Back pain is one of the most common reasons for doctor visits, and low back pain specifically is now the leading cause of disability worldwide. Back pain a symptom, not a disease, and can be caused by one or more unknown abnormalities. For this reason, only 10% of doctor visits result in a diagnosis.
For these reasons, we worked with our experts to assemble a list of the top facts and statistics related to back pain. Our references are captured at the bottom of the resource. As always, please contact us if you have any questions or feedback.
How many adults suffer from back pain?
- Back pain is one of the most common medical conditions with 80% of adults experiencing it during their lifetimes.
- Low back pain is the leading cause of disability worldwide.
- 50% of all working adults report having back pain symptoms each year.
Who has more lower back pain, women or men?
- In most countries where it's tracked, women. A German study found a 7-day prevalence for women of 40% vs. 32% for men. A study from Spain estimated the current prevalence of low back pain at 18% for females and 11% for males.45% of pregnant women report lower back pain, which is believed to be due to changes in their posture and center of gravity which causes muscle and ligament strain.
- See graph below comparing men and women's low back pain in the United States from 1997-2016:
Source: US Department of Health and Human Services; CDC; https://www.statista.com/statistics/188858/adults-in-the-us-with-low-back-pain-by-gender-since-1997/
Is low back pain more common among younger or older adults?
How common is lower back pain?
- In the United States, just over 8% of the population has severe lower back pain.
- Worldwide, back pain is the single leading cause of disability.
|Low Back Pain Type||Estimated Population Average||Population with Pain Average||Prevalence|
|Frequent, Severe Low Back Pain||145,804,000||11,882,000||8.18%|
|Low Back Pain Attributed to Work||145,742,000||8,274,000||5.25%|
How many back pain sufferers find relief?
- It's one of the most mysterious conditions with only 10% of doctor visits tied to back pain resulting in a firm diagnosis.
- Most sufferers recover, though a small percentage will develop a chronic problem that leads to constant pain and limited mobility.
For sufferers, how often are they in pain?
- 1 in 3 people state that back pain impacts their everyday life.
Is back pain becoming more common?
- Worldwide, disability caused by back pain has increased by 54% from 1990 to 2015. This is mainly due to an increase in population as well as aging, with the biggest increases seen in low-income and middle-income countries.
- Low back pain is expected to become more common, increasing disability and costs (especially in low and middle-income countries that aren't equipped to deal with this problem).
Economics of Back Pain
How much is spent in the United States annually on back pain?
- The most recent estimate is that $86 billion is spent annually on back pain in the U.S.
What can reduce the cost of back pain treatment?
- Costs are reduced by 55% when introducing physical therapy prior to more invasive treatment options.
Are increased clinical treatment options and expenditures leading to better patient outcomes for back pain?
- While costs have increased substantially, there is no evidence of improvement in back pain with patients according to the Journal of the American Medical Association.
How many days of work are lost to employers per year due to back pain?
- There are 186.7 million days of work lost per year that results in lost productivity, insurance costs, and worker's compensation.
- Back pain is one of the most common reasons for missed work.
What is the direct cost of missed work days attributed to back pain?
- The direct cost of missed work due to back pain is estimated to be around $20 billion.
How much does back pain cost the average consumer each year?
- Back pain costs the average sufferer just over $2,000 per year.
What is the percent of people that are limited at work because of lower back pain?
- 60% of people with limitations at work cite lower back pain as the cause of their limitations.
What other costs result from back pain?
- Sufferers of back pain tend to experience worry and fear about increased costs and the inability or reduced ability to earn money, worry about social consequences, experience family strain, social withdrawal, disappointment with health-care providers (especially general practitioners), as well as have to come to terms with the pain and learn self-management strategies.
- Globally, low back pain contributes to inequality and poverty as sufferers are less able to earn a living. In Australia for example, the average value of accumulated wealth for those who retire early due to low back pain is AUD $5,038. The average for those who can continue working is AUD $339,121.
Does osteopathic manipulative treatment (OMT) result in lower healthcare costs?
- Osteo-manipulative treatment (OMT) has been found to reduce prescription and radiology costs.
Estimated average total costs (A), radiology costs (B), and prescription costs (C) by the duration of treatment per patient.
OMT is osteopathic manipulative treatment.
Back Pain Classification
What is the difference between acute, subacute, and chronic back pain?
- Acute pain is more common, and it lasts less than 6 weeks and is usually caused by an accident or event such as a fall or car accident. It normally goes away when the cause of the pain is gone, and then life can go back to normal.
