Low Back Pain Risk Factors

Don't Let Your Acute Back Pain Turn Chronic

Low back can affect anyone. From office workers to manual laborers, fitness buffs to couch potatoes, we are all at risk.

If you're not careful, acute low back pain—which may initially be due to an injury, trauma, or the progression of a degenerative spinal condition—may become chronic. It's helpful to be aware of low back pain risk factors so that your pain doesn't get worse.

The Difference Between Chronic Back Pain and Acute Back Pain

Chronic back pain is generally defined as spine-related pain that lasts longer than three months. Acute back pain, on the other hand, lasts up to 72 hours, and is generally brought on by some kind of incident. It represents the first phase in the healing of an injury.

The sub-acute phase takes place between the acute and chronic phases. It picks up where the acute phase leaves off at approximately 72 hours, and continues until the chronic phase starts, which, again occurs at around the three-month mark.

Acute Back Pain Treatment

Experts recommend seeing a doctor immediately after any type of trauma to your structure, including the spine, especially if the impact results in pain. Early diagnosis, which then leads to early treatment, is key to full recovery. In other words, getting medical attention for your back injury earlier on in the process may help you avoid a long-term  chronic condition.

If your back pain is caught early and your doctor confirms that it's not due to a serious underlying disease or problem, it can often be managed quite well with over-the-counter pain medications,  a temporarily reduction of your physical activity, and specifically-designed therapeutic exercises. Most of the time, it's best to get an exercise program from a licensed physical therapist.

Reducing your activity for a few days to a few weeks while you’re healing may help you avoid making matters worse. Note that this bit of advice is not about committing yourself to complete bed rest. Bed rest used to be the standard recommendation, but more recently, it has been replaced with something like “stay active but adjust the intensity downward so that you’re not moving with pain.”

Over-the-counter pain medications may help relieve the short-term pain as well as reduce inflammation. Inflammation is a response by your immune system to the trauma to your tissues; it delivers healing chemicals to the affected area. A little inflammation is a good thing in this case, but left unchecked, it can create problems in the long run. In other words, by not taking anti-inflammatory pain medication such as aspirin or other NSAID, you may be setting yourself up for tight muscles and a higher risk for re-injury. Be advised, however, that some NSAIDs, particularly Advil, may pose serious risks to your health.

A therapeutic exercise program—such as one provided by a physical therapist—may help you get moving again in a safe way. Exercise programs usually place a big emphasis on developing core support, which may help you return to your usual activities like gardening, housework, child care and even sitting at your computer for long hours.

The program may also help you to avoid re-injuring yourself and can help decrease pain.

By following these simple guidelines, you may be able to return to typical activities quickly and easily after a back injury. Not doing so may result in a long-term back problem.

The Greatest Risk Factor for Long-Term Low Back Pain

While a number of things contribute to a higher risk for long-term back problems, having that first incidence or episode of low back pain is the likely the biggest. A 2014 review and meta-analysis, published in Spine Journal looked at 41 studies but was unable to identify any one consistent risk factor that leads a person to have back pain for the first time in their life.

The exception was having had an incidence of back pain in the past. The researchers found that previous low back pain consistently predicted future problems.

Now that you know a first time experience with back pain may up your risk for future incidences, and that ignoring it may create a chronic problem, the next step is to take a look at your lifestyle.

Controllable Low Back Pain Risk Factors

Low back pain risk factors can be controllable or uncontrollable. Controllable risk factors are those you can do something about. Uncontrollable risk factors include characteristics you cannot change, such as age and gender.

Managing controllable risk factors may require some effort on your part. But there’s a silver lining to making that extra effort: it may help improve other areas of your health as well. Examples include reducing your risk for heart attack, stroke or diabetes.

BMI

Obesity and overweight conditions (BMI of 30 or higher) are associated with an increased risk for back pain in both men and women, according to a 2014 meta-analysis published in the journal Clinical Spine Surgery. The authors of this study say that maintaining a healthy body weight may be one of several things that prevent low back pain from occurring.

BMI, which stands for body mass index, is a measure of how much weight you have relative to your height. It is very commonly used to categorize people into underweight, normal weight, overweight, obese and morbidly obese conditions.

For men only, a 2016 study published in Medicine (Baltimore) found that high intensity low back pain and/or disability were more likely to occur in obese men, particularly when these men also had an emotional disorder.

Remember that certain low back disorders can cause leg pain, a condition that many non-medical people loosely label as sciatica. A 2014 study published in the American Journal of Epidemiology found consistently that being overweight or obese raise the risk for lumbar radicular pain in both men and women. Lumbar radicular pain is radiating pain that goes into the leg. It is due to inflammation or other form of irritation to a spinal nerve root.

The researchers found that the more weight study subjects carried, the great was their risk for this type of spine related leg pain.

And one can’t fully cover the topic of obesity as it relates to back pain without mentioning regular exercise. Regular exercise may help speed weight loss, as well as build the muscle strength needed to support the weight you carry around with you. In other words, strong muscles protect joints from wear and tear, and undo pressure.

