Your Back Pain and the Calorie Connection

Despite the recent trends in awareness and promotion of healthy living and diet/exercise management, 68.8% of Americans are overweight or obese. Besides the obvious health issues that often subtract years from the lives of people who are overweight or obese, there are many quality of life concerns as well. I want to dive into one of those concerns today and how weight relates to lower back pain.

Let’s do a quick breakdown of lower back pain before going further.

There are 318.9 Million people living in America right now

68.8% of them are overweight or obese: That’s 219.4 Million Americans

1/3 of all people who are overweight or obese have episodes of lower back pain: 73.1 Million overweight or obese Americans have low back pain

That’s a lot of sore backs! Don’t forget too, there is a cost related to lower back pain. For example in 2016, the cost of lower back pain was $100 Billion including almost 2/3 of that from lost wages and reduced productivity.


What’s The Connection?

But why? Why the connection? What is it about carrying those extra pounds that causes back pain?

Crazy as this sounds, the science is still out on the why. Using some logic and biophysics, this is the best answer I put together…

Tired muscles do not perform properly. That’s a given, right?  Increased weight increases the work of our weight bearing muscles (the ones that work when we are upright). This leads to poor performance of these muscles where they eventually need some backup.

Before going on, an interesting thing to mention about our muscles are that they are separated into two categories: ones that move us and get tired quickly (called fast twitch muscles), and ones that help with posture and usually don’t get tired so easily (called slow twitch muscles). Our postural muscles are the ones that support our spine by stiffening it up and preventing unsafe motion, like sheering. Once the posture muscles can’t do the job by themselves, they call upon the ones that help us move (fast twitch) to assist stiffening of our spine. The fast twitch fibers are not built for prolonged use so when they are fatigued, they cause muscle aches.

If we take this a few steps further, you can see how an acute lower back muscle strain (mini-muscle tear/ache) can cause more chronic and more serious injuries. As our spinal stability fails to stiffen the spine by itself (which we mentioned happens quicker in those who are overweight or obese), compensation kicks in. The unintended consequences of these compensations usually cause unsafe sheering forces on the discs (cushions between the vertebrae), which could lead to herniation/slipped discs.

Don’t Forget About Arthritis

We also have arthritis which can cause pain in the spine. Most people, I think, have a good understanding of what arthritis is and how it occurs, if not- here ya go!

Think of every joint in our body having a limit to how many times in can move before it breaks down (this would be a very high number). When we gain weight, there is naturally more strain on the joint due to increased compression when we walk, sit, stand, climb stairs, etc… That extra compression eats up that high number we said the joint would be able to move (I.e. instead of each step counting as one, maybe it counts as two or three). Therefore, decreasing overall weight decreases added compression slowing down the process of arthritis throughout the body.

How We Measure Obesity

Though I don’t necessarily care for the BMI (body mass index) to assess health, it is used often in medical studies and thus I will discuss it here. If you have a BMI of 25 or higher, you are at risk for developing arthritis (not just in the spine). Here’s a chart

There is now even evidence to support a correlation between higher intensity lower back pain with people at a BMI of 28 or higher

Now What…

So, you found your BMI, and maybe you’re not too pleased. What to do about this now?

In my last article I dropped this bombshell: One of the most important things you can do for the management of your lower back pain is to start moving, get stronger, and avoid end range motion (bent all the way, one way or another). Does Physical Therapy help? You bet your matzah brei/Easter basket it does! By first focusing on getting you moving so that you can manage that flat tire you may be carrying around, PT can be extremely beneficial in the management of lower back pain. Gray Cook, a guru in the field of movement (he wrote the book on it actually) has a tagline associated with his functional movement assessment (the FMS), “Move Well, Move Often”


Exercise, however, is not enough. A lifestyle change to a diet rich in healthful and nutritionally dense foods while maintaining calorie awareness is a necessity. Margaret Marshall, the Long Island author of “Healthy Living Means Living Healthy”, has a saying that I think makes a lot of sense, “Smart eating (is) eating foods enjoyable to you in quantities that are good for you.” She also has a really great guide helping divide up what kind of foods you should eat called the “5 Finger Food Guide”

So, quick recap

  • Lower back pain is a common co-morbidity related to obesity
  • Excessive weight may cause postural muscles to need assistance to stiffen the spine, which comes at the price of easily fatigued muscles helping, but also causing unsafe sheering motion
  • Obesity increases compression at our weight bearing joints (ankle, knee, hip, spine) causing increased breakdown leading to arthritis
  • Physical Therapy is hugely beneficial to managing lower back pain in people who are overweight or obese primarily by assisting in getting them to start moving more on their own
  • Exercise is great, but obviously not the only thing associated with managing your weight, as diet is incredibly important.
  • Your hand is a great guide to divvy up how much you should eat
    • Middle finger: fruits and veggies (eat the most of these)
    • Ring finger: proteins (next these)
    • Index finger: carbs (then these)
    • Pinky finger: fats (a little bit of these)
    • Thumb: specials, guilty pleasures (the least of these)

Now that you finished that chocolate covered Easter bunny or matzah, it’s time to think about the calorie connection to your back pain and get moving- first well, then often 🙂


Be Well,

Dr. Daniel Davids PT

For help with your back pain or exercise in general, you can contact The Traveling Phsyical Therapist at (646)733-4737


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