Your Back Doesn't Hurt Because You Are Fat - New Thoughts on the Obesity and Back Pain Relationship
Why weight alone isn't enough to cause back pain
What is it about being overweight that can cause pain?
Empowering the overweight patient to get better results It’s no secret that being overweight or obese carries a higher risk of having back pain. Patients struggling with weight issues hear about it all of the time that if they want their backs to feel better, they have to shed those extra pounds. In fact, one of the first things a patient with low back pain will tell ME is that they have to lose weight before I even say anything. They’ve been convinced that their weight issues are the CAUSE of the pain in their backs. Historically I would normally just agree with the patient’s point of view. I’d let them know that I will do my best to support them in a goal to shed those unwanted pounds., but in the past couple of years I’ve had a change of heart. Don’t get me wrong, I know that obesity and back pain are related. There’s no disputing that or the evidence that supports that idea. However, when it comes to taking care of people it’s so important that patients have a strong understanding of cause and effect. When we think about your weight and your spine, we should think about excess bodyweight as a symptom and aggravating factor for back pain as opposed to the cause. Why? Because I have seen the following things happen way too many times for me to ignore it:
A lot of people are obese and never develop back pain
A lot of people are obese, get proper structural care for their spine, and their back pain disappears without losing a single pound.
Many people who start to change their diet and exercise start to feel their back pain improve before any weight loss occurs
Many people who get weight loss surgeries still have back pain even after the weight is gone Now that's not to say that people who lose weight don't get great changes in the status of their back pain because that certainly does happen. But maybe we are looking at the problem the wrong way. Now these observations aren’t based on a rigorous scientific study or survey. These are just things I've noticed past 6 years in practice. Here are some thoughts as to why these things happen.
Check the Foundation One of the analogies I make about the spine as it relates to the health of the body is that the hip/pelvis is similar to the foundation of a building. Just as a building relies on a level foundation to support the overall structure of the building, a level pelvis dictates the health of the spinal joints.When the hips and pelvis are level, then the force of gravity gets distributed through your joints, ligaments, and muscles more evenly. Your body parts become team players for the benefit of the whole. When the hips and pelvis are unlevel, then some of the joints will start carrying a heavier load than the opposite side causing increased inflammation and arthritic changes. Some muscles will work harder and fatigue faster than others leading to tension and pulling of muscles. Now here’s where obesity becomes problematic. While the extra weight doesn’t cause the body to breakdown, it can compound a problem that’s already there. That’s one of the big reasons that people in our office can start getting relief pretty quickly once we get their hips level, there is an immediate change in how the joints of the spine become loaded.
Be Strong Enough to Support Yourself Another issue with people that are overweight is that they tend to be weak compared to their bodyweight. In my experience, people that are overweight, but are strong tend to have less severe pain issues than those who are overweight and sedentary. This is especially true for women, and my guess is that women who are obese and sedentary are much weaker than their male counterparts. The science is clear that exercise doesn’t aid much in weight loss, but exercise is FAR from useless for the obese patient. Building strength is one of the most important things you can do for your overall health. Being strong means you can pick things up from the ground without it throwing your back out. Strong muscle tissue is also going to support your spine for routine things like standing and sitting. Hell, just the act of getting up from bed or from a chair can be miserable for someone with back pain, but it’s a LOT better if the person has the muscle strength to support themselves in these movements. This doesn’t just mean that your back needs exercise. It means that your arms, legs, chest, butt, and shoulders need to be strong so that your body can perform your activities of daily living. As renowned (and a little infamous) physiotherapist Adam Meakins always says: “You can’t go wrong going strong”
Put the fires out Chronic inflammation might be the most underappreciated problem when it comes to the connection between obesity and back pain. Chronic inflammation is like having a bunch of small fires running uncontrolled through the body. The metabolic problems associated with obesity are a large product of inflammation. While we know this inflammation can be a risk factor for things like heart disease and diabetes, it’s also a key player in arthritis and joint pain. Inflammation is controlled by your immune system which produces chemical signals called cytokines. Elevated inflammatory cytokines in the blood stream effect the joints in multiple ways. They can damage tendons, promote osteophytes, and sensitize nerve endings that stimulate pain.The thing that not enough people talk about is that inflammation can be affected by the foods that you eat. Things like processed sugar, processed vegetable oils, trans fats, and excessive carbohydrate intake promote inflammation in the body. I encourage many of my patients to play with a low-carbohydrate diet while they are coming to see me, but not because I need them to lose weight. I want them to eat differently because of how inflammation can impact the brain and joints. The great thing about dietary changes is that they can act on inflammation faster than it can affect bodyweight. It’s not uncommon for patients with back pain, knee pain, or hip pain to start feeling better within a few weeks of an anti-inflammatory diet, even though weight loss has been minimal. While most can and do lose weight on this type of diet, the anti-inflammatory effects of this way of eating may have deceived us for years into thinking that weight loss is the key to back pain management.
But Weight Loss is Good, Shouldn’t We Promote it Anyway? Everyone wants to lose weight, and it’s likely beneficial for most people to shed a few extra pounds anyway, so why take the emphasis off of losing weight? I think the reason we need to change our thinking is because deep down you can probably relate to this.
Losing weight is hard and someone telling you to lose weight to solve your problems is as frustrating as not getting any answer at all For decades we have been telling overweight and obese people to lose weight because it will make their lives better in every way. But here's the thing, you’ve seen the success rate on long-term effects of diet and weight loss programs; they are terrible! If we can’t get people to lose weight to save their heart, protect their brain, or look better in a bathing suit, how the heck are we going to get people to lose weight to get rid of back pain. I don’t think we can, and from my experience, we don’t have to. Just telling someone to lose weight to make their problems go away is so damn disempowering to someone who knows and understands the struggles of losing weight.