- Subacute back pain lasting between 6 weeks and 3 months.
- Chronic pain is pain lasting a long time, usually more than 3 months. It is ongoing and can continue even after the event that caused the problem has gone away. Some people are affected by chronic pain even when there's no injury or apparent damage, which leads some researchers to believe that there's a mind/body connection.
What are the different types of low back pain?
- Low back pain can be broadly classified into 2 main categories:
- Mechanical-the most common cause of back pain that comes from muscles, bones, ligaments, or joints.
- Radicular-occurs when a spinal nerve becomes inflamed or impinged.
What type of back and neck pain is the most common?
- According to a 2018 online survey of Americans aged 18 years and above, the following percentages of people visited a health care professional for 4 different types of back/neck pain:
Sources: Statista; Palmer College of Chiropractic, Gallup
International Back Pain Statistics
How do low back pain prevalence rates vary around the world?
- The 2010 Global Burden of Disease Study concluded that low back pain is one of the top injuries and diseases that account for the highest number of disability-adjusted life years (DALYs), which are years of healthy life lost due to injury or death. The lifetime prevalence of low back pain is estimated to be at 60% to 70% in industrialized countries. The rate for children is lower than adults but increasing. Prevalence peaks between ages 35 and 55.
- In the United Kingdom low back pain causes more than 100 million workdays lost per year and is the most common disability in young adults.
- In Sweden, the number of days or work lost quadrupled from 7 million in 1980 to 28 million in 1987, though the existence of social compensation systems may be responsible for some of this increase.
- In China, low back pain is the second cause of years living with a disease that causes impairment (YLD), and is especially prevalent in females. The percentage of people with low back pain in 2016 was 4.2%, which is lower than the world average of 7%. In China in 2015 the average was 4.3%. The number of people with low back pain has increased since 1990, but prevalence has decreased, probably due to China's population experiencing increased income and occupations with requiring less physical labor.
- Beijing had an average of 6.6% which leads researchers to believe that sleeping less than 7 hours per day and working hard may be risk factors for lumbar disk disease. Beijing is known as a hard-working city with high stress and citizens working lots of hours.
- The higher prevalence in females may be explained by higher sensitivity to pain in females, a greater willingness to report pain, as well as menstrual cycle fluctuations, hormonal changes, pregnancy, and menopause.
- Other cities with higher prevalence rates are Hong Kong and Henan.
- 540 million people worldwide are impacted by low back pain, and according to the Lancet, most are treated in a manner that isn't consistent with best practices.
- In rich countries in 2015, the second most common cause of DALYs is low back and neck pain, which used to be third in 1990.
- Worldwide in 2015, the fourth most common cause of DALYs is low back and neck pain, which was twelfth in 1990.
- Age is one of the significant factors in low back pain prevalence, as evidenced by the higher rates seen in counties with aging populations like Germany, considered one of five of the "super-aged" countries. Germany is expected to have one-third of its population over 65 by 2050.
- Research from 2010 from the University of Queensland's School of Population Health in Australia compared the prevalence levels of low back pain in different areas of the world:
- Western Europe: 15%
- North Africa/Middle East 14.8%
- North America: 7.7%
- Central America: 6.6%
- Caribbean: 6.5%
- The lead researcher in the Australian study referenced above hypothesized that higher levels of exercise, shorter height, higher pain threshholds, and less access to health insurance may be reasons why developing countries report lower levels of back pain.
- Another study from Australia and the United States looked at data from 1990 and 2010 and found that over one-third of all work-related disability was related to low back pain. The risk of low back pain was almost four times higher for people working in animal husbandry, forestry, fishing and hunting, and agriculture as compared to other professions. Workers in production, as well as labor and transport equipment operators, had a 54% higher risk while service workers had a 47% increased risk. Clerical work had the lowest rates.
Structures of the Back
What are the different structures of the spine and back?
The spine is divided into 3 sections:
- Cervical spine - the neck and uppermost area of the spine containing 7 vertebrae (numbered C1 to C7).It has an inward curve called a lordotic curve.
- C1 - called the atlas, it sits between the skull and the rest of the spine.
- C2 - called the axis, it has a bone that protrudes (called the odontoid process) that fits within a hole in the atlas to allow rotation of the neck.
- Thoracic spine - the chest contains 12 vertebrae (T1 to T12), and it's in this part of the spine where the ribs attach. The thoracic spine bends outward and is called the kyphotic curve.
