Obesity and Lumbar Pain

December 1, 2014

brianDr. Brian White, an Osteopathic physician and physiatrist at the Bassett Spine Care Institute in Cooperstown, recently served as Course Director for a session titled “Obesity and Musculoskeletal Pain” at the 2014 annual meeting of the American Academy of Physical Medicine and Rehabilitation (AAPMR) in San Diego.

“Unfortunately, obesity is a worsening problem, both nationally as well as locally. Obesity is bad for the body in terms of potential for developing chronic medical conditions as well as the development of a variety of painful musculoskeletal conditions including lumbar pain,” says White. “I see evidence of its impact on people’s health in my practice every day.”

As a physiatrist, Dr. White is consulted when pain, weakness, or disability prevents a patient from achieving their desired level of function. He helps patients maximize their functional capacity and assists patients in adapting to what they cannot.

“For most people, increased body weight is typically located anterior to the center of mass for the body. This position in front of the center of mass creates a ‘lever arm’ resulting in a multiplier effect. This magnifies the force that increased body weight applies to the lumbar discs, for example, 50 pounds of weight in the abdominal area causes several hundred pounds of force increase in the lumbar disc,” White explains. “Further, excess adiposity creates a state of chronic inflammation which has notable negative consequences for many medical issues as well as tending to magnify many musculoskeletal conditions, many of which have an inflammatory component to their painful character.”

The increased forces caused by obesity lead to biomechanical breakdown followed by biochemical changes in the lumbar disc. “Initially the patient has pain from the disc itself. But ultimately, as the discs fails, there is a resulting loss of disc height, and an accelerated development of degenerative changes in the lumbar facet joints, leading to further pain,” White says.

There are number of options for treating patients with lower back pain. Of course, the first recommendation for people with lumbar pain is to address as many ‘controllable’ factors as possible. For those with lumbar pain who are overweight or obese, step one is to lose weight. Treatment goals also need to focus on improving lumbar stability and decreasing lumbar stresses. A variety of therapies, including injection treatments, may be an appropriate adjunct to weight loss to help patients manage their pain.

“Many times, patients want to focus on total eradication of their pain, but unfortunately this approach is destined to fail. The goal needs to be identifying and addressing, if possible, the root cause of the problem while simultaneously working toward improving function to the best possible extent. It’s unrealistic to think many of us can attain the level of function we remember from our youth, that said, a much better quality of life is possible for most patients with the right approach.”

In addition to being the Course Director for the obesity and pain session at the Annual Assembly of the AAPMR in San Diego, Dr. White was also selected at this meeting to the position of At-large representative to the Musculoskeletal Council of the AAPMR.

Dr. White also serves as an instructor for the International Spine Intervention Society, teaching several courses around the country annually on interventional spinal treatments.

His clinical practice at Bassett Medical Center includes a focus on non-surgical spine and musculoskeletal care as well as electrodiagnostic medicine. Dr. White is a board certified physiatrist by the America Board of Medical Specialties and is also board certified in the subspecialty of Sports Medicine as well as board certified in Electrodiagnostic medicine by the American Board of Electrodiagnostic Medicine.

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