Is obesity a risk factor for low back pain? An example of using the evidence to answer a clinical question

Abstract

BackgroundObesity as a causal factor for low back pain has been controversial with no definitive answer to this date. The objective of this study was to determine whether obesity is associated with low back pain. In addition this paper aims to provide a step-by-step guide for chiropractors and osteopaths on how to ask and answer a clinical question using the literature.MethodsA literature review using the MEDLINE search engine using the keywords "obesity", "low back pain", "body mass index" "BMI" and "osteoarthritis" from years 1990 to 2004 was utilised. The method employed is similar to that utilised by evidence-based practice advocates.ResultsThe available data at this time is controversial with no clear-cut evidence connecting low back pain with obesity.ConclusionThere is a lack of a clear dose-response relationship between body mass index (BMI) and low back pain. Further, studies on the relationship between obesity and related lumbar osteoarthritis, knee pain, and disc herniation are also problematic.There is little doubt that future studies with controlled variables are needed to determine the existence of an unambiguous link, if any.

Effect of obesity on posture and hip joint moments during a standing task, and trunk forward flexion motion

“…6 Postural adaptations and trunk segment motion limitations may have implications for further understanding the aetiology of musculoskeletal pain in obesity. Although there is no clear relationship between BMI and low back pain, 12 self-reported work-restricting pain in the neck and back areas and hip joints is more common in obese people. 8 As postural loading and discomfort increase, and the time a posture can be held decreases with increased trunk flexion, 13 the postural adaptations and increased hip joint moments seen for the obese group during the standing work task are a possible explanation for the reported increase in work-restricting pain in this group.…”

Back and neck pain among school teachers in Poland and its correlations with physical activity

“…On the one hand, it appears that obesity is a predisposing factor to the more prevalent LBP. However, the results of several studies are controversial, and this hypothesis requires examination in further studies [19,20].…”

Are obesity and body fat distribution associated with low back pain in women? A population-based study of 1128 Spanish twins

“…Although it is generally assumed that obesity and LBP are associated, the actual path between these conditions remains controversial [6,8]. For instance, whereas some studies have shown that obesity increases LBP prevalence [9,10], others have failed to observe any association between the two [11,12].…”

“…The frequent measure used to classify obesity in previous studies was BMI [2,8,13] which does not account for the distribution of fat in the body. Although there is evidence that body fat distribution rather than absolute total fat is associated with increases in the risk of diseases such as diabetes and coronary artery disease [14], most studies [2,8,13] have not investigated it.…”