- Lumbar spine - the lower back contains 5 vertebrae (L1 to L5), although some people have 6, this is where the spine connects to the pelvis. These vertebrae are the largest as they carry more of the body's weight. The lumbar spine curves inward (lordotic).
Below the lumbar spine there are 2 sections:
- Sacrum - a large bone that contains several vertebrae that fuse during the baby's growth in the womb.
- Coccyx - located below the sacrum is this small bone also called the tailbone. It also fuses from several vertebrae while in the womb.
In between the vertebrae are intervertebral discs which are flat, round cushions that act as shock absorbers for the vertebrae.
- The spinal cord runs through the spinal canal. Its purpose is to facilitate communication between the brain and the rest of the body.
- The spinal cord branches off into 31 pairs of nerve roots that branch off through openings in the spinal cord called the neural foramen, which is between the vertebrae on both sides of the spine.
- The nerves of the cervical spine control the upper chest and arms, the thoracic controls the chest and abdomen, and the lumbar nerves control the legs, bladder, and bowels.
The soft tissues of the spine include:
- tendons - connect the muscles and bones
- ligaments - connect bones
- muscles - these contract or extend to moves bones
What are the causes of back pain?
- There are many causes of back pain. 5.3% of the US population attributes lower back pain to their job.
- There are many causes of back pain, including:
- sprained ligaments
- strained muscles
- injury from sports, car accident, a fall, which can injure tendons and ligaments or cause compression of the spinal cord
- herniated or ruptured discs
- intervertebral disc degeneration
- radiculopathy (caused by compression, inflammation, and/or injury to the spinal nerve root)
- sciatica (a form of radiculopathy cause by compression of the sciatic nerve)
- spondylolisthesis (where vertebrae of the lower spine slip out of position, which pinches nerves exiting the spinal column)
- poor posture
- bone loss
- psychological stress
- spinal stenosis (a narrowing of the spinal column that puts pressure on the spinal column)
- irregular curvature of the spine such as scoliosis (a sideways curve) or lordosis (a large arch in the lower back)
- kidney stones
- cauda equina syndrome (a complication resulting from a ruptured disc)
- abdominal aortic aneurysms (a large blood vessel that supplies the abdomen, pelvis, and legs becomes enlarged)
- osteoporosis (progressive loss of bone density and strength)
- fibromyalgia (a condition that causes extreme sensitivity to pain, fatigue, and muscle stiffness)
- endometriosis (a buildup of uterine tissue outside of the uterus)
|Low Back Pain Type||Estimated Population Average|
|Vertebral compression fracture||4%|
For people suffering from low back pain, how often does is return?
- Around 50% of people in primary care continue to have fluctuating pain of low to moderate intensity.
- Most episodes of low back pain improve significantly within 6 weeks, and after 12 months pain levels are low. However, around 66% still report some pain at 3 months and 12 months.
- The best estimates for low back returning within a year is 33%.
Is age a factor in back pain?
- Most lower back issues start between the ages of 30 and 50, and the pain tends to get more common over time, but back pain can happen to people of any age. This is due to the loss of:
- bone strength and osteoporosis which leads to fractures
- flexibility and muscle tone
- fluid and flexibility of the intervertebral discs
Does working out help prevent back pain?
- Yes, as strong back and abdominal muscles help support the spine. Low-impact aerobic exercise (such as walking, cycling, and swimming) is beneficial for maintaining the integrity of the intervertebral discs. Static loading, torsional loading, flexion with compression, rapid loading, high-impact loading, and explosive tasks are likely detrimental for the IVD. Reduced physical activity and disuse appear to be detrimental for the IVD.
Does losing weight reduce the risk of back pain?
- Experts recommend staying within 10 lbs. of your ideal body weight.
What role does genetics play?
- A lot more research needs to be done, but for conditions such as lumbar disc degeneration, it's estimated that for 65-80% of people with this condition, genes play a major role.
Are some occupations higher risk for developing back pain?
- Jobs that involve heavy lifting, pulling, pushing, and especially combined with twisting significantly increases the odds of back pain. Another common cause is a sedentary job. Sitting for long periods, especially with poor posture, is believed to be one of the most popular causes of back pain.
- Worldwide, disability from low back pain is highest in working-age groups.
What causes back pain in children?
- Though relatively rare, children do experience back pain often due to carrying heavy backpacks, often only on one shoulder. Surgeons recommend that backpacks do not exceed 15-20% of the child's weight.
What are the most common risk factors for low back pain?
- Smokers, the obese, people with physically demanding jobs, and people with physical and mental comorbidities (the presence of two or more diseases).
