Big Belly – Back Pain
Danielle R. Steilen, MMS, PA-C
- It is not often that surgeons and doctors agree, but there are some rarities. One topic of agreement is the problem of obesity in treating lumbar disc herniation.
In a recently published article in the American Journal of Bone and Joint Surgery, researchers examined the effect that obesity has on patients managed for symptomatic lumbar disc herniation. They studied a group of patients who underwent back surgery and a group of patients who had more conservative non-surgical treatments. Both groups showed significantly less improvement as it related to problems of obesity.1.
In more research, doctors suggest that even if you do not lose weight, even moderate physical activity will help low back pain. Here are the highlights of their research:2
- If you have a big belly, even if you are pain free now, you are at high risk for developing low back pain.
- If you have no physical activity you are at high risk factor for low back pain.
- If you are obese with no physical activity – you are at very high risk for low back pain or more severe back pain.
Exercise suggestions revolving around the core
Prolotherapists routinely see patients who try to relieve their low back pain with high intensity workouts. Often the patients are doing more harm than good. Low back pain patients must remember that they need exercise that brings circulation and muscle building to the low back area, but they should be cautious to engage in accelerated or extreme activities.
“Compared to general exercise, core stability exercise is more effective in decreasing pain and may improve physical function in patients with chronic low back pain in the short term. However, no significant long-term differences in pain severity were observed between patients who engaged in core stability exercise versus those who engaged in general exercise.”3
This should not surprise anyone. Patients with low back pain have weakened and stressed ligaments. This causes instability and low back pain. What is not mentioned in the above research is the likely cause for the core exercises not showing a very clear advantage: overuse.
On occasion a Prolotherapist will see a patient return two months after completing a successful comprehensive Prolotherapy treatment, complaining of worsening low back pain. Typically the patient will reveal that they felt so good that they begin to engage in extreme activity without a slow, gradual buildup.
The main movements that injure newly healed lumbar ligaments are ones that involve flexing at the waist and twisting to the side. The lower back, for most people, does not have enough flexibility and strength to perform motions, especially fast ones that involve both flexing and twisting. The sacroiliac ligaments, in particular, are fine if you twist with a straight back or flex forward without twisting. Once you flex and twist, it puts such a great torque on the lower back.
Activity following Prolotherapy must use proper back mechanics. The lower back was not meant to sustain a twisting motion while it is in the flexed position. Core exercises that involve flexing at the waist and twisting, will in all likelihood, lead to low back pain. Always consult your Prolotherapy doctor for an exercise plan to strengthen your lower back and core based on your individual case and ask for general exercise recommendations.
In another article, spinal surgeons said that a component of failed spinal surgery was obesity. Amazingly enough this two-year-old research was the first to examine obesity’s role in recurrent disc herniation. A study should have been performed to see what took so long to make an obvious connection: “Obesity was a strong and independent predictor of recurrent (disc herniation) after lumbar microdiscectomy. Surgeons should incorporate weight loss counseling into their preoperative discussions with patients.”4
There is even suggestion that elevated cholesterol levels and triglycerides have a role: “patients with symptomatic herniated lumbar disc showed statistically significant higher triglyceride concentration and total cholesterol concentration. Serum lipid levels may be a risk factor for [symptomatic disc herniation]. An enhanced understanding of these factors holds the promise of new approaches to the prevention and management.”5
Again, this all comes down to lifestyle choices to accelerate healing or make healing more difficult. We discuss the lifestyle choices in regards to healing at length in our article on the relationship between obesity and healing.
Addressing obesity and back pain
It should be obvious that if you have joint deterioration, a change in lifestyle in addition to any treatment will be beneficial.
“new models of care and strategies to train community health-care workers and primary health-care practitioners to detect and initiate the management of patients with musculoskeletal disorders at an earlier stage are required. There is also a need for prevention strategies with campaigns to educate and raise awareness among the entire population. Lifestyle interventions such as maintaining an ideal body weight to prevent obesity, regular exercises, avoidance of smoking and alcohol abuse, intake of a balanced diet and nutrients to include adequate calcium and vitamin D, modification of the work environment and avoidance of certain repetitive activities will prevent or ameliorate disorders such as osteoarthritis, osteoporosis, rheumatoid arthritis, gout and musculoskeletal pain syndromes including low back pain and work-related pain syndromes. These prevention strategies also contribute to reducing the prevalence and outcome of diseases such as hypertension, cardiovascular diseases, diabetes and respiratory diseases.”6
The most successful Prolotherapy offices are those that promote healthy lifestyles along with Prolotherapy to achieve the most efficient healing.
1. Rihn JA, Kurd M, Hilibrand AS, Lurie J, Zhao W, Albert T, Weinstein J. The Influence of Obesity on the Outcome of Treatment of Lumbar Disc Herniation: Analysis of the Spine Patient Outcomes Research Trial (SPORT). J Bone Joint Surg Am. 2012 Nov 28. doi: 10.2106/JBJS.K.01558. [Epub ahead of print]
2. Shiri R, Solovieva S, Husgafvel-Pursiainen K, Telama R, Yang X, Viikari J, Raitakari OT, Viikari-Juntura E. The role of obesity and physical activity in non-specific and radiating low back pain: The Young Finns study. Semin Arthritis Rheum. 2012 Dec 25. pii: S0049-0172(12)00227-2. doi: 10.1016/j.semarthrit.2012.09.002. [Epub ahead of print]
3. Wang XQ, Zheng JJ, Yu ZW, et al. A Meta-Analysis of Core Stability Exercise versus General Exercise for Chronic Low Back Pain. PLoS One. 2012;7(12):e52082. doi: 10.1371/journal.pone.0052082. Epub 2012 Dec 17.
4. Meredith DS, Huang RC, Nguyen J, Lyman S. Obesity increases the risk of recurrent herniated nucleus pulposus after lumbar microdiscectomy. Spine J. 2010 Jul;10(7):575-80. Epub 2010 Mar 27.
5. Longo UG, Denaro L, Spiezia F, et al. Symptomatic disc herniation and serum lipid levels. Eur Spine J. 2011 Oct;20(10):1658-62. Epub 2011 Mar 9.
6. Mody GM, Brooks PM. Improving musculoskeletal health: global issues. Best Pract Res Clin Rheumatol. 2012 Apr;26(2):237-49.