Lower back pain causes more disability than any other condition
As new research reveals the devastating toll of disability inflicted by lower back pain, Jeanette Wang looks at a widespread problem
"Most people will suffer from lower back pain at least once in their life," says Dr Michael Tse, assistant director of University of Hong Kong's Institute of Human Performance. "Most" refers to about 80 per cent of adults, according to the Hospital Authority's Smart Patient website.
In fact, an international study published a couple of weeks ago in the Annals of the Rheumatic Diseases shows that lower back pain causes more disability around the world than any other condition.
Researchers looked at data from the World Health Organisation's Global Burden of Disease 2010 study, which assesses ill health and disability arising from various conditions in 187 countries. These countries were grouped into 21 regions, and the data covers 1990, 2005 and 2010. Of all 291 conditions in the study, lower back pain ranked number one in terms of years lived with disability - 83 million years in total in 2010, to be exact.
The study found almost one in 10 people (9.4 per cent) had lower back pain, and that men were affected more than women (10.1 per cent compared with 8.7 per cent). The condition's prevalence and overall impact increased with age.
Western Europe had the highest prevalence (15 per cent) and the Caribbean the lowest (6.5 per cent). In East Asia, the region which includes China, prevalence was 6.7 per cent.
"With ageing populations throughout the world, but especially in low and middle-income countries, the number of people living with lower back pain will increase substantially over coming decades," the authors conclude.
Lower back pain could be caused by a number of factors, including weak abdominal and back muscles, obesity, inactivity, poor posture, sitting for extended periods at work stations, the wrong random movement, or muscle strain resulting from strenuous physical activity. These tend to be the common causes of lower back pain in middle-aged and young people.
"Because the body is like a kinetic chain, lower back pain could arise from a dysfunction elsewhere in the body, such as a stiff upper spine, weak glutes, tight hip flexors and hamstrings, or sometimes even having one leg which is longer than the other," says Tse, who is also director of the institute's Active Health Clinic.
Backache in the elderly, however, is typically caused by age-related degeneration of the intervertebral discs in the spine.
But generally, most people will experience an occasional bout of non-specific lower back pain, whereby careful observation along with over-the-counter pain medication and targeted physical activity may be all that's needed to resolve the issue, says Dr Scott Forseen, neuroradiologist at Georgia Health Sciences University.
Forseen was the co-author of a 2012 study in the Journal of the American College of Radiology that put together a set of diagnosis and treatment guidelines based on the overwhelming evidence that hi-tech imaging exams and back surgeries don't improve outcomes for most patients.
"Conservative treatment is usually better," says Tse. "The body tends to heal itself, so if you do nothing, pain usually subsides in a couple of weeks. If pain doesn't go away in two weeks, you should get it checked. "On the other hand, treatment to address the root of the problem will help prevent lower back pain from happening again."
There are many options for conservative treatment, such as physiotherapy, massage, acupuncture and chiropractic, Tse says, while yoga, Pilates, strengthening and stretching may help with future prevention. These various modalities share the common goals of improving mobility, strength and posture.
Dr Michal Katz-Leurer, of Tel Aviv University's Sackler Faculty of Medicine, suggests a simple programme of aerobic walking two or three times a week for 20 to 40 minutes each time. In her study published last year in the journal Clinical Rehabilitation, after six weeks of doing the programme, participants saw significant improvements in their condition that was comparable to a group who did a typical clinic-based muscle strengthening programme.
The human body is structured in such a way that mobility at each joint helps share the load of daily physical exertions, Tse says.
With age, we tend to move less on a daily basis, leading to stiffer and more immobile joints, which puts strain on other areas along the kinetic chain. As the hips and upper back tend to stiffen from inactivity or improper activity, people tend to rely on increased flexion, extension and rotation of the lower back.
"This can be a recipe for disaster, as the lower back is meant to be stiff and stable," says Tse.
He recommends not only strengthening around the hips and core, but also maintaining joints which are supple and sufficiently mobile for a pain-free body.
Here, he suggests a series of simple exercises that you can do at home to prevent or alleviate lower back pain. The entire circuit will take about 10 to 15 minutes. If your muscles are very weak, start out holding each pose for 15 seconds and gradually work your way up to a minute. Repeat each pose for two to three times per side. You can do the circuit three to four times a week, any time of the day, says Tse.