Lower back pain has become a major reason for visits to doctors in Spain and throughout Europe. It not only limits daily life, but also affects sleep quality, work performance, and emotional well-being, especially after a certain age.
Far from being a simple passing discomfort, lower back pain is associated with disability, prolonged absences from work, and a significant increase in healthcare costs . Recent studies and surveys show that it is a widespread problem that still receives less attention than it deserves in terms of prevention.
A very common problem in Spain and Europe
In Spain, the official data is clear: one in five people suffers from chronic lower back pain (19,8% of the population), according to the Spanish National Health Survey (INE). This makes lower back pain the second most common chronic illness , second only to hypertension (20,2%).
This type of pain doesn't discriminate based on social class or profession, although it particularly affects the elderly and those who perform physically demanding work. As primary care and community pharmacy specialists remind us, any alteration in the different regions of the spine —sacrococcygeal, lumbar, thoracic, or cervical—can generate intense and, in many cases, highly debilitating discomfort.
Furthermore, it is estimated that between 30% and 40% of the population will experience neck pain at some point in their lives. Although the primary focus is on the lumbar region, there is often a continuum of problems throughout the back that share common causes and management strategies.
Experts emphasize that the likelihood of developing persistent lower back pain increases significantly from the fourth decade of life onward . And in later years, this pain tends to become chronic, with a consequent impact on independence and quality of life.
Causes and risk factors of lower back pain
In most cases, lower back pain doesn't originate from a single serious injury, but rather from a combination of everyday factors . One of the most common is poor posture : spending hours hunched over a computer, walking with slumped shoulders, or sleeping in awkward positions eventually takes its toll. It's also advisable to avoid exercises that are contraindicated for lower back pain, as they can worsen the strain.
Along with these poor postures, other common triggers include muscle strains from overexertion, degenerative disc disease, irritation or compression of nerve roots, fibromyalgia, trauma, and even some tumors. Often, the patient doesn't connect a specific incident with the onset of pain because the strain has accumulated over the years.
Clinical data suggests that obesity, being overweight, and certain sedentary lifestyles are associated with a higher risk of lower back pain. Smoking, physically demanding jobs—such as repetitive lifting or carrying—and the presence of other chronic diseases also contribute to this risk. Staying physically active with activities that strengthen the back helps reduce this risk.
In the case of pregnant women, weight gain and changes in the body's center of gravity increase pressure on the lower back , so it's not uncommon for discomfort to appear in the later stages of pregnancy. There are specific support belts available that can alleviate some of this strain, always under professional guidance.
On the other hand, stress and emotional tension also play a role. Many people report that episodes of lower back pain become more frequent or intense during periods of greater psychological pressure, reinforcing the idea that the back also "somatizes" daily life.
Weight and body mass index: every pound counts
In recent years, the relationship between lower back pain and body mass index (BMI) has been explored in greater depth. This is not merely a clinical observation: a large study conducted in the United States , involving more than 110.000 outpatients, systematically analyzed the relationship between weight and the presence of lower back pain; the results are detailed in a comprehensive study on lower back pain.
The study, published in a pain journal, observed that the prevalence of lower back pain increased progressively from a low BMI (around 18) up to 35. The most striking finding was that for each additional BMI point—equivalent to about 4,5 kilograms of weight—the risk of lower back pain increased by approximately 7%.
Above a BMI of 35, the prevalence stabilized, but remained elevated. This does not mean that all overweight people will experience back pain, nor that those at a healthy weight are "safe," but it does point to a clear and modifiable risk factor.
The study authors conclude that maintaining a BMI within a healthy range likely contributes to reducing the occurrence of lower back pain, especially in patients with other risk factors, such as strenuous physical work or a history of spinal problems. Weight management is often emphasized in clinical practice as part of a prevention plan.
In practical terms, this finding reinforces the message that many professionals repeat in consultations: controlling weight is one more piece of the puzzle for taking care of your back, along with exercise, quitting smoking and correcting posture.
Lower back pain and sleep: a one-way relationship
The connection between lower back pain and poor sleep is well known to those who suffer from it, but recent research sheds interesting light on the matter , especially in older adults. A longitudinal study in elderly men, published in the journal Innovation and Aging, analyzed over several years whether poor sleep predicted back pain or vice versa.
