How to Manage Lower Back Pain? Interview with Daniele Burattini.

Back pain is currently among the top eight leading causes of disability worldwide, and by 2050, it is expected to climb even higher, surpassing debilitating conditions like Alzheimer's disease (source: "Burden of disease scenarios for 204 countries and territories 2022-2050," Lancet, May 2024). This condition is extremely common and can affect people of all ages. We spoke with Daniele Burattini, Head of the Physical Therapy Department at UPMC Salvator Mundi International Hospital, to better understand the reasons behind its prevalence, the triggering causes, and the available treatment options.

What are the main causes of lower back pain, commonly known as "back pain"?

There are many causes of lower back pain. In some cases, the pain is due to a structural issue, which can be identified through X-rays or an MRI. If these tests don’t show a precise cause, it’s possible that back pain is caused by a weakness in the core muscles, in which case therapeutic exercises are often recommended. Genetics can also play an important role, as back problems and disc degeneration are often hereditary.

We often hear that stress can cause lower back pain. Is this true?

Yes, stress can certainly contribute to back pain. The central nervous system, which is directly influenced by stress, can trigger muscle tension that manifests as back pain. People who experience chronic stress, fatigue, exhaustion, or anxiety tend to suffer from headaches, neck pain, and lower back pain. In some cases, stress can even cause pain in the tailbone area.

Is it true that spinal alignment also affects back pain?

Yes, spinal alignment is crucial. The spine has natural curves: lordosis, present in the lumbar and cervical areas, and kyphosis, in the thoracic area. If the lumbar curve is not aligned properly, it can lead to posture and alignment issues, increasing stress on the back and contributing to lower back pain.

Why is back pain such a common issue worldwide?

Back pain is extremely widespread, primarily due to a sedentary lifestyle and poor posture. Long periods of sitting, whether at work or in the car, put excessive pressure on the lower back, as the pelvic and leg muscles are not supporting the body. On the other hand, when walking or standing, the weight is better distributed. Obesity also contributes to the issue by adding extra strain on the spine. To reduce the risk, it’s crucial to stand up regularly, engage in exercises to strengthen the core muscles, and maintain a healthy weight.

What are the most effective ways to treat lower back pain?

Lower back pain can be treated in various ways, with physical therapy as the first choice, especially for new cases of acute or chronic lower back pain. Osteopathic treatments and massages can be helpful, but massages often provide temporary relief if the underlying causes, such as muscle weakness or inactivity, are not addressed.

However, the key to preventing and managing lower back pain is maintaining a healthy weight and regularly engaging in aerobic exercises such as brisk walking, swimming, or cycling.

For those who experience pain upon waking, it may be worth evaluating their mattress, though morning stiffness could also be a symptom of arthritis. Lastly, surgery is an extreme option, reserved for cases involving nerves or well-diagnosed conditions.