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 is 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.

This is why we have worked with our experts to assemble a list of the top facts and statistics related to back pain. You will find the sources we referred to at the bottom of the page. As always, please contact us if you have any questions or feedback.

Prevalence

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 lifetime.
• Low back pain is the leading cause of disability worldwide.
• Behind skin disorders and osteoarthritis/joint disorders, back pain is the third most common reason for visits to the doctor’s office.
• Each year, 50% of all working adults report having back pain symptoms.

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 the changes in their posture and center of gravity causing muscle and ligament strain.
• Refer to the graph below comparing men and women's low back pain in the United States from 1997-2016:

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 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 in 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, resulting 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 percentage of people who 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, and worry about social consequences. They also experience family strain, social withdrawal, disappointment with healthcare providers (especially general practitioners), as well as having 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.

Source: JAOA.
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, 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 goes back to normal.
• Subacute back pain lasts between 6 weeks and 3 months.
• Chronic pain is pain that lasts 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 without 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 - This 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 healthcare professional for 4 different types of back/neck pain:

Sources: Statista; Palmer College of Chiropractic, Gallup

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 contains 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 which 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.

Nerves:

• 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 contract or extend to move bones.

Causes

What are the causes of back pain?

• Most instances of back pain aren't caused by a disease or serious medical condition (such as arthritis) but are mechanical or non-organic.
• Low back pain is a complex condition with multiple contributors, including:
  • - psychological factors
  • - social factors
  • - biophysical factors
  • - comorbidities
  • - pain-processing mechanisms
  •  
• 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 caused by compression of the sciatic nerve)
  • - spondylolisthesis (where vertebrae of the lower spine slip out of position, which pinches nerves exiting the spinal column)
  • - arthritis
  • - poor posture
  • - obesity
  • - pregnancy
  • - 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)
  • - infections
  • - tumors
  • - 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)

Lower Back Pain Causes - data retrieved from a 2015 NHIS
Occupational Health survey of workers with frequent, severe
low back pain and low back pain attributed to work⁽⁴⁾

Low Back Pain Type	Estimated Population Average
Non-specific	90%
Vertebral compression fracture	4%
Metastatic cancer	0.7%
Cauda equina	0.04%
Infection	0.01%
Other causes	5.25%

For people suffering from low back pain, how often does it 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%.

Risk Factors

Is age a factor in back pain?

• Most lower back issues start between the ages of 30 and 50, with pain tending to become 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 (IVD). 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 if combined with twisting significantly, increase 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 common 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, which is often due to carrying heavy backpacks 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?

Source: Lancet

Diagnosis

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 pain is located, the severity of the pain, when it tends to happen, if it limits mobility, and any other health conditions that 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: this involves 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: to detect issues in the bone, including fractures and infections.
• Blood tests: to test for arthritis.
• Ultrasound: to investigate muscles, tendons, and ligaments.

Prevention

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).
• 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.

Treatment

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 seek 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 referred their patients to a physical therapist.

What are the different ways to treat back pain?

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 the 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 - 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.
• Surgery:
  • 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 or 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:

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