ChiroACCESS Article

Improving Low Back Pain and Sciatica with Weight Reduction

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ChiroACCESS Editorial Staff



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February 28, 2013

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Several important studies published during the past year reinforce the association between chronic low back pain, acute low back pain and sciatica to comorbidities like obesity.  This association has been documented across multiple cultures, with a variety of occupations and in diverse age groups.  With low back pain being the most common reason for patients to seek chiropractic care, it is important for the profession to be aware of this significant association as well as develop skills to educate patients on managing obesity.  Weight loss studies, which include conservative management as well as bariatric surgery, have demonstrated reduced low back pain, improved sciatica and increased disc height associated with weight loss. 

Note:  These mini-reviews are designed as updates and direct the reader to the full text of current research.  The abstracts presented here are no substitute for reading and critically reviewing the full text of the original research.  Where permitted we will direct the reader to that full text.

Role of environmental factors and history of low back pain in sciatica symptoms among Finnish adolescents.  [Link]

Spine (Phila Pa 1976). 2013 Jan 24. [Epub ahead of print]

Karjalainen U, Paananen M, Okuloff A, Taimela S, Auvinen J, Männikkö M, Karppinen J.
1Oulu Center for Cell-Matrix Research, Biocenter and Department of Medical Biochemistry and Molecular Biology, University of Oulu, Oulu, Finland 2Department of Physical and Rehabilitation Medicine, Institute of Clinical Medicine, University of Oulu, Oulu, Finland 3Finnish Institute of Occupational Health, Work and Health Ability, and Disability Prevention Centre, Finland 4Department of Public Health, University of Helsinki, Finland 5Institute of Health Sciences, University of Oulu, Oulu, Finland.

Study design. Cross-sectional study in a subcohort of the 1986 Northern Finland Birth Cohort (n = 1987).

Objective. To investigate the role of environmental factors and LBP history in sciatica symptoms among Finnish young adults.

Summary of Background Data. History of low back pain (LBP), smoking, and male gender are associated with sciatica in adult populations. The role of the environmental determinants of sciatica has not been evaluated in populations consisting of adolescents only.

Methods. Sciatic symptoms and environmental exposures were elicited by a postal questionnaire and the associations were analyzed using multinomial logistic regression.

Results. Female gender was associated with severe sciatica at 18 years (OR 3.9, 95% CI 1.6-9.3). Both reported LBP at 16 years and LBP requiring consultation of a health care professional were associated with mild sciatica at 18 years (OR 2.5, 95% CI 1.3-4.9 and OR 3.8, 95% CI 1.2-11.9). In addition, LBP at 16 years requiring consultation of a health care professional was associated with severe sciatica at 18 years (OR 5.0, 95% CI 1.7-15.3). Smoking, obesity, physical workload and level of physical activity were not associated with sciatica.

Conclusions. Females reported sciatic pain more often than males. LBP at 16 years predicted sciatica at 18 years.

Nature or nurture in low back pain? Results of a systematic review of studies based on twin samples.  [Link]

Eur J Pain. 2013 Jan 20.

Ferreira PH, Beckenkamp P, Maher CG, Hopper JL, Ferreira ML.
Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia.

Twin studies are becoming popular to investigate risk factors for low back pain (LBP) because they consider the genetic factor and allow for more precise estimates of risks. We aimed to identify and summarize the results of studies based on twin samples investigating risk factors for LBP. The MEDLINE, CINAHL, LILACS, Web of Science and EMBASE databases were searched. Prospective and cross-sectional observational studies of LBP involving twins were included. The exposure factors could be genetics (heritability) or environmental such as smoking, alcohol consumption, body mass index and medical history. Pooling was attempted using an inverse variance weighting and fixed effects model. Twenty-seven studies were included. Estimates of heritability effects ranged from 21% to 67%. The genetic component was higher for more chronic and disabling LBP than acute and less disabling LBP. Smoking was significantly associated with LBP [pooled odds ratio (OR)?=?3.0; 95% confidence interval (CI) 2.8-3.3] with a longitudinal and a cross-sectional study also identifying a dose-response relationship in people with chronic LBP. Obesity was associated with LBP (pooled OR?=?1.9; 95% CI 1.6-2.2) with a cross-sectional study identifying a dose-response relationship. No association between alcohol consumption and LBP was identified. Co-morbidities such as asthma, diabetes and osteoarthritis were associated with LBP (pooled OR ranging from 1.6 to 4.2). The contribution of genetics to LBP appears to be dependent on the severity of the condition. Twin studies could be better used to explore possible causation paths between lifestyle factors, co-morbidities and LBP.