The follow-up of 1.055 men who underwent two clinical sleep studies at least six years apart showed a fairly clear pattern: those who already had back pain at the start were, years later, much more likely to suffer from sleep problems.
The researchers defined these sleep disorders as irregular sleep, insufficient sleep, daytime sleepiness, and a feeling of dissatisfaction with sleep quality . Overall, initial back pain was associated with a 12% to 25% increase in the likelihood of developing these disorders.
What's striking is that the relationship didn't work in the opposite direction : the sleep problems present at the beginning of the study didn't consistently predict the subsequent development of lower back pain. Everything seems to indicate that it's the pain, and not so much the underlying insomnia, that starts the vicious cycle.
Experts offer several explanations: firstly, the pain itself makes it difficult to find a comfortable sleeping position ; secondly, persistent discomfort can fuel stress and depressive symptoms, which in turn worsen sleep. Therefore, they recommend not normalizing lower back pain and consulting a doctor when it becomes recurrent.
Who is more likely to suffer from lower back pain?
Although anyone can experience an episode of lower back pain, some groups are more likely to develop persistent discomfort . Among them, specialists highlight those who are overweight or obese, pregnant women, and those who work lifting heavy objects or spend many hours on their feet.
Also at risk are people who perform repetitive twisting or bending movements of the back , as occurs in certain industrial, healthcare, or logistics tasks. When these movements are repeated without proper technique or breaks, the muscles and supporting structures of the spine become overloaded.
Age is another factor to consider: after age 40, the likelihood of experiencing lower back pain increases , and in older individuals, the risk of the pain becoming chronic also rises. However, specialists emphasize that it is “not normal” to have continuous pain simply because of getting older; there is usually some modifiable factor that should be addressed.
Within this context, professionals recommend paying close attention to warning signs : pain that does not improve after several weeks, loss of strength in the legs, changes in sensation, fever, or unexplained weight loss. In these cases, medical evaluation should be a priority to rule out more serious problems.
At the other extreme, when it comes to mild and recent discomfort, the advice usually leans more towards controlled movement and physiotherapy than towards absolute rest, which is reserved for very specific and time-limited situations.
Common treatments: from local heat to physiotherapy
The treatment of lower back pain often combines several strategies. One of the simplest is the application of local heat to the painful area , using electric blankets, hot water bottles, or specific heating devices. These are usually applied in sessions of about 15-20 minutes, several times a day, always taking precautions to avoid burns.
When pain severely limits activity, doctors may recommend, for a short period, analgesics, anti-inflammatories, or muscle relaxants . These medications help improve functionality in the acute phase, and in clinical research, even a cannabis extract has been shown to reduce lower back pain . However, specialists emphasize that these medications should only be used for a few days and under medical supervision.
Physiotherapy plays a central role in the treatment of lower back pain. Techniques such as therapeutic massage, gentle mobilizations, the application of heat through pressure showers or specific devices, and guided exercise programs help reduce stiffness, improve muscle strength, and restore mobility.
In certain cases of associated neck pain or instability, specialists may suggest the temporary use of cervical collars or lumbar supports . Their function is to provide support and limit certain movements while the most painful phase resolves, but prolonged use is not recommended because it can weaken the muscles.
Surgery is only considered in more complex situations—for example, a herniated disc that significantly compresses the spinal cord or nerve roots, with striking neurological symptoms . However, it is reserved for carefully selected cases, when conservative measures have failed and the risk of not intervening outweighs the risk of the operation itself.
Exercise and strengthening: why moving helps
Rehabilitation and physiotherapy specialists agree on one key point: controlled movement is fundamental for lower back health . Except in very specific acute cases, absolute bed rest tends to prolong the problem rather than resolve it.
One of the most frequently repeated recommendations is to incorporate exercises to strengthen the lower back and core muscles . Among these, the so-called "Superman" exercise has become popular. This involves lying face down with arms extended in front of the head and legs straight, and simultaneously raising the arms and legs a few centimeters while keeping the abdominal muscles engaged. These supervised and adapted therapeutic exercise programs are the most highly recommended.
