Obesity and Low Back Pain
We are pleased to provide another superb blog on obesity and low back pain by our nurse practitioner, Monika Jarzmik, NP. Jump straight to the bottom for 3 quick tips on losing weight to improve your back pain. It is estimated that over 80% of the population will suffer from back pain sometime during their life. Furthermore, amongst those who are classified as overweight (BMI 25-29.9) or obese (BMI > 30) 1/3 will suffer from back pain which could be significantly improved or eliminated with weight loss. It is a fact that most people's backs are a very neglected part of their musculature. While working out most of us concentrate on the abdominal muscles, the pectoral muscles (pecs), the arm muscles, the glutes and even legs because getting these in shape is what makes us look good. The back however is rarely an area of much concern. For that very reason even those who are "fit" are at risk for back injury and back pain. We have many fit, strong athletes come to use with low back pain and they are often very reluctant to consider physical therapy (PT) because they feel they are already strong. However, when tested, even athletes often have back extension strength and control that is well below expected normal. When the additional factor of extra weight is added on, the risk only increases.
So one may wonder why exactly is it that extra weight causes low back pain? The answer is quite complex.
First of all every extra pound of weight (especially belly weight) puts approximately 4 pounds of extra strain on the lower back. In order to compensate for this weight the lumbar spine undergoes unnatural forces and may develop an exaggerated curve forward (lumbar lordosis, also commonly called 'swayback'). This creates an enormous tension on the muscles and ligaments which are supposed to keep the spinal column aligned. Muscle spasms develop and the abnormal forces on the bony structures lead to back pain. Due to the extra weight on the spine, wear and tear is accelerated leading to an increased risk of premature degenerative disc disease (DDD) by as much as 30-79% (https://www.sharecare.com/health/back-pain/article/could-weight-gain-be-the-cause-of-your-back-pain). Please note, of course, as highlighted in a recent blog post, degenerated discs do not ALWAYS create low back pain. When this happens, the annulus fibrosis, which is a tough exterior membrane of the disc, weakens and the disc flattens losing its fullness and height. This in turn can lead to the vertebral bones slipping forward or backward (spondylolisthesis) and in certain cases creating instability of the spine. Loss of disc height also decreases the spaces between each vertebral bone causing more pressure on the little joints in the spine called the facet joints. This can lead to increased destruction of the articulating cartilage, development of arthritis and growth of bone spurs. Obesity can also be a big factor when it comes to disc bulges and disc rupture. Due to the increased forces on the vertebral column and DDD, discs can easily bulge and compress nerves leading to the buttocks, legs and feet. When the disc ruptures, in addition to causing pressure on the nerve structures it spills its inner contents, the nucleus pulposus, and causes direct chemical irritation to the nerves. This may lead to numbness tingling, pain, and muscle weakness. Considering all this it is not surprising that some patients may eventually develop permanent disability. Many folks who struggle with weight and all the problems which may go along with it, find themselves at a loss. They don't know where to start -- it seems as if their life revolves around a vicious cycle--extra pounds lead to lack of activity which leads to fatigue which leads to shortness of breath which leads to depression and lack of motivation and an increased appetite which all in turn leads to activity intolerance and more weight gain.
So where do we begin and how do we make the necessary changes to finally break this crazy cycle?
After all we deserve to be in less pain, have more energy, have confidence in ourselves, be able to accomplish our everyday goals and overall lead a happier life! So the question remains - how do we go about all this? The answer is -- start small, think big, persevere and don't give up no matter how many times you fail! In the meantime get ready for my next post where I will unravel how to go about changing your life for the better! Keep moving! All of us at Eastern Idaho Spine Center