Who gets back pain?

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Waking up with back pain is more common than you think.
Waking up with back pain is more common than you think.

President of the South African Spine Society and neurosurgeon Dr Jacques du Plessis estimates that 60–80% of our population get back pain at some stage in their lives.

In most instances, the pain lasts a few months and, in up to 90% of cases, the pain clears up, with or without treatment. 

Obesity a major cause

In 85–95% of cases, lower back pain (LBP) is the result of a combination of factors, often making it difficult to determine the exact cause. South Africa’s obesity epidemic is, however, a major cause of the increased incidence of back pain.

Dr Scott Shemory, an orthopaedic surgeon with Summa Health System in the United States, presented findings from a study conducted among 26 million people – 1.2 million (4%) of whom had lower back pain – at the 2015 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS).

His research showed that LBP was most common among:

  • Smokers (16.5%)
  • Alcohol-dependent drinkers (15%)
  • Obese people (17%) 
  • People suffering from depression (19%)

Other groups of people prone to developing back pain are very tall people, pregnant women, those who overexert their backs during sport or repetitive work, and those suffering from diseases or hereditary conditions that affect the back (e.g. scoliosis).

Dr Lienka Botha, who manages a back-pain care clinic in Cape Town called FX Health, says they find that individuals who work outdoors, doing repetitive manual tasks (e.g. construction or City Council workers) more frequently report LBP symptoms, while office workers are more inclined to suffer from neck and upper back pain. 

There’s also an increase in back pain reported by long-distance truck drivers, chauffeurs, ambulance drivers as well as taxi drivers who sit in poorly-supported car seats for long hours. 

Orthopaedic surgeon Dr Chad Patton of Maryland in the United States notes that the rise of services such as Uber and Lyft (allowing for tens of thousands of amateur drivers to suddenly become professionals who then carry luggage and sit in their cars for long hours at a time) are adding to the rise in back pain numbers.

Top 10 ‘back-breaking’ jobs

The North American Spine Society (NASS) conducted a survey among its 8 000 members in 2016 and found that “driver” tops the list of careers most harmful to back health.

The other careers are as follows:

  • Driver 
  • Construction worker 
  • Nurse 
  • Office worker 
  • Manual labourer 
  • Dentist 
  • Warehouse worker 
  • Mechanic 
  • Factory worker 
  • Mother 

Other at-risk professions include carpenter, plumber, electrician, assembly-line worker, baggage handler, pilot, motor mechanic, checkout worker, professional athlete, dancer, musician and office worker (especially those who sit in poorly designed chairs all day).

Tip: American orthopaedic spine surgeon Dr James Manzanares says sitting on an overstuffed wallet my cause discomfort and back pain. If you’re going to be sitting for a prolonged period of time while driving, for example, it’s important to remove your wallet from your back pocket. 

Other groups of people prone to back pain

Sportsmen and women. Any sports activity in which improper body mechanics is used can damage the back, e.g. a jerky golf swing or the incorrect use of exercise equipment. Cyclists often experience LBP, which can be resolved by adjusting the angle of the bicycle seat. 

Some research suggests that, over time, high-impact exercise such as rugby or aerobics may increase the risk for degenerative disc disease. In turn, hyperextension of the spine (as in gymnastics, pole-vaulting, weight lifting, football and cricket, especially in the case of bowlers) may lead to a stress fracture (spondylolysis).

Back strain is the most common sports injury. This refers to injury of the lower back (lumbar) spine’s soft tissues (muscles, nerves, ligaments, tendons and blood vessels).

Pregnant women are prone to back pain due to the shifting of abdominal organs, the forward redistribution of body weight (the same as in people with excessive abdominal obesity), and the loosening of ligaments in the pelvic area prior to delivery. 

Smokers are prone to back pain, possibly because it decreases blood circulation to the tissues of the back. Smoking is also known to accelerate the degeneration of the lower spine. It interferes with the body’s ability to absorb and use calcium, leading to osteoporosis-related bone and back problems. Another contributing factor could be that physical exercise is less common in smokers than in non-smokers.

People with high stress levels and/or psychiatric conditions. Research shows that pre-existing depression and feelings of helplessness may have a negative influence on your perception of pain and your ability to cope with pain and back problems. If you suffer from stress, anxiety and/or depression, you are also more likely to have LBP. 

Back pain is also seen in individuals with low levels of social support at home and in the workplace, as well as those with low levels of job control, high psychological demands, pending litigation, perceived injustice, and work dissatisfaction. 

Psychosocial factors appear to play a substantial role in the frequency of LBP, which is why these factors should be addressed during management planning.

Individuals with predisposing genetic factors. Some people are genetically susceptible to back pain, usually because they inherited spinal structural abnormalities. For example, mutation of the COL9A2 gene may be linked to about 10% of sciatica cases. This gene plays a role in producing collagen, an important protein component of the discs. The defective gene may cause disc deterioration, leading to sciatica.

In 2012, researchers at King’s College London identified a gene, the PARK2 gene, as a cause of LBP associated with lumbar disc degeneration (LDD). LDD is inherited in 65–80% of people with the condition, suggesting that genes play a key role.

Reviewed by general practitioners Dr Lienka Botha and Dr Suzette Oelofse, FX Health. April 2018

- President of the South African Spine Society and neurosurgeon Dr Jacques du Plessis.
- Study identifies smoking, obesity, alcohol abuse and depressive disorders as low back pain risk factors, 2015 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS), North American Spine Society (NASS). 
- Press release by the North American Spine Society. 5 October 2016. “Driver” Tops Spine Specialists’ List of Most Back-Breaking Jobs
- Nagaya, T, et al. (2007). "Cigarette smoking weakens exercise habits in healthy men." Nicotine & Tobacco Research 9(10): 1027-1032.
- Susan Spinasanta. High-risk Jobs: Is Your Job Putting Your Spine at Risk? Spine Universe. September 2017.
- New back pain gene identified in largest genetic study of its kind. ScienceDaily.com. September 2012.

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