Low back pain is one of the common health problems that 50-80% of adults experience at some point in their life ¹. It is estimated that people over the age of 18 who can work are most susceptible to LBP, which is, globally, the most critical reason for disability ^{2, 3}. The burden of LBP stemming from work-related ergonomic exposures was projected to result in about 21.8 million disability-adjusted life years (DALYs), in 2010 (95% confidence interval (CI) 14.5-30.5) ². Of this, 8.3 M DALYs were in females and the remaining 13.5 million were in males. Nearly everyone will suffer from lower back discomfort at some point in their lives ⁴. The prevalence of the 1 year period generally occurs in adults worldwide and increases when one reaches the middle-age period. Women are more likely to have LBP than men. People with low back discomfort who cannot engage in everyday activities have a greater risk of developing such conditions with age ⁵. Numerous individual and environmental risk factors for LBP have been identified ⁶. For example, individual factors, such as metabolism, biochemistry, physical factors, and expressive tendencies, have been identified as risk factors for LBP ⁷. Moreover, environmental risk factors, such as job satisfaction, lifting heavy weights, prolonged standing, forward bending and carrying school backpacks, have been identified ⁶. However, there is limited evidence of other associated risk factors of LBP, such as arthritis, diabetes, and hypertension.

 AIMS & OBJECTIVES: The aim of this study to determine the prevalence and risk factors of lower back pain among the young adults in our geographical area.

The study was a cross-sectional survey carried out in the department of orthopedics in a tertiary care teaching hospital, India from June 2020 to November 2020  (06 Months). A total of 800 young adults suffering for low back pain attending out patient’s department during the study period were enrolled.

INCLUSION CRITERIA

1. Patients aged between 18 and 50 years.
2. Participants who provide consent for the study.

EXCLUSION CRITERIA

1. Patients <18 or > 50 years of age.
2. Participants who not provide consent for the study.
3. Immuno compromised or patients on steroid.

Detailed Socio-demographic data was taken from all the patients. Data included the age, gender, residential status, socio economic status, BMI, travelling history, diet, smoking and alcoholic status, type of work, posture while studying (walking, sitting in a chair and forward bending, sitting in a chair with back support, sitting on the floor with back support, and sitting on the floor without back support), Type and duration of sport, history of previous LBP, history of osteoporosis, history of spine problems, the intensity of pain, factors that aggravate and relieve LBP, duration of pain, i.e. the frequency of pain in a day are also taken. Pain was assigned a score of 0-100.

STATISTICAL ANALYSIS

The data were analyzed using the SPSS ver. 19 (SPSS). Percentages and proportions were calculated. The chi-square test was used for categorical variables. P value <0.05 to be considered as statistically significant.

Prevalence of the low back pain in the present study was 23.5% (800/3400). Out of the total patients the most common age group to be affected was 41-50 years (40%), predominantly females (56%). Majority of them (62%) were residing at rural area, 52% belong to lower socio-economic class and 42% had education up to primary school. Most of the people under study were married (89%), many of the patients (42%) were laborers, 70% of participant was vegetarian. 49% of the people were nonsmokers while 43% were occasional smokers and 55% consumed alcohol occasionally [table:1].

Table 1: Socio-demographic details of low back pain patients

Most of the patients had moderate physical exercise on daily basis (53.75%). Only 15% had past history of spine problem, 55% have regular weight lifting, 40% patients were occasional sitting for long time. Most of the patients (44%) were overweight, 59.5% had family history of LBP and 24% having history of fracture (table 2).

Table 2: Risk factors associated with low back pain

Majority (66%) of the patients had LBP for around 1 year, 61% of the patients were position of the pain in the lower back and 45% of patients had moderate degree of pain (Table 3).

Table 3: Time, duration and severity of low back pain

Among relation of co morbidities and LBP, 34.5% was diabetic, 30.5% had hypertension, 31.5% patients having dyslipidemia, 15% of asthma and 23% patients had depression. Osteoporosis was present in 44.5% of LBP patients and 38.7% had arthritis.

Table 4: Correlation of low back pain with other comorbid conditions

Lower back pain is one of the common causes for frequent visits to hospital, as well as absence from work and activity. It results in financial stress due to frequent hospital visits and mental and physical stress to the individual and his family. LBP has been reported from throughout the world, both developed and developing countries alike. LBP occurs at any time, to anybody ^8-9. The prevalence of low back pain in middle-aged adults was 23.5%, in agreement with the Waterman BR, et al.¹⁰ and Jacobs JM,et al.¹¹ reported prevalence of LBP were 28% and 23% respectively. Present study was found females to be more affected by back pain than males, corroborated by Hoy et al.¹² and Rodrigo, et al.¹³.

In our study LBP was most commonly affect 41-50 years older adults, concordance with the Hayden J, et al.¹⁴ and Meucci RD,et al.¹⁵.  Prevalence of LBP was increases with the age. Higher prevalence of LBP in this age group is said to be associated with the occupational as well as domestic pressures that overload the lower back along with the degenerative articular process shown after 30 years of age.  In the present study, we had found no significant association with the marital status, literacy, smoking and alcohol consumption to LBP, our results correlate with the Ramdas J et al.¹⁶. Current study observed that LBP was more among rural and lower socio-economic class persons, comparable with the Freburger et al.¹⁷. The most common risk factors for LBP in present study were physical exercise, lifting weights; family history of LBP, obesity and sitting for long periods, similar finding also reported by Heneweer H, et al.¹⁸ and Heuch I, et al.¹⁹. Sedentary life style especially due to sitting at computers for long period of time contributed to the lower back pain. Obesity is known to promote overloading of the articular structures of the lumbar spine, thus causing predisposition to degeneration resulting in LBP. In our study patients had LBP for around 1 year and moderate in nature, consistent observation seen by Ramdas J et al.²⁰.

