1.1 Introduction
Low back pain is a medical condition defined as pain, stiffness, or discomfort localized in the lumbar region of the spine, and it is recognized as one of the most common causes of disability worldwide affecting both clinical and non-clinical populations (Hartvigsen et al., 2018). It is often multifactorial in origin and may result from mechanical strain, degenerative spinal changes, lifestyle factors, and body composition variations. In clinical practice, accurate identification of contributing factors is essential for effective management and prevention of recurrence.
Body Mass Index according to World Health Organization (WHO) is a standardized anthropometric indicator used to classify individuals based on body weight relative to height and it is commonly applied in epidemiological and clinical studies to assess obesity-related health risks (WHO, 2023).
As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are significance of the study, scope of work, research hypothesis and questions, limitation of the study and definition of terms.
1.2 Background of Study
Low back pain remains one of the most prevalent musculoskeletal conditions globally, affecting individuals across different age groups, occupations, and socioeconomic backgrounds. According to the World Health Organization (2023), low back pain is defined as pain or discomfort located between the lower rib margin and the gluteal folds, with or without leg involvement, and it is recognized as a leading cause of disability worldwide. The condition not only affects physical functioning but also contributes significantly to reduced productivity, increased healthcare utilization, and long-term disability in severe cases.
Hartvigsen et al. (2018) reported that low back pain is now considered a complex condition influenced by biological, psychological, and social factors rather than a purely structural spinal disorder. Body Mass Index (BMI), which is a widely used indicator of body fat based on weight and height, has been increasingly examined as a contributing factor to musculoskeletal disorders. According to the World Health Organization (2023), BMI is categorized into underweight, normal weight, overweight, and obese classifications and is used globally to assess health risks associated with abnormal body weight. Excess body weight has been linked to increased mechanical stress on the lumbar spine, which may accelerate degenerative changes and contribute to the development of low back pain.
Nguyen and colleagues (2014) reported that higher BMI is significantly associated with an increased risk of developing chronic low back pain, particularly among obese individuals. They asserted that excess adipose tissue may lead to altered biomechanics, increased axial loading, and systemic inflammation, all of which may negatively affect spinal health. In addition, prolonged mechanical strain on the lumbar vertebrae may contribute to disc degeneration and facet joint stress over time.
Shiri et al. (2010) contended that while obesity is a risk factor for low back pain, the strength of the association varies depending on age, gender, physical activity level, and occupational exposure. Lumbar radiological findings play a crucial role in understanding structural changes within the spine that may be associated with low back pain. According to Modic and Ross (2007), common radiological findings include intervertebral disc degeneration, disc herniation, vertebral endplate changes, and osteophyte formation. These changes are often detected using imaging techniques such as magnetic resonance imaging (MRI), computed tomography (CT), and X-rays, which provide detailed visualization of spinal anatomy. Furthermore, Brinjikji et al. (2015) stated that the prevalence of spinal degenerative changes increases with age, even among asymptomatic individuals. They contended that such changes may represent normal aging processes rather than pathological conditions in all cases.
The interaction between BMI and lumbar radiological findings has gained increasing attention in recent years. According to Samartzis et al. (2012), obesity may contribute to earlier onset and faster progression of intervertebral disc degeneration due to increased mechanical loading and metabolic effects on spinal tissues. They reported that inflammatory mediators released from adipose tissue may also play a role in degenerative changes of the lumbar spine.
Similarly, Bener et al. (2013) asserted that individuals with higher BMI are more likely to exhibit significant degenerative changes on lumbar imaging, particularly in weight-bearing spinal segments. However, they also noted that not all radiological findings are symptomatic, which further complicates the clinical interpretation of imaging results in patients presenting with low back pain.
This study is set against the backdrop of the need to better understand the relationship between Body Mass Index, lumbar radiological findings, and the incidence of low back pain in order to improve clinical decision-making and patient outcomes.
1.3 Statement of Problems
Investigation revealed that Body Mass Index (BMI) is widely used as a simple anthropometric measure of nutritional status and body fat distribution, and it is calculated using weight in kilograms divided by the square of height in meters (kg/m2). High BMI, particularly in overweight and obese individuals, is frequently associated with increased mechanical load on the lumbar spine, altered posture, and degenerative changes that may contribute to low back pain (WHO, 2023). However, not all individuals with elevated BMI present with radiological abnormalities or clinical symptoms, suggesting that additional factors may be involved in the progression of lumbar spine disorders.