Body mass index as a risk factor for developing chronic low back pain: a follow-up in the Nord-Trøndelag Health Study.  [Link]

Spine (Phila Pa 1976). 2013 Jan 15;38(2):133-9.

Heuch I, Heuch I, Hagen K, Zwart JA.
Department of Neurology, Oslo University Hospital, Oslo, Norway.

STUDY DESIGN: A population-based, prospective cohort study.

OBJECTIVE: To determine whether overweight, obesity, or more generally an elevated body mass index (BMI) increase the probability of experiencing chronic low back pain (LBP) after an 11-year period, both among participants with and without LBP at baseline.

SUMMARY OF BACKGROUND DATA: Chronic LBP is a common disabling disorder in modern society. Cross-sectional studies suggest an association between an elevated BMI and LBP, but it is not clear whether this is a causal relationship.

METHODS: Data were obtained from the community-based HUNT 2 (1995-1997) and HUNT 3 (2006-2008) studies of an entire Norwegian county. Participants were 8733 men and 10,149 women, aged 30 to 69 years, who did not have chronic LBP at baseline, and 2669 men and 3899 women with LBP at baseline. After 11 years, both groups indicated whether they currently had chronic LBP, defined as pain persisting for at least 3 months continuously during the last year.

RESULTS: A significant positive association was found between BMI and risk of LBP among persons without LBP at baseline. The odds ratio for BMI 30 or more versus BMI less than 25 was 1.34 (95% confidence interval [CI], 1.08-1.67) for men and 1.22 (95% CI, 1.03-1.46) for women, in analyses adjusted for age, education, work status, physical activity at work and in leisure time, smoking, blood pressure, and serum lipid levels. A significant positive association was also established between BMI and recurrence of LBP among women. LBP status at baseline had negligible influence on subsequent change in BMI.

CONCLUSION: High values of BMI may predispose to chronic LBP 11 years later, both in individuals with and without LBP. The association between BMI and LBP is not explained by an effect of LBP on later change in BMI.

The role of obesity and physical activity in non-specific and radiating low back pain: The Young Finns study.  [Link]

Semin Arthritis Rheum. 2012 Dec 25.

Shiri R, Solovieva S, Husgafvel-Pursiainen K, Telama R, Yang X, Viikari J, Raitakari OT, Viikari-Juntura E.
Centre of Expertise for Health and Work Ability, and Disability Prevention Centre, Finnish Institute of Occupational Health, Helsinki, Finland. Electronic address:

OBJECTIVE: To study the effects of obesity, physical activity, and change in physical activity on the incidence of low back pain and explore whether obesity modifies the effects of physical activity.

METHODS: As part of the ongoing Young Finns Study, 1224 subjects aged 24-39 years free from low back pain during the preceding 12 months at baseline in 2001 were included. Obesity was defined based on the body mass index (BMI) and waist circumference, and physical activity was assessed by the metabolic equivalent of task (MET) index in 2001 and 2007.

RESULTS: Abdominal obesity, defined by an increased waist circumference, was associated with an increased incidence of radiating low back pain (adjusted odds ratio (OR) = 1.7 and 95% confidence interval (CI) 1.1-2.7), while it had no effect on non-specific low back pain. BMI was associated neither with the incidence of radiating low back pain nor with non-specific low back pain. Compared with subjects who stayed active during follow-up, those with a low level of physical activity (adjusted OR = 2.0 and 95% CI 1.1-3.5) and active subjects who further increased their physical activity during follow-up (OR = 3.1 and 95% CI 1.5-6.7) had a higher incidence of radiating low back pain. Low level of physical activity was associated with an increased incidence of radiating low back pain in obese (OR = 3.3 and 95% 1.1-10.4), but not in non-overweight subjects (OR = 1.1 and 95% CI 0.6-1.9). Physical activity was not associated with non-specific low back pain.

