Low back pain affect productive people and influence an individual’s work capacity and overall well-being.(13) The prevalence of low back pain is very high and is a major cause of living with disabilities.(14) There are several factors that determine the incidence of LBP such as sociodemographic, ergonomic, and psychosocial factors.(15)
Risk factors of LBP in middle age adult
Our study demonstrates gender was associated with LBP. In agreement to other studies, we found that the prevalence of LBP was higher in females than in males.(5, 7, 19, 20) Females tend to have a lower pain threshold than men, therefore they often report the symptoms of LBP than men. (21, 22) Other studies have reported that that females tend to have a higher risk of LBP because of hormone imbalances. During pregnancy, the hormonal imbalances loose the spinal ligaments that decrease the strength of the lower back muscles and increase the risk of LBP.(6, 23, 24) Fernandez et al suggested that menopausal osteoporosis caused LBP in women (25) and another study concluded obesity is associated with LBP in women.(26) Another reason of females having more LBP was loads of housework(7), menstruation (27–29).
In agreement with earlier findings,(5, 30) our findings suggested that BMI was one of significant risk factors of low back pain. Simsek et al, reported that low back pain was 0.9 times more prevalent in people with higher body mass indeks.(5) A study among healthcare workers also suggested that high BMI was associated with LBP.(31, 32) Possible explanations include (1) Increasing mechanical compression in the lumbar spine during movements in obese people possibly enhances mechanical burden (2) The likehood of having of an accident thus possibly increasing the risk of LBP.(3) Adipose tissues produce produces some proinflammatory cytokines (e.g., tumor necrosis factor-α, interleukin-6) that trigger the release of C-reactive protein (CRP), and this statement was supported by the fact that females with normal waist circumference and high CRP have tendency to report LBP than females with low CRP.(26, 32)
Consistent with other researchs, we observed LPB is more prevalent in people who rarely or never did exercises.(5, 6, 21, 32, 33) LBP occurs due to of shortened and weaken back muscles, therefore causes misalignment of the spine. Exercise decreases the event of LBP due to (1) lengthen the back muscles to support and keep the spine in proper alignment. Regular exercise increases blood supply to the spine muscles, joints, and intravertebral discs to minimize injury and increasing repairment.(6, 21). (2) Exercise reduces stress and the level of cortisol which increases in stress conditions.(34–36) Other studies have reported that strengthening the spinal muscles by exercises such as stretching or aerobic training decreases LBP by 30% in terms of intensity of pain and disability.(26)
The result of this study suggested that the severity of stress had a significant correlation with low back pain. This study was in line with a study from Korea that confirmed severe stress was correlated with a 2.8-fold increase in risk of chronic low back pain compared to the general population. (37) Stress triggers the secretion of cortisol in the bloodstream. Cortisol is a potent anti-inflammatory hormone, and repeated peaked cortisol stimulates cortisol defect. Consequently, this lead to oxidative stress, release free radicals, cellular injury, which lead to chronic pain.(38) Higher cortisol levels are associated with a lower strength of lumbar muscles, resulted in LBP.(6, 34)
Our study results confirmed that working time was significantly associated with LBP. This fact correlates with a study that focused on nurse, that 5 years of experiences nurses were 3 times more likely to experience LBP. (39–41) The explanation for this fact is, that nurses are more likely to expose to physical and psychological hazards during his/her entire works. (40)
The limitation of this study was (1) the sampling method which did not use probability (random) sampling due to the COVID-19 pandemic, so the results might be biased. However, we present a local survei with quite huge number of pupulation. (2) The data of height and body weight might be not original presented because due to pandemic that hinders direct contacts, measurements of height and body weight were not possible.