What are the Best Practices for Treating Lower Back Pain in Patients with Obesity?
— By Dawn M. Sweet, Ph.D
Lifestyle changes such as exercise and diet changes can reduce lower back pain.
Lower pain is a symptom of underlying health issues. These health issues may be related to injury, spinal degeneration, or physical demands of one’s job, and pain in the lumbar area affects roughly 70-80 percent people at least once during their lives.1 Risk factors associated with lower back pain include a sedentary lifestyle, which is also a risk factor weight gain. Pro-inflammatory cytokines can activate C-reactive protein — a marker of acute inflammation and linked to musculoskeletal pain.2 Prostaglandin E2 is an inflammatory marker that is known to trigger a sensation of pain and inflammation.2 Elevated levels of Prostaglandin E2 has been observed in patients suffering from lower back pain.
Because lower back pain can affect quality of life, lifestyle changes such as exercise and physical activity may mitigate the mediating the effect of C-reactive proteins and Prostaglandin E22. Dietary changes have also been found to be an effective treatment for lower back pain.3
Exercise, Dietand Lower Back Pain
The risk of lower back pain for people who maintain a sedentary lifestyle is 1.41 times greater than physically active counterparts; those who don’t follow the recommended ³ 150 minutes of physical activity per week are 1.23 more likely to develop lower back pain.2 As reported in a 2018 study2, persons with obesity are the most susceptible to lower back pain.
Exercise can not only counteract the mediating effects of C-reactive proteins and Prostaglandin E2 (PGE2) but also reduce weight and promote positive changes such as reduction in low-grad inflammation, improved lipid profiles, reduce risk of type 2 diabetes, and heart disease.2 Because exercise is inversely related to chronic low-grade inflammation, it should be considered as a form of treatment. For example, moderate exercise — such as walking 3,000 steps per day five times per week — has been a successful intervention for reducing inflammatory markers in adults with obesity.2
Dietary lifestyle changes are also important for treating lower back pain. For example, when low calorie diets (500-700 kcal) are used in conjunction physical activity, weight loss can be optimized.3 A recent meta-analysis4 showed that dietary interventions such as reducing caloric intake, following healthy-eating guidelines, and using meal replacements promoted weight loss and reduce musculoskeletal pain. The same meta-analysis found that when dietary changes were coupled with exercise, weight loss was optimized, and pain was reduced.
Implications for Clinical Practice
Given the optimal results for weight loss when diet and exercise are paired, clinicians should work with their patients with obesity to develop tailored programs to transition them to a more active lifestyle that includes a Low Calorie Diet (LCD) or a Very Low Calorie Diet (VLCD). Health care providers should work with patients to develop a physical activity plan that is in-line with their patients’ abilities. Shifting to an LCD or VLCD are beneficial ways to jump start weight loss, which in turn could facilitate leading a more physically active life. Weight loss can reduce patients’ pain and improve their quality of life.