase the pain sensitivity of areas that are most likely to be affected by gravitational forces bearing down on a bone structure not developed for carrying the extra weight of the body-fat.
Further studies affirm that overweight people and “obesity increase the risk of low back pain,” (10) and that being “overweight and obesity have the strongest association with seeking care for low back pain and chronic low back pain,” (11) “physical inactivity and high BMI are associated with an increased risk of chronic pain in the low back and neck/shoulders in the general adult population” (12) and a third study “found potentially modifiable risk factors in adolescence that predicted hospital treatments for low back disorders during adolescence and young adulthood.” (13) Again the correlation between obesity and lower back pain is expertly shown as it relates to other significant health-deficient conditions.
Postmenopausal obese women are one high risk group for lower back pain
Finally, In a study fielded by Medical University Pleven, Bulgaria, with data collected from GPs and clinics in the Pleven area: “Obese postmenopausal women often suffer from [lower back pain]” (14) and “the intensity of the pain in postmenopausal women depends on their BMI, and the duration and the type depend on the obesity spots.” (15) The study further illuminates that: “Chronic pains in the back seem to appear due to the statogravitational mechanism exercising a higher pressure on the lower part of the spine due to an increased abdominal mass of fat tissue- with higher estimates of the hip and waist circumferences, as well as the waist-to-hip ratio.” (16) This seems to line up with the reasoning of the study conducted in Finland (17) which indicate obesity-related lower back pain caused by “lumbar disc disorders through mechanical load.”
Lose weight now: combat lower back pain
This is by far no means a survey of all the available literature and it was not the intent of this article to make the studies providing evidence towards a correlation between obesity and lower back pain more credible than the ones denying any link. This despite the fact that most of the studies against a correlation (18) come from an older line of thinking, whereas the newer research coming out of Scandinavia and Bulgaria (19) is more willing to make conclusions about a correlation. In fact, what can be surmised seems to be in accord with the evidence: “The reduction of obesity and especially in the abdominal area fat tissue would significantly improve the quality of life of these women.” (20) This is not just the case for menopausal women, because the issue here is not really whether or not obesity has a direct correlation with lower back pain, but the issue is that obesity is undoubtedly a major health risk and should be tackled by every overweight person as soon as possible by seeking the correct medical advice and weight loss and dietary programs.
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1. Obesity and lack of exercise linked to chronic pain, Eric Schultz, accessed 22nd June 2010, http://in.reuters.com/article/2011/06/20/us-chronic-pain-idINTRE75J6YO20110620
2. ‘Does obesity cause low back pain?’, Garzillo MJ, Garzillo TA., Henderson Center Chiropractic Clinic, King of Prussia, PA 19406; ‘Obesity and Low Back Pain’, Derek Tobin, Tom Shaw, Ellen Daly, GGBPS Research, March 2009
3. ibid.
4. Schultz, Reuters, 2011
5. ibid.
6. The Association Between Obesity and the Prevalence of Low Back Pain in Young Adults: The Cardiovascular Risk in Young Finns Study, Rahman Shiri, Svetlana Solovieva, Kirsti Husgafvel-Pursiainen, Simo Taimela, Liisa A. Saarikoski, Risto Huupponen, Jorma Viikari, Olli T. Raitakari, Eira Viikari-Juntura, American Journal of Epidemiology. 2008;167(9):1110-1119. 2008, Oxford University Press
7. Shiri, et. al., 16-18,20,21
8. ibid., 22
9. ibid., 23
10. The Association Between Obesity and Low Back Pain: A Meta-Analysis, Rahman Shiri, Jaro Karppinen, Päivi Leino-Arjas, Svetlana Solovieva and Eira Viikari-Juntura, Correspondence to Dr. Rahman Shiri, Centre of Expertise for Health and Work Ability, Finnish Institute of Occupational Health, Topeliuksenkatu 41 a A, FIN-00250, Helsinki, October 2009
11. Shiri, et. al.
12. Physical Exercise, Body Mass Index, and Risk of Chronic Pain in the Low Back and Neck/Shoulders: Longitudinal Data From the Nord-Trøndelag Health Study, Tom Ivar Lund Nilsen, Andreas Holtermann and Paul J. Mork, Correspondence to Dr. Paul J. Mork, Department of Human Movement Science, Norwegian University of Science and Technology, N-7491 Trondheim, February 2011
13. Sports, Smoking, and Overweight During Adolescence as Predictors of Sciatica in Adulthood: A 28-Year Follow-up Study of a Birth Cohort, Anni E. Rivinoja, Markus V. Paananen, Simo P. Taimela, Svetlana Solovieva,Annaleena Okuloff, Paavo Zitting, Marjo-Riitta Järvelin, Päivi Leino-Arjas andJaro I. Karppinen, Correspondence to Anni E. Rivinoja, Finnish Institute of Occupational Health, Aapistie 1, 90220 Oulu, November 2010, Finland
14. Obesity and Low Back Pain in Postmenopausal Women, Valeri Ts. Nikolov, Miroslava P. Petkova, Nikolai V. Kolev, Medical University Pleven, Trakia University Stara Zagora, Pleven, 2009
15. Nikolov, et. al., 2009
16. ibid.
17. Shiri, et. al., 2009
18. Garzillo et. al., 2009; Tobin et. al., 2009; and the body of knowledge cited by these studies
19. Mork, et. al., 2011; Shiri., et. al., 2009; Rivinoja., et. al., 2010; Nikolov, et. al., 2009
20. Nikolov, et. al., 2009