American Association Of Obesity has confirmed that over-weight individuals usually suffer more accelerated loss of cartilage and bone mass. As such, this leads to weaker musculo-skeletal elements and high propensity to develop dislocations and fractures. The effects are far more pronounced in the lower body (or weight bearing joints like knees, vertebral column and hip joint).
According to a latest study published in the peer reviewed American Journal of Epidemiology (1), investigators studied the association between lower back pain and high body mass index. The scientists specifically targeted young over-weight adults only (between 29 to 39 years of age), since physiological aging is a very important risk factor that may leads to back pain independently, After careful analysis, it was observed that about 39.5% females and 31.2% males experienced at least one episode of lower back pain in the past 12 months.
This high prevalence can be explained by the fact that excessive weight can expose the joints to undue stress and strain. The process of joint degeneration and accelerated stress is disastrous in all weight bearing joints of the body, but the rate of complications is even higher in spinal joints because:
- Spinal joints are central in position with vertical alignment. In simple words, the support of spine is poor because of its longitudinal placement in the body.
- A lot of individuals are unaware that our spine is not straight. In fact it has two angulations or curves. The cervical curvature is the angulation in the neck region, whereas the lumbar curvature is situated in the region of lower back. These spinal curvatures are responsible for stabilizing and supporting the vertebrae, which evenly distributed the body weight to perform normal daily functions. Obesity on the other hand can push or disrupt this natural curvature and shape of the spine, leading to back pain.
- The area of spinal articulating surfaces is very small and the joint connection is largely supported by the ligaments and the surrounding muscles. Any disease process that affects the integrity of ligaments can easily destabilize spinal joints leading to back pain. Unfortunately over-weight individuals are more prone to develop diabetes, hypertension and other metabolic issues that may compromise the integrity of muscles and ligaments.
- Needless to say that fat deposition at or around the vertebral tissues can push and pressurize skeletal elements directly.
- The bones and joints are in constant state of remodeling. However, with poor physical activity (that is fairly common in obese individuals), the process of remodeling usually comes to a halt.
What are the characteristic features of obesity related back pain?
In the setting of obesity-related back pain, symptoms are largely chronic (with acute exacerbation) and may present as persistent achy pains, muscle spasms, joint degradation changes and other similar ailments. In some chronic cases of obesity, the spine may undergo permanent curvature shifts that may distort the entire spinal alignment.
Some overweight patients are also likely to suffer from stomach pain, in addition to lower back pain. This is because as your abdomen starts gaining excessive weight, it can pull your body forward and literally leave it sagging. This pulling effect strains your lower back muscles and causes both lower back as well as stomach pain, as mostly seen in obese women.
Other notable features of obesity related back pain are:
- Sciatica: Sciatica nerve innervates the lower back, part of the hip region and finally the major part of the lower limbs. With excessive pressure on the lower lumbar spine, the integrity of nerves that exits out of the vertebral foramina is generally compromised, leading to sciatica. The severity of symptoms is largely dependent on the involvement of spinal discs due to obesity.
- Arthritis: Arthritis is a fairly common complication of moderate obesity due to accelerated cartilage degeneration (as discussed earlier in this post). Arthritis of spinal disc is characterized by painful inflammation of connective tissue elements in addition to muscle spasm, limited range of motion and physical disability.
- Osteoarthritis: This condition is characterized by swollen bones and joints that is caused by excessive pressure and damaged bony architecture over time.
- Other neuromuscular disorders: Neuromuscular disorders such as piriformis syndrome and pinched nerve can also occur in chronic cases of obesity as a result of spinal degeneration or herniation. This occurs when additional weight presses onto the nerve fibers leading to numbness, tingling and pain in different parts of the body.
- Medical complications: Obese patients are more likely to experience articular as well as extra-articular complications. For example, the risk of injuries is higher since joints and bones are weak and poorly mineralized in obese individuals. Likewise, the process of healing is slow or delayed due to metabolic de-rangements.
According to a new study published in Orthopedics (2), investigators concluded that obese patients require much vigilant interventions and more extensive rehabilitation after long bone fractures. In addition, several research studies also provided statistical evidence that the rate of complications is much higher in obese individuals as compared to normal-weight subjects.
Top Weight Loss Tips For Back Pain Relief
Over weight and obese patients should focus on losing the excess body weight instead of just trying to tone down their abdomen girth or thighs fat. The goals for ideal weight loss regimen mainly focus around:
- Knowing the normal body weight according to height and weight and calculating the body mass index. A BMI value of under 25 kg/m2 is generally considered normal.
- In some cases, waist measurements are also taken into consideration, when weight loss regimens have to be designed. For women a waist of above 35 inches and for men a waist of above 40 inches is considered as a qualifying number for weight loss.
After identifying the amount of excess fat or weight that your body is carrying, make an appointment with your primary care provider. It is very important to take careful and schematic approach (especially if you have an active illness or metabolic condition). Taking aggressive measures to lose weight can often increase the risk of metabolic de-rangements. Here are some of the weight loss tips that may help you in achieving losing weight without substantially affecting the bone mineral density of your bones.
DO’s Of Weight Loss
Healther Vincent (4) and associates conducted a study to ascertain the relationship of weight loss in obese patients to the overall improvement in backache symptoms. Investigators identified that moderate weight loss in obese patients (regardless of the nature of method used) can greatly help in improving the symptoms of backache and joint issues.
