By: Jean Johnson for Back1Common sense says that too much weight is hard on the back. That said, John Ratliff, MD, an assistant professor of neurological and orthopedic surgery at Jefferson Medical College of Thomas Jefferson University in Philadelphia, says the science is not conclusive.
“It makes sense to think that more people who need back surgery might be more likely to be overweight and obese, though evidence in the medical literature is unclear,” Ratiliff told ScienceDaily in advance of his October 2006 presentation at the Congress of Neurological Surgeons Annual Meeting in Chicago. “We don’t really know if obesity contributes to back pain.”
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The NASS offers the following tips for keeping the back in good shape:
Do regular aerobic and weight-bearing exercise three to five times a week to improve overall fitness and decrease the likelihood of a back injury.
General rules of thumb for exercising:
Do each movement slowly.
Do each exercise twice a day.
Start with five repetitions of each exercise and work up to 10.
If an exercise increases your back pain after five repetitions, stop.
Always stretch gently before and after an exercise session.
Do focus on the abdominal and gluteal muscles to build core strength that can reduce the strain on the spine.
Develop the habit of stretching throughout the day. Stretching helps keep muscles flexible and less prone to injury.
Stand up straight. “Bad posture can worsen back pain, while using your abdominal muscles to sit or stand upright takes a load off your spine. This is especially true if you have excess weight in the form of a ‘beer belly.’”
Bring an extra pillow to bed. “Sleeping on your back puts 55 lbs. of pressure on the your spine. Putting a couple pillows under your knees cuts the pressure in half. Lying on your side with a pillow between your knees also reduces the pressure.”
Eat well, including enough dairy and leafy greens to get a daily dose of calcium and vitamin D.
Stop smoking. “Nicotine restricts the flow of blood to the discs that cushion the vertebrae of your spine.” |
Perhaps not, but Ratliff’s review of over 300 cases of thoracic and lumbar spinal surgeries for routine degenerative conditions that he performed from 2002 to 2005 led him to the conclusion that at the very least, obesity raised the incidence of complications related to spinal surgery. “We found that the incidence of complications related directly to the degree of obesity,” he said. “Not only does being obese raise the risk of complications, but the greater the obesity, the greater the risk of having something go wrong around the time of surgery.”
‘Take a Load Off Your Back’
The nation’s leading spine organization isn’t waiting until all the studies are in. Indeed, the North American Spine Society (NASS) has inaugurated an education campaign called ‘Take a Load Off Your Back.’ As part of its efforts, the NASS sent out a national survey to 3900 spine care professionals in 2005 and received 421 replies.
“The survey unveiled an increasing trend in the number of obese patients being treated for spine-related disorders – up nearly 67 percent from just five years ago,” states NASS. Put another way, the survey indicated that 44 percent of the patients that physicians who specialize in disorders of the back and spine see are considered obese.
According to Tom Facizewski, MD, a leading orthopedic surgeon at the Marshfield Clinic in Wisconsin and a NASS member, “People are coming in not by dozens but in droves because of obesity and back pain.”
The survey supports Facizewski’s observations. “A starling 87 percent of spine professionals surveyed agree that obesity plays a significant role in back pain,” stated the NASS. “The vast majority of those surveyed (94 percent) also said they recommend weight loss as a treatment option for their obese patients and, in follow-up treatment for patients who lose the weight, 55 percent found a significant improvement in their patients’ symptoms as a direct result of weight loss.”
Back Problems Common to Overweight and Obese Patients
“I hope you talk about what some of the problems are for us full figured people,” said Michelle Sparks of Los Angeles. “I’ve wavered borderline between overweight and obese most of my life. I’ve already paid the price in my shoe size. I wear a double E shoe, and it’s because my weight has caused the bones of my feet to splay out. That had already happened by the time I was a teen, and it was so sad seeing me trying to fit into all the princess shoes my girlfriends looked so cute in. That was back when the shoes were pointed. I looked so ridiculous.
“But all that adolescent sorrow is behind me now, I suppose. Now I have new worries. I’ve just turned forty, and since I’ve never really been able to deal with my weight problem I’m afraid I’m in line for some super serious problems. Physical aches and pains, to put it politely.”
Sparks says that her back does hurt.
“Yes, most of the time. I’m embarrassed to say that I have a big belly. I mean it’s not that huge. I wear about a size 14 or 16 these days and am average height. But my tummy is there, and I’m sure that doesn’t help the situation. Also being so large, it’s not all that fun to exercise, something I imagine the docs are going to say even us chubby ones need to do.”
Degenerative Disc Disease
As far as the problems Sparks is interested in hearing about, the NASS lists three that are common to obese patients. A condition called degenerative disc disease tops the roster. When there is sufficient wear and tear on any of the 23 vertebral discs that act like shock absorbers between adjacent vertebrae, degenerative disc disease results.
“Over time, spinal discs dehydrate and become stiffer, causing the disc to be less able to adjust to compression. While this is a natural aging process, as the disc degenerates it can become painful for some individuals,” states the NASS. “The most likely reason for this is that the degeneration can produce micromotion instability and the inflammatory proteins (the soft inner core of the disc) probably leak out of the disc space and inflame the well-innervated structures next to the disc (e.g. nerve roots). Sometimes a twisting injury damages the disc and starts a cascade of events that leads to degeneration.”
Spondylolisthesis
Spondylolisthesis (spawn-de-low-lis-THE-sis) is a rather ungainly term for discs on the lower back that become so unstable from wear and tear that they slip. When this happens nerves can get pinched and pain can ensue both in the back and in the arms and legs.
Disc Rupture and Herniation
With disc slippage, notes the NASS, can come disc rupture or herniation, a condition that arises when the soft center part of the disc is displaced through a crack in the hard outer layer of the disc.
“Most disc herniations occur in the bottom two discs of the lumbar spine, at and just below the waist,” states the NASS. “A herniated disc can press on the nerves in the spine and may cause pain, numbness, tingling or weakness of the leg called sciatica. Sciatica affects about 1 to 2 percent of all people between the ages of 30 and 50.”
NASS adds that “obese patients are also at an increased risk of developing spondylolysis (spawn-de-low-LI-sis), a fracture in the vertebrae, and spinal stenosis, which is narrowing of the spinal canal.”
Self-Care for the Back: A Catch-22?
“Physical activity is extremely important, and the most often prescribed treatment for spine health since a patient’s back joints and discs rely on motion to keep them healthy,” the NASS explains. “Overweight patients often suffer from muscle atrophy (shrinkage or a loss of tone) due to inactivity which worsens back symptoms and problems. NASS physicians such as Dr. Facizewski are encouraging those with overloaded springs to take their lifestyles seriously.”
Philadelphia’s Ratliff concurs, but he understands how difficult this can sometimes be.
“Obesity and back pain is a Catch-22,” he told ScienceDaily. “A person is obese, has back pain, and the doctor says to exercise. But because of the pain he may not be able to exercise enough and continues to put on weight. Then the back hurts more, and he becomes even more inactive.”
When we shared Ratliff’s thoughts with Sparks, she got up out of her chair. “That does it. I’m not going wait until there’s a crisis. Starting today, I promise – it’s off to the gym. And don’t worry, I won’t overdo it. There’s a trainer there, and he helps me set goals and keep my pacing steady.
“But hey, thanks for the interview and the education,” Sparks said. “It really does help to remember how delicate our spines are. All those little bones and the pads and the nerves. What a gift. I’m not waiting for the new year and any resolution. I’m starting now. If I can’t deal with the weight just yet, at least I can keep things moving. I might even check out a yoga class.”
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