2007-03-16 / Columnists

Eye On Physical Therapy

Commentary By Dr. Tim Rohrs

Commentary By Dr. Tim Rohrs

This past week one of my employees experienced severe low back pain. Her visit to the emergency room at Peninsula Hospital Center could be considered common. After a workup and x-rays the attending physician told her that it would help if she "lost some weight." This is a personal thorn in my side, as a person who struggles with their weight. As a physical therapist, I can attest to the fact that more thin people present to my office for low back, knee and hip pain than overweight people. Of course, close to 11 years of experience may not convince those that believe otherwise.

Those in the medical community that study the causes of low back pain have been focusing their efforts on identifying co-morbidities that play a role in the development of chronic low back pain. Co-morbidities that we normally think of in low back pain could include arthritis, obesity, osteoporosis, lack of exercise etc.

Some recent studies suggest that these preconceptions may be misconceptions. A study published in the British Medical Journal in 1999 by Thomas et al found that the presence of the following increased the chance of acute low back pain progressing to chronic low back pain: 1. high levels of psychological stress, 2. poor self rated health, 3. dissatisfaction with work. The presence of these co-morbidities increased the chance of progression to chronic symptoms six- fold. In another study, published in the journal SPINE in 2004, Smith etal found that the factors associated with the persistence of low back pain four years after the initial survey included poor mental health, high level of expressed need and preexisting arthritis.

None of these studies identified obesity as a contributing factor in the progression of acute to chronic low back pain. There are many other health related reasons for people to lose weight; cardiovascular disease, diabetes, and early onset osteoarthritis. As my colleague with the back pain noted, the overused comment of the medical community "lose some weight", is not only demeaning, but unnecessary as most overweight people are painfully aware of their obesity and the need for weight loss. In addition, many feel that the comment to "lose some weight" is a medical cop out when the cause of the pain is unknown.

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