- People that have had low back pain before are at an increased risk of having another episode.
- People with asthma, headaches, and diabetes are more likely to experience low back pain than people in good health.
- People with poor mental health, such as depression.
- Those with low levels of physical activity.
- Those with low income (less than $20,000/year) and less education (no high school education) experience low back pain disproportionally more than others.
- 25% of adults with back pain report having fair to poor health.
What ages are most susceptible to low back pain?
How is back pain diagnosed?
A medical professional will do a complete medical history and physical exam. They will ask about how long the pain has been occurring, where, the severity of the pain, when it tends to happen, if it limits mobility, and any other health conditions may be related.
A doctor may order several tests to rule out specific causes of pain, such as:
- X-ray-to see damaged vertebrae or broken bones, as well as misalignments.
- Computerized tomography (CT)-to see tumors, ruptured discs, and spinal stenosis.
- Discography-injecting a dye into a spinal disc to reproduce the pain the patient is experiencing. If it does, the dye will help show the damaged area on CT scans taken after the injection.
- Myelograms-a contrast dye is injected into the spinal canal to help enhance an x-ray or CT scan.
- Magnetic resonance imaging (MRI)-showing muscles, ligaments, tendons, and blood vessels.
- Electrodiagnostics-these procedures include electromyography (EMG), nerve conduction studies (NCS), and evoked potential (EP) studies. These studies are used to see if a patient has lumbar radiculopathy.
- Bone scans-used to detect issues in the bone, including fractures and infections.
- Blood tests-may be used to test for arthritis.
- Ultrasound-used to investigate muscles, tendons, and ligaments.
What are the ways that you can prevent back pain?
- Practice good posture.
- Practicing yoga helps to strengthen the muscles of the core as well as increase flexibility and reduce stress
- Avoid long periods of inactivity; make a point to get up and move every 20 minutes
- Walk every day.
- Wear shoes that help facilitate good posture and movement, and avoid shoes that tend to cause imbalances, such as high heels.
- Lift heavy objects with your back straight and your elbows close to your body; avoid twisting while lifting heavy objects.
- Create a work environment with good ergonomics, such as using a standing desk where you can work standing as well as seated.
- When seated, use chairs with good lumbar support.
- Make sure your mattress gives you enough support (firmness), but is soft enough to not cause pain. Everyone has different needs for their mattress. Make sure that you replace your mattress every 8 years on average(depending on the type of mattress you own), or more often.
- Replace couches that sag and don't give proper support.
- Avoid sleeping on your stomach (for many people this can put pressure on the vertebrae in the lower spine and neck).
- Stay close to your ideal weight.
- Don't smoke. Smoking reduces blood flow to the spine, impedes healing, and increases the chances of osteoporosis.
- Engage in regular exercise.
- Get enough sleep.
What percentage of people with back pain use opioids to relieve their pain?
- In 2017, a quarter of adults reported using opioids to relieve back pain.
What type of care do people see for back pain compared to prescription drugs?
How many doctors refer their patients with back pain to a physical therapist?
- From 1997-2010, only 10% of primary care physicians refer their patients to a physical therapist.
What are the different ways that back pain is treated?
There are many different methods for treating back pain:
- Heat and cold therapy-heat is used to bring blood to the affected area, bringing nutrients and oxygen, as well as to decrease stiffness, and is normally recommended after initial swelling has subsided. Cold is used to reduce inflammation and reduce pain and is normally recommended for the first 24-72 hours.
- Muscle relaxers-used in cases of muscle spasms lasting more than 3 months. Muscle relaxers can release or reduce the spasm, reduce pain, and increase mobility. Common muscle relaxers include baclofen and benzodiazepines (such as Valium, Ativan, or Restoril).
- Chiropractic-manipulation of the spine, ribs, and other bones and joints to facilitate proper alignment.
- Physical therapy-strengthening muscles that support the back to help improve flexibility and mobility, and to reduce or eliminate pain.
- Inversion therapy-using an inversion table or decompression device that helps open up the space between vertebrae to allow fluid to rehydrate and give nutrition to the intervertebral discs, which act as shock absorbers for the spine.
- Traction-the use of weights and pulleys to pull bones into alignment. There is little evidence that this is effective long-term.
- Acupuncture-an ancient Chinese system of healing using needles strategically placed in the body to stimulate healing.
- Transcutaneous electrical nerve stimulation (TENS)-wearing electrodes that give electrical stimulation to block pain signals. It's believed to stimulate the body's natural pain-blocking chemicals.