CONCLUSIONS: Our findings indicate that both obesity and low level of physical activity are independent risk factors of radiating low back pain. The current findings propose a U-shaped relation between physical activity and radiating low back pain. Moderate level of physical activity is recommended for the prevention of low back pain, especially in obese individuals. In all, our findings imply that obese individuals should stay physically active, even if they may not lose weight.

Relations of C-Reactive Protein and Obesity to the Prevalence and the Odds of Reporting Low Back Pain.  [Link]

Arch Phys Med Rehabil. 2012 Nov 24.

Briggs MS, Givens DL, Schmitt LC, Taylor CA.
Health and Rehabilitation Sciences PhD Program, School of Health and Rehabilitation Sciences, Ohio State University College of Medicine, Columbus, OH; Division of Physical Therapy, School of Health and Rehabilitation Sciences, Ohio State University College of Medicine, Columbus, OH; Sports Health and Performance Institute, Ohio State University Sports Medicine, Ohio State University Wexner Medical Center, Columbus, OH. Electronic address:

OBJECTIVE: To assess the odds of reporting low back pain (LBP) as related to systemic inflammation and obesity. DESIGN: Cross-sectional analysis of the 1999 to 2004 National Health and Nutrition Examination Survey (NHANES).

SETTING: National database analysis.

PARTICIPANTS: Population-based sample of 15,322 participants in the 1999 to 2004 NHANES databases.

MAIN OUTCOME MEASURES: Systemic inflammation was measured by C-reactive protein (CRP) and fibrinogen. Obesity was quantified by body mass index and waist circumference (WC). LBP was identified by self-report. Analysis included logistic regression to assess the odds of reporting LBP as related to systemic inflammation and obesity.

RESULTS: It was hypothesized that obesity and systemic inflammation would increase the odds of reporting LBP. Participants with elevated CRP (>3.0mg/dL) had 1.74 (95% confidence interval [CI], 1.04-2.91) greater odds of reporting LBP. Those who were obese (=30kg/m(2)) with elevated CRP had 2.87 (95% CI, 1.18-6.96) greater odds of reporting LBP than those without elevated CRP. When using WC as the measure of obesity, participants with high WC values had significantly greater odds of reporting LBP (odds ratio=2.39; 95% CI, 1.09-5.21).

CONCLUSIONS: To our knowledge, this is the first study showing that high levels of CRP may increase the odds of reporting LBP, especially in those who are obese. These findings warrant further investigation of the interrelations among obesity, systemic inflammation, and LBP.

Low back pain prevalence and associated factors in Iranian population: findings from the national health survey.  [Link]

Pain Res Treat. 2012;2012:653060.

Biglarian A, Seifi B, Bakhshi E, Mohammad K, Rahgozar M, Karimlou M, Serahati S.
Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.

Background. There are very few studies that had a sample size sufficient to explore the association between factors related to low back pain in a representative sample of the Iranian population.

Objective. To examine the relationship between sociodemographic factors, smoking, obesity, and low back pain in Iranian people.

Methods. We used Iranian adults respondents (n = 25307) from the National Health Survey. Adjusted odds ratios and 95% confidence intervals were estimated by using logistic regression.

Results. The prevalence of low back pain was found in 29.3% of the studied sample. High age, female sex, being married, obesity, low-economic index, being smoker, in a rural residence, and low educational attainment, all increased the odds of low back pain.

Conclusions. Our findings add to the evidence on the importance of obesity in relation to low back pain. These results can be used as a basis to reinforce health programs to prevent obesity.

Obesity is a risk factor for musculoskeletal pain in adolescents: findings from a population-based cohort.  [Link]

Pain. 2012 Sep;153(9):1932-8.

Deere KC, Clinch J, Holliday K, McBeth J, Crawley EM, Sayers A, Palmer S, Doerner R, Clark EM, Tobias JH.
Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK.