On the other hand, some individuals present with significant radiological abnormalities but report minimal or no pain, while others experience severe pain with little visible structural change, creating a diagnostic inconsistency that complicates clinical interpretation. In many healthcare settings, including orthopaedic and physiotherapy units, low back pain continues to be managed primarily based on symptoms rather than a combined evaluation of BMI and lumbar radiological outcomes.
Furthermore, there is limited localized evidence examining how BMI interacts with lumbar radiological findings in predicting the incidence and severity of low back pain, particularly in developing regions where lifestyle and occupational exposures may differ significantly from global patterns. It is against this backdrop that this study seeks to examine the relationship between Body Mass Index and lumbar radiological findings in the incidence of low back pain.
1.4 Aim and Objectives of Study
The aim of this study is to evaluate Body Mass Index and lumbar radiological findings in the incidence of low back pain. In achieving this aim, the following specific objectives were laid out as follows:
- To determine the Body Mass Index of patients presenting with low back pain.
- To identify common lumbar radiological findings among patients with low back pain.
- To examine the relationship between Body Mass Index and incidence of low back pain.
- To assess the association between BMI categories and specific lumbar radiological changes.
- To determine whether lumbar radiological findings influence the severity of low back pain.
1.5 Research Questions
The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:
- What is the Body Mass Index of patients presenting with low back pain?
- What are the common lumbar radiological findings among patients with low back pain?
- What is the relationship between Body Mass Index and the incidence of low back pain?
- How do BMI categories relate to specific lumbar radiological findings?
- Do lumbar radiological findings influence the severity of low back pain?
1.6 Research Hypotheses
In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.
Hypothesis One
- H0: There is no significant relationship between Body Mass Index and incidence of low back pain.
- H1: There is a significant relationship between Body Mass Index and incidence of low back pain.
Hypothesis Two
- H0: There is no significant association between Body Mass Index and lumbar radiological findings among patients with low back pain.
- H1: There is a significant association between Body Mass Index and lumbar radiological findings among patients with low back pain.
Hypothesis Three
- H0: Lumbar radiological findings do not significantly influence the severity of low back pain.
- H1: Lumbar radiological findings significantly influence the severity of low back pain.
1.7 Significance of Study
It is believed that at the completion of the study, the findings will improve clinical decision-making by providing clearer evidence on the relationship between Body Mass Index and lumbar radiological findings in low back pain cases. Also, the study will assist healthcare professionals in identifying obesity-related risk factors contributing to spinal degeneration and pain occurrence.
Furthermore, the result obtained will support early diagnosis and better management strategies for patients with low back pain in hospital settings. It will also guide future research on preventive and rehabilitative approaches for low back pain.
Lastly, the findings will contribute to existing medical literature on musculoskeletal disorders and obesity-related spinal conditions.
1.8 Scope of Study
The study focuses on patients attending Asaba Specialist Hospital, Delta State, Nigeria, with particular attention to individuals diagnosed with low back pain. It examines Body Mass Index and lumbar radiological findings among selected patients within the orthopedic and radiology departments of the hospital.
1.9 Limitations of the Study
The study was limited by the inability to include all patients with low back pain due to hospital attendance patterns and restricted sampling access. It was also constrained by the scope of available diagnostic records and departmental cooperation.
1.10 Definition of Terms
Body Mass Index (BMI):
Body Mass Index is a numerical value derived from an individual's weight and height used to classify underweight, normal weight, overweight, and obesity conditions (World Health Organization, 2023).
Low Back Pain:
Low back pain is pain or discomfort localized between the lower rib margin and gluteal folds, which may or may not radiate to the lower limbs (Hartvigsen et al., 2018).
Lumbar Spine:
The lumbar spine refers to the lower portion of the vertebral column consisting of five vertebrae (L1–L5) that support body weight and allow movement.
Radiological Findings:
Radiological findings are structural changes in the body detected through imaging techniques such as X-ray, CT scan, or MRI, used to assess spinal conditions (Modic & Ross, 2007).
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