The study also concluded that early weight loss can prevent the joint related damage due to wear and tear changes and physiological aging. Although it may sound unbelievable but ‘healthy’ weight loss is a pretty challenging task. This is mainly because morbidly overweight individuals may find it easier to take short-cuts, which may worsen your back pain and weight related goals.
Here are some Do’s and Don’ts of weight loss if you want to manage your back pain:
- Boost your basal metabolism: Obese individuals generally have a low basal rate of metabolism, which also means that their average expenditure of energy at rest is slow. Therefore, adopt a healthy approach to boost your metabolism. This include:
- Divide your total recommended calorie intake in several small portions (at least 6 to 8 servings per day). This not only activates your metabolism, but will also prevent over-snacking.
- Drink plenty of fresh water (especially after waking up in the morning) to kick start your metabolism.
- Increase your intake of green leafy vegetables, fresh fruits and other healthy nutrients.
- Diet modification is the key to weight loss. Incorporate negative calorie foods like broccoli or nutrients that stimulate your metabolism like lemon juice.
- Exercises and physical activity
Incorporate healthy exercises and regimens to enhance your weight loss process. It is possible that you may not perform high impact exercises in the beginning due to joint stiffness, but healthcare providers believe that incorporating simple interventions like swimming, bicycling and walking can help in establishing the pace. In addition, stretching exercises and resistance training gently helps in the movement and mobility of the joints.
It is important to keep in mind that exercise and physical activity offers a two-fold solution to your problems. Not only can you lose weight but can also prevent back pain and discomfort.
- Consider dietary supplements
One important cause of backache in the setting of obesity is vitamin D deficiency. Consider taking vitamin D and calcium supplements, especially when you are on a weight loss regimen. In addition, you may need other supplements (since obesity is often associated with micro-nutrient deficiencies. Supplementation with zinc, vitamin B complex, vitamin C and iron is usually recommended.
- Seek professional help
If you are morbidly obese, it becomes very challenging to lose weight without assistance or guidance. In addition, if you have other health issues (like chronic backache or joint issues), it will further limit your options to lose weight via strenuous physical activity. In all such cases, it is recommended to get professional advice or weight loss tips from a registered dietitian, personal trainer or a healthcare professional.
- Yoga training or specialized exercises
Yoga is one of the most recommended, safest and beneficial form of exercise that is widely used by individuals of all age group. It is equally helpful for elderly, pregnant, athletes and obese individuals with acute or chronic backache. Deep relaxation strengthens the immune system of people with back pain and assists in alleviating the ongoing inflammation of joints that is causing the pain, stiffness and discomfort in your back region.
- Alternative medicine
Sometime the cause of back pain is more organic and therefore requires intervention as well. You should consider taking the help from a registered chiropractor or physical therapist to alleviate and identify the organic illness that is worsened by your weight gain.
Other popular intervention that are equally helpful in obese patients for the management of low back pain are:
- Spinal mobilization
- Spinal manipulation
- Massage therapy
DON’Ts Of Weight Loss
Ideally, if you are planning to lose weight for the management of your chronic health issues or back pain, refrain from these popular yet hazardous methods:
- Surgery: There are several surgical options (like tummy tuck, bariatric surgery, stapling of stomach, resection of gut). It has been observed that these procedures are harmful for the health of your body in the long term and may even lead to other metabolic issues.
- Commercial weight loss supplements: It is important to keep away from the over-the counter weight loss supplements that may negatively affect your physical and bone health by affecting mineralization status.
- Starvation: It is likely that you may not achieve speedy goals in the beginning, but make sure not to starve your body of essential nutrients and metabolites by starving.
In conclusion, if you or your loved-ones are experiencing low back pain due to metabolic issues like obesity, it is highly recommended to adopt weight loss tips from a professional who can assists you to optimize bone and joint health.
1. Shiri, R., Solovieva, S., Husgafvel-Pursiainen, K., Taimela, S., Saarikoski, L. A., Huupponen, R., … & Viikari-Juntura, E. (2008). The Association between Obesity and the Prevalence of Low Back Pain in Young Adults The Cardiovascular Risk in Young Finns Study. American journal of epidemiology, 167(9), 1110-1119.
2. Baldwin, K. D., Matuszewski, P. E., Namdari, S., Esterhai, J. L., & Mehta, S. (2011). Does morbid obesity negatively affect the hospital course of patients undergoing treatment of closed, lower-extremity diaphyseal long-bone fractures?. Orthopedics, 34(1), 18.
3. Vincent, H. K., Vincent, K. R., Seay, A. N., & Hurley, R. W. (2011). Functional impairment in obesity: a focus on knee and back pain. Pain management, 1(5), 427-439.
4. Vincent, H. K., Heywood, K., Connelly, J., & Hurley, R. W. (2012). Obesity and weight loss in the treatment and prevention of osteoarthritis. PM&R, 4(5), S59-S67.
5. Samartzis, D., Karppinen, J., Mok, F., Fong, D. Y., Luk, K. D., & Cheung, K. M. (2011). A population-based study of juvenile disc degeneration and its association with overweight and obesity, low back pain, and diminished functional status. The Journal of Bone & Joint Surgery, 93(7), 662-670.
6. de Rooij, M., Lems, W. F., van der Leeden, M., & Dekker, J. (2014). Comorbidity, Obesity, and Exercise Therapy in Patients with Knee and Hip Osteoarthritis. In Exercise and Physical Functioning in Osteoarthritis (pp. 119-126). Springer New York.