Lower Back Pain

Low back pain is now the leading cause of disability worldwide. 

"Low back pain is the leading worldwide cause of years lost to disability and its burden is growing alongside the increasing and ageing population" (Buchbinder, et al, 2018)

Globally, years lived with disability caused by low back pain increased by 54% between 1990 and 2015, mainly because of population increase and ageing, with the biggest increase seen in low-income and middle-income countries

Most low back pain is unrelated to specific identifiable spinal abnormalities and therefore I want to take a look at why it is affecting so many of us and what we can potentially do to combat low back pain.


What is Low Back Pain?

"Low back pain is a symptom, not a disease... and is defined by the location of pain, typically between the lower rib margins and buttock creases" (Hartvigsen et al, 2018)

There are some serious causes of persistent low back pain, such as vertebral fracture, infection, and inflammatory disorders. However, these account for a very small proportion of cases. People with low back pain often have concurrent pain in other areas of the body, and more general physical and mental health problems.

How Common is Low Back Pain?

Low back pain is uncommon in the first decade of life, but prevalence increases steeply during the teenage years. Most adults will suffer low back pain at some point. 

Low back pain was responsible for around 60·1 million years lived with disability (YLD) in 2015, an increase of 54% since 1990.4 It is the number one cause of disability globally. In the USA, low back pain accounts for more lost workdays than any other occupational musculoskeletal condition.

Systematic reviews of cohort studies indicate that lifestyle factors such as smoking, obesity, and low levels of physical activity that relate to poorer general health are also associated with occurrence of low back pain episodes or development of persistent low back pain.

What Can be Done to Combat Low Back Pain?

Here are some of the recommendations made by Buchbinder et al (2018) in their recent paper in the Lancet titled "Low Back Pain: A Call to Action": -

  • Call on WHO to put disabling low back pain on the target list for all nations and increase attention on the burden it causes, the need to avoid excessively medical solutions, and the need to integrate low back pain into all chronic disease initiatives - essentially low back pain needs to be given a much greater priority by the WHO
  • Call on international and national political, medical and social policy leaders to adequately fund public health strategies focused on preventing low back pain from interfering with life, ensuring inclusion of disadvantaged and culturally diverse populations - Direct more resources to the fund health strategies to prevent low back pain
  • Call on national and international funding agencies to make low back pain research a global health priority in recognition of its impact on people's lives in all countries
  • Develop and implement strategies to address modifiable risk factors for disabling low back pain at all levels (society, workplace, health professionals, individuals)
  • Integrate back pain care with public health initiatives providing credible advice that people who develop low back pain should stay active and remain working, and that people with low back pain should be supported in early return to work
  • Develop interventions to address misconceptions about low back pain among health professionals, patients, the media, and the general public
  • Promote the concept of living well with low back pain: person-centred care focusing on self-management and healthy lifestyles as a means of restoring and maintaining function and optimising participation
  • Avoid harmful and useless treatments by adopting a framework similar to that used in drug regulation—ie, only include treatments in public reimbursement packages if evidence shows that they are safe, effective, and cost-effective

Buchbinder et al (2018) suggest that  prevalence of long-term disabling low back pain could be reduced by adopting a "positive health approach". Such an approach centres on learning how to cope with a long-term health problem through self-management activities, and learning to seek health care only when needed. Passive approaches such as rest and medication are linked with worsening disability, whereas active strategies such as exercise are associated with reduced disability and less reliance on formal health care.

Looking at the above paragraph, you can see that one of main recommendations the experts are making is for increased exercise/activity, which has to be a priority for the many people who spent the great majority of the day sitting. I wrote an article previously about some simply stretches that can be applied whilst at your desk - see here. Standing desks are becoming increasingly common in the workplace, but even if you don't have access to one, setting a reminder to get up and walk around for a few minutes every hour can be highly beneficial. Either way, making time to move more will be beneficial for your health, waistline and lower back.