- Epidural steroid injections-used for low back pain and sciatica associated with inflammation. The pain relief tends to be temporary and long-term outcomes tend to be worse for those who received injections compared to those who did not receive them.
- Medication-both over the counter (OTC) and prescription drugs are used for back pain:
- Nonsteroidal anti-inflammatories (NSAIDS)-reduce inflammation and pain.
- Analgesics-to reduce pain, they include aspirin, acetaminophen, and in more serious cases, codeine, oxycodone, morphine, and hydrocodone.
- Counter-irritants-applied topically, they stimulate the skin and give a sense of warmth or coolness and dull the sensation of pain.
- Antidepressants-used for chronic low back pain, their effectiveness is unproven.
- Anticonvulsants-drugs used to treat seizures that may be used for cases involving radiculopathy.
- Spinal fusion-fusing degenerated vertebrae.
- Laminectomy-removing parts of the bone, bone spurs, or ligaments to relieve pressure on the spinal nerves, reducing pain.
- Discectomy-removing part of all of a disc that has slipped out of place causing pressure on a spinal nerve that causes pain.
- Foraminotomy-removing some bone to allow more space for nerves where they exit the spine to reduce nerve pain.
- Disc replacement-replacing a damaged disc and replacing it with an artificial one.
- Interlaminar implant-implanting a U-shaped structure between two vertebrae in the lower back, easing pressure on nerves of the spine.
Are chiropractors seen as helpful for back pain?
- Though there's a range of opinions in the medical field about the effectiveness of chiropractic care, in 2017 adults in the U.S. had a pretty positive view:
Source: Palmer College of Chiropractic; Gallup, https://www.statista.com/statistics/757457/helpfulness-chiropractic-care-various-body-pains-us/
- People who see chiropractors for their back pain report that they're more satisfied with their care than those who see medical doctors. These patients are more likely to say that chiropractors explain their treatment and give self-care advice.
How many back pain sufferers treat their own pain?
- In 2017, 55% of Americans treated their own pain.
What methods are commonly used for relieving back pain?
Source: https://www.statista.com/statistics/680723/ways-to-relieve-back-pain-adults-us/; Truven Health Analytics; NPR
How do different generations treat their back pain?
- Vallfors B. Acute, Subacute and Chronic Low Back Pain: Clinical Symptoms, Absenteeism and Working Environment. Scan J Rehab Med Suppl 1985; 11: 1-98.
- https://journals.lww.com/pain/Fulltext/2019/01000/The_prevalence_and_years_lived_with_disability.24.aspx :
- https://www.theatlantic.com/health/archive/2016/10/how-back-pain-took-over-the-world/503243/ :
- https://www.medscape.org/viewarticle/825885 :
- R. P. Hertzman-Miller, H. Morganstern, E. L. Hurwitz, Fei, Y., Adams, A. H., Harber, P., and Kominiski, G. F. (2002). “Comparing the Satisfaction of Low Back Pain Patients Randomized to Receive Medical or Chiropractic Care: Results from the UCLA Low-Back Pain Study.” American Journal of Public Health, 92(10): 1628-1633.
- Chou R, Hoyt Huffman LH. Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians Clinical Practice Guideline. Ann of Internal Med 2 Oct. 2007;147(7):492-504.
- "Low Back Pain Fact Sheet". National Institute of Neurological Disorders and Stroke. National Institute of Health. Archived from the original on 19 July 2013. Retrieved 12 July 2013.
- Hart LG, Deyo RA, Cherkin DC. Physician office visits for low back pain. Frequency, clinical evaluation, and treatment patterns from a US national survey. Spine. 2005;20:11-19.
- Ritzwoller DP, Crounse L, Shetterly S, Rublee D. The association of comorbidities, utilization and costs for patients identified with low back pain. BMC Musculoskelet Disord. 2006;7:72. Available at: http://www.biomedcentral.com/1471-2474/7/72. Accessed February 17, 2009.
- Hoy D, March L, Brooks P, et al The global burden of low back pain: estimates from the Global Burden of Disease 2010 study Annals of the Rheumatic Diseases Published Online First: 24 March 2014. doi: 10.1136/annrheumdis-2013-204428.
- Sauver, JL et al. Why patients visit their doctors: Assessing the most prevalent conditions in a defined American population. Mayo Clinic Proceedings, Volume 88, Issue 1, 56–67.
- Hartvigsen J et al. Low Back Pain Series: What Low Back Pain Is and Why We Need to Pay Attention. Lancet, June 2018; Volume 391, Issue 10137; p2356-2367.