A 2017 study published in Spine Journal found only a weak association between a sedentary lifestyle and the presence of low back pain. Mostly, the authors conclude, this association occurs in females.

Mood

One very important factor in determining if acute back pain will develop into a chronic condition is your emotional and psychological well-being. A February 2018 review published in the journal Psychology, Health and Medicine found evidence that psychosocial factors are associated with the transition between short term and chronic conditions in non-cancer pain cases, which, of course, includes most types of neck and back pain.

Psychosocial factors are attitudes or behaviors that exert a slowing or negating influence on the prognosis (outcome) of treatment for an injury, condition or disease.

Specifically, the Psychology, Health and Medicine study identified depression and fear-avoidance, in other words, letting the fear of pain or re-injury upon movement stop you from being active, as strong predictors for progression of acute back pain incidences into chronic, long term conditions. The study authors call for a change in the culture of pain medicine to reflect this information, and in particular to use it in early stages of care, as well as preventatively.

Smoking

Smoking is one of the worst habits for your back.

Not only does it negatively affect the delivery of nutrients to the structures of the spine, and therefore their maintenance, but it may alter your perceptions of pain.

Smoking is sometimes the defining factor in an unsuccessful back surgery, as well. If you can’t do anything else prior to a spinal procedure, quit smoking. It may make the difference between a satisfying outcome and a failure.

Authors of a 2016 study published in the journal Cureus found that current smokers have more back pain than those who have quit, and those who have quit have more back pain than those who have never smoked.

Uncontrollable Low Back Pain Risk Factors

Some people need more vigilant about back pain than others. Being female, getting older, having emotional issues and/or having a job with a high degree of physical demand are some of the main uncontrollable risk factors for chronic low back pain.

Gender

Possibly due to hormones, women and girls are at a higher risk for back pain. A 2016 study published in the April issue of Quantitative Imaging in Medicine and Surgery found that back pain was more prevalent in females than males. The researchers say the sharpest distinction between male-female back pain cases occurs in the school-aged group. In the study, post-menopausal women were also more likely than other adult age groups to have back pain.

Age

With increasing age you can expect at least some development of degenerative spinal changes. While you can’t control this, you can influence the rate of development as well as how comfortable your are. Flexibility and range of motion exercises are key for slowing degenerative changes and reducing pain. Strengthening exercises are almost as important for the same reasons. Ask your doctor or physical therapist for a program that’s right for you, given your condition.

Even though women and senior citizens top the list of people who are at in the increased risk for back pain that does not exclude other types of people from having this issue. For example, whether you’re male or female, when you’re younger and more generally more active, your disks are filled with water, making it easier to herniate a disc, strain a muscle, sprain a ligament or sustain similar injuries.

Your Job

Occupational back pain problems are common. Jobs with high physical demand increase the risk the most, but sedentary jobs can also cause musculoskeletal disorders (MSDs) which are injuries or conditions affecting the soft tissues of the body. MSDs often lead to stiffness, pain and decreased physical functioning.

Are You at Risk?

Although rare, a serious health problem maybe at the root of your back pain. The problem is, you may not know it unless you get checked by a board-certified M.D. This is one of several reasons why seeing a doctor after an injury or trauma, or when you notice new symptoms, is recommended.

Part of a physician's job during that initial appointment is to identify any red flags, or signs and symptoms that suggest underlying disease or serious spinal pathology are at work in your body.

Underlying disease may be life-threatening; serious spinal pathology generally is not, but can be extremely painful and debilitating nonetheless. It often leads to specific back pain. Specific back pain is pain with an identifiable cause.

A more common variety of back pain, which is related to muscles and posture, is called non-specific back pain, also known as mechanical back pain. Doctors regard back pain as non-specific once they’ve ruled out all the possible specific conditions, for example, osteoporosis, spinal fracture, scoliosis and more.

Mechanical back pain is generally easier to deal with than specific back pain. A few visits to physical therapy—along with adherence to your home exercise program—may be all you need to move past the pain. Anti-inflammatory pain medication and/or skeletal muscle relaxers may also help, especially in the beginning, by calming down tension and pain so you can do your best work in the physical therapy sessions.

A Note From Verywell

The risk for back pain is always there. It’s just the type and cause that can change. Keeping your muscles strong and flexible, your weight in check and quitting smoking are powerful protectors against spine related issues.

Sources:

Amorim, A., et. al. Does sedentary behavior increase the risk of low back pain? A population-based co-twin study of Spanish twins. Spine J. July 2017.

Chou, L., et. al. The Association Between Obesity and Low Back Pain and Disability Is Affected by Mood Disorders: A Population-Based, Cross-Sectional Study of Men Medicine (Baltimore) April 2016.

Green, B. Association Between Smoking and Back Pain in a Cross-Section of Adult Americans Cureus. Sept. 2016.

Hruschak, V., et. al. Psychosocial predictors in the transition from acute to chronic pain: a systematic review Psychology, Health and Medicine. Feb 2018.

Kokkas, B. Tissue Injury and inflammation. Ann Gen Psychiatry. April 2010.