Co morbidities like diabetes, hypertension, asthma, dyslipidemia, arthritis and osteoporosis was not significantly associated with the LBP in this study, our results comparable with thesome other researchers ^21-22.

This study shows that lower back pain is prevalent especially in the adult community. The predisposing factors for this condition are obesity, carrying weights, stress, sitting in a position for a long period of time, etc. Identification of these risk factors at an early stage will prevent the progression of acute LBP to chronic LBP. As chronic LBP has the potential to curb individual quality of life and increase economic burden, creating awareness about the modifiable risk factors in young adult populations may lead to lifestyle modifications, thereby improving their quality of life and increasing productivity.

1. Rubin DI (2007) Epidemiology and risk factors for spine pain. Neurol Clin 25(2):353–371.
2. Hoy D, March L, Brooks P, Woolf A, Blyth F, Vos T, Buchbinder R. Measuring the global burden of low back pain. Best Pract. Res.Clin.Rheumatol.2010, 24, 155–165.
3. Bressler, H.B.; Keyes, W.J.; Rochon, P.A.; Badley, E. The Prevalence of Low Back Pain in the Elderly. Spine1999, 24, 1813–1819.
4. Lemeunier, N.; Leboeuf-Yde, C.; Gagey, O. The natural course of low back pain: A systematic critical literature review. Chiropr. Man. Ther. 2012, 20, 33.
5. Buchbinder, R.; van Tulder, M.; Öberg, B.; Costa, L.M.;Woolf, A.; Schoene, M.; Croft, P.; Lancet Low Back Pain Series Working Group. Low back pain: A call for action. Lancet 2018, 391, 2384–2388.
6. Parreira, P.; Maher, C.G.; Steffens, D.; Hancock, M.; Ferreira, M.L. Risk factors for low back pain and sciatica: An umbrella review. Spine J. 2018, 18, 1715–1721.
7. Bressler HB, Keyes WJ, Rochon PA, Badley E (1999) The prevalence of low back pain in the elderly: a systematic review of the literature. Spine 24(17):1813
8. Hoy D, Toole MJ, Morgan D, Morgan C. Low back pain in rural Tibet. Lancet. 2003; 361(9353):225-6.
9. Jin K, Sorock GS, Courtney TK. Prevalence of low back pain in three occupational groups in Shanghai, People's Republic of China. J Safety Res. 2004; 35(1):23-8.
10. Waterman BR, Belmont JP, Schoenfeld AJ (2012) Low back pain in the United States: incidence and risk factors for presentation in the emergency setting. Spine J 12(1):63–70
11. Jacobs JM, Hammerman-Rozenberg R, Cohen A, Stessman J. Chronic Back Pain Among the Elderly: Prevalence, Associations, and Predictors. Spine. 2006; 31(7):E2003–E7.
12. Hoy D, Brooks P, Blyth F, Buchbinder R. The Epidemiology of low back pain. Best Pract Res Clin Rheumatol. 2010; 24(6):769-81
13. Rodrigo Dalke Meucci, AnaclaudiaGastal Fassa, Neice Muller Xavier Faria, Prevalence of chronic low back pain: systematic review, Rev SaúdePública 2015;49:73
14. Hayden J, Tougas M, Riley R, Iles R, Pincus T: Individual recovery expectations and prognosis of outcomes in nonspecific low back pain: Prognostic factor exemplar review. Cochrane Database of Syst Rev 9:CD-11284, 2014
15. Meucci RD, Fassa AG, Faria NMX. Prevalence of chronic low back pain: systematic review. J Public Health. 2015; 49:1.
16. Stewart Williams J, Ng N, Peltzer K, Yawson A, Biritwum R, Maximova T, et al. (2015) Risk Factors and Disability Associated with Low Back Pain in Older Adults in Low- and Middle- Income Countries. Results from the WHO Study on Global ageing and Adult Health (SAGE). PLoSONE10(6):e0127880.doi:10.1371/journal.pone.0127880
17. Freburger JK, Holmes GM, Agans RP, Jackman AM, Darter JD, Wallace AS, et al. The rising prevalence of chronic low back pain. Arch Intern Med. 2009; 169(3):251-8.
18. Heneweer H, Vanhees L, Picavet HS. Physical activity and low back pain: a U-shaped relation? Pain. 2009; 143(1-2):21-5.
19. Heuch I, Hagen K, Heuch I, Nygaard Ø, Zwart JA. The impact of body mass index on the prevalence of low back pain: the HUNT study. Spine. 2010; 35(7):764-8.
20. Ramdas J, Jella V. Prevalence and risk factors of low back pain. Int J Adv Med 2018; 5:1120-3.
21. Sikiru L, Hanifa S, Prevalence and risk factors of low back pain among nurses in a typical Nigerian hospital, African Health Sciences Vol 10 No 1 March 2010.26
22. Sudhir Ganesan, Anita Shankar Acharya, Ravi Chauhan, Shankar Acharya, Prevalence and Risk Factors for Low Back Pain in 1,355 Young Adults: A Cross-Sectional Study, Asian Spine J 2017;11(4):610-617.