How Back Pain Became Common in Our Modern World

Four out of five: That’s the number of Americans who experience back pain at some point in their lives.

It’s the leading cause of disability around the world among adults, second only to infections as a reason for seeking treatment.

As a chiropractor, I treat patients with this affliction every day. Back pain has become more prevalent and ubiquitous in our modern world, and much of that has to do with how we interact with our environment.

There are things we do too much of, and others we’re not doing nearly enough — which is causing both structural and mechanical changes, leading factors in pain, dysfunction, and disability.

A primary driver for the increase in back pain has to do with the changing nature of work. Our occupations have shifted; from active jobs, to more sedentary ones.

According to Johns Hopkins, physically active jobs now make up less than 20% of the U.S. workforce. The American Heart Association also found sedentary jobs have increased by 83% since 1950. These occupations come with a unique set of circumstances — causing and contributing to back pain — and it all starts with sitting.

Sitting too often, for too long, with poor posture

You’re probably sitting right now. And that’s fine, provided you haven’t been doing so for over an hour without standing at least once. Therein lies the problem: an average person spends more than half their day sitting, while an office worker sits 15 hours every workday.

All that sitting is harmful for a host of reasons. When we sit, blood flow decreases and tends to pool in our legs, major muscle groups become inactive while others become taught and spastic, and our posture pays the price.

The glutes are among the largest, most powerful muscle groups in our body, and sitting turns them off like a light switch. We have the compounded effect of tightening the psoas muscle (a primary hip flexor), as well as tightening our hamstrings (a primary knee flexor). Essentially, we are deactivating a powerful muscle group (the glutes) and putting tension in other muscle groups (the psoas and hamstrings) which further inhibits or deactivates the glutes.

If you’re in an office setting now, look around; you’ll find most people are sitting with their heads flexed forward or looking down, shoulders internally rotated and their upper back hunched, rounded, or flexed forward. These positions place stress on the spinal erector muscles, the group responsible for keeping you upright.

Being seated also inhibits abdominal muscles, leads to postural changes in the neck and upper back, which further cause breakdowns in the kinetic chain.

Muscle weakness → spinal instability

Most back pain is structural or mechanical in nature. Muscle groups inhibited or weakened by sitting—the glutes, abdominals and spinal erector muscles — are essential for spinal strength and stability. Prolonged sitting perpetuates a harmful cycle — creating muscle inhibition and weakness, causing poor posture and structural changes — leading to more back pain.

While half of Americans meet physical activity guidelines, less than one quarter achieve recommendations for strength training. Strengthening exercises, specifically for core muscle groups, can decrease back pain more so than general exercise.

Focusing on muscle groups inhibited or weakened by sitting, and limiting sitting altogether, can help break the back pain cycle. Standing at least once every hour and performing a few squats to activate the glutes is a great way to increase blood flow and energy. The following step-by-step exercise is also helpful:

1. Ensure your head, shoulders and hips are in a straight line

2. Interlace your fingers and place your arms behind your head

3. Elevate your torso, and retract your elbows back a few inches by squeezing your shoulder blades together

4. Tighten your core muscles (contract abdominals and back extensors)

5. Hold for a few seconds

Performing other exercises while seated can activate core muscles as well.

Sit less, move more, maintain a healthy weight

Despite all the turmoil of the past year and a half — brought on by a pandemic and ensuing lockdowns — as a general rule, modern humans sit more and move less than ever before. Sitting for long periods can lead to much more than back pain; studies have found a direct link with heart disease, diabetes, and researchers are looking into links to certain types of cancer. Sedentary occupations also contribute to weight gain, another factor in the prevalence of back pain.

Compared to 1960, Americans on average, are one inch taller, but 25 pounds heavier. In various studies, higher BMI and waist–hip ratio were associated with high-intensity low back pain and/or high disability, after adjusting for confounders such as age, emotional disorder, education, and mobility. While some causes of back pain are outside our control, including genetics, congenital factors, or injuries; muscle weakness, poor posture, and weight gain can all be addressed.

Sitting less, moving more, and core exercises are a great start. Adequate hydration and a healthy, plant based diet, can also help. In my chiropractic training, we had a saying, ‘motion is life and water is the key’, unlock your potential for greater health and less pain.