Obesity is a risk factor for fibromyalgia in adults, but whether a similar relationship exists in children is uncertain. This study examined whether obesity is associated with reporting of musculoskeletal pain, including chronic regional pain (CRP) and chronic widespread pain (CWP), in adolescents, in a population-based setting. A pain questionnaire was administered to offspring of the Avon Longitudinal Study of Parents and Children at age 17, asking about site, duration, and pain intensity, from which participants with different types of musculoskeletal pain were identified. Relationships between obesity and pain were examined by calculating odds ratios stratified by gender and adjusted for socioeconomic status as reflected by level of maternal education. A total of 3376 participants (1424 boys) with complete data were identified, mean age 17.8; 44.7% of participants reported any pain within the last month lasting 1day or longer; 16.3% reported lower back pain, 9.6% shoulder pain, 9.4% upper back pain, 8.9% neck pain, 8.7% knee pain, 6.8% ankle/foot pain, 4.7% CRP, and 4.3% CWP; 7.0% of participants were obese. Obesity was associated with increased odds of any pain (odds ratio [OR] 1.33, P=.04), CRP (OR 2.04, P=.005), and knee pain (OR 1.87, P=.001), but not CWP (OR 1.10, P=.5). Compared with non obese participants, those with any pain, knee pain, and CRP reported more severe average pain (P<.01). Obese adolescents were more likely to report musculoskeletal pain, including knee pain and CRP. Moreover, obese adolescents with knee pain and CRP had relatively high pain scores, suggesting a more severe phenotype with worse prognosis.

The effects of shift work and interaction between shift work and overweight/obesity on low back pain in nurses: results from a longitudinal study.  [Link]

J Occup Environ Med. 2012 Jul;54(7):820-5.

Zhao I, Bogossian F, Turner C.
School of Nursing and Midwifery, The University of Queensland, Brisbane, Australia.

OBJECTIVE: To examine whether shift work is a risk factor for low back pain (LBP) and the interaction effects of shift work and overweight/obesity on LBP over time among nurses.

METHODS: A longitudinal study over 2 years. Measurements included reported LBP, shift work status, and selected potential confounders.

RESULTS: Among 928 LBP-free nurses at baseline, 319 (34.4%) developed LBP over 2 years. After adjusting for confounders, shift workers were 1.15 times more likely to develop LBP (adjusted odds ratio [aOR], 1.15; 95% confidence interval, 1.05 to 1.40; P = 0.03). The interaction analysis showed that overweight/obese shift workers were more likely to develop LBP than day workers (overweight: aOR, 1.23 vs aOR, 1.03, respectively; obesity: aOR, 1.34 vs aOR, 1.10, respectively).

CONCLUSIONS: Our findings suggest that shift workers are at a higher risk of developing LBP over time, especially those who are overweight/obese.

Multivariable analyses of the relationships between age, gender, and body mass index and the source of chronic low back pain.  [Link]

Pain Med. 2012 Apr;13(4):498-506.

DePalma MJ, Ketchum JM, Saullo TR.
Virginia Spine Research Institute, Inc, and Virginia iSpine Physicians, PC, Richmond, Virginia 23235, USA.

OBJECTIVE: To examine the combined relationships between age, gender, and body mass index (BMI) and the specific source of chronic low back pain.

DESIGN: Retrospective chart review.

SETTING: University spine center.

PATIENTS: Charts from 378 cases from 358 consecutive patients were reviewed and 157 independent cases from 153 patients who underwent definitive diagnostic injections were analyzed.

INTERVENTIONS: Discography, dual diagnostic facet joint blocks, sacroiliac joint injections, anesthetic interspinous ligaments/opposing spinous processes/posterior fusion hardware injections, percutaneous augmentation.

OUTCOME MEASURES: Chronic low back pain source was the primary outcome variable. Predictor variables included age at initial presentation, gender, and BMI.

RESULTS: Age, gender, and BMI were each significantly associated with the source of chronic low back pain, after controlling for the effects of each other. Increases in age were associated with significant decreases in the odds of internal disc disruption (IDD) vs facet joint pain (FJP), sacroiliac joint pain (SIJP), and other sources and decreases in the odds of FJP and SIJP vs other sources. Being female was associated with significant increases in the odds of SIJP vs IDD, FJP, and other sources. Increased BMI was associated with significant increases in the odds of FJP vs SIJP.

CONCLUSIONS: These findings suggest a significant relationship among gender, age, and BMI and structural causes of chronic low back pain. Lumbar IDD is more prevalent in young males while FJP is more prevalent in females with increased BMI. Female gender and low BMI are associated with SIJP.
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