This exercise aims to improve back extension and strengthen the lumbar extensors, paraspinal muscles, and gluteus maximus . When performed with good technique and progressively, it helps stabilize the lumbar region and pelvis, facilitating basic activities such as walking or standing for extended periods.
Physical therapists recommend performing the movements slowly and with control, holding the position for a few seconds and then gently lowering the limbs. To begin, simply lifting a few centimeters may be enough, placing a towel under the forehead or a small pillow under the abdomen to improve comfort and alignment.
This type of exercise, however, is not suitable in all circumstances . If symptoms such as tingling, numbness, or pain radiating down the legs—known as radicular pain—appear, or if you are in the midst of an acute injury, it is best to stop exercising and consult a healthcare professional before continuing.
Beyond Superman, disciplines like yoga, Pilates, and supervised therapeutic exercise programs can improve core strength, flexibility, and posture—key aspects for relieving lower back strain in the medium and long term. Additionally, learning to do abdominal exercises correctly helps protect the lower back.
Postural hygiene: small gestures that make a difference
An important part of preventing lower back pain involves correcting how we move and maintain our posture throughout the day. These are seemingly minor changes that, when combined, reduce the strain on the spine.
When walking, it's best to keep your back straight and your gaze forward , avoiding slouching and leaning forward. It's also advisable to avoid wearing high heels and carrying bags or backpacks that put a lot of weight on one side of the body, as these can create imbalances.
During nighttime rest, many guidelines recommend the fetal position : lying on your side with your upper leg bent and your lower leg extended. Your head and neck should be aligned with the rest of your spine, which requires a good mattress and a pillow of the right height —neither too soft nor too firm.
In the workplace, especially in office jobs, it's crucial to adjust the computer screen height to eye level , ensure your back is properly supported by the chair's backrest, and keep your feet flat on the floor or on a footrest. Adjustable chairs with good lumbar support make it easier to maintain a healthier posture.
When lifting objects from the floor , the classic recommendation still applies: bend your knees, keep your back straight, and bring the load as close to your body as possible, avoiding sudden twists. If these maneuvers are repeated often, it may be helpful to use a back support belt occasionally, but not as a permanent aid.
Finally, it's important to avoid constantly repeating the same movements without breaks. Scheduling short breaks to stretch, change position, or take a few steps helps prevent the back muscles from becoming overloaded in the same areas. In this regard, the exercises and movements to avoid are well established.
Lifestyle and weight: allies or enemies of the back
Beyond posture and specific exercises, overall lifestyle also has a significant impact on lower back health. Maintaining a healthy weight reduces stress on the back muscles and joints , which is especially important in the lower spine.
In overweight individuals, the extra strain on the back can contribute to both disc degeneration and muscle fatigue. For pregnant women, specialized support belts help redistribute some of that weight and reduce, to some extent, the lower back pain associated with pregnancy.
Another important aspect is stress management . Relaxation techniques, breathing exercises, meditation, and activities like yoga not only benefit the mind but also help release tension accumulated in the back and neck muscles.
The general recommendation is to incorporate regular physical activity adapted to each individual , avoiding both extreme sedentary behavior and strenuous, one-off efforts without prior preparation. Brisk walking, swimming, gentle cycling, or following guided strengthening routines are reasonable options for most people.
If the pain is intense or lasts longer than desired, it's advisable to consult your doctor or pharmacist about using analgesics or anti-inflammatories , and even muscle relaxants for very short periods. The idea is not to rely on medication indefinitely, but to use it as occasional support while working on longer-term prevention and strengthening measures.
New lines of research: from the laboratory to the spine
While traditional recommendations focus on correcting habits and improving physical fitness, science is working on new solutions for cases of lower back pain resulting from the deterioration of the intervertebral discs . In Europe, a team from the Health Research and Innovation Institute at the University of Porto is exploring a promising approach.
Their proposal stems from a striking idea: the biological environment of tissues in the early stages of development has a much greater regenerative capacity than in adulthood. Certain molecules present in childhood disappear over the years, and with them, part of that natural ability to repair damage is lost.
Inspired by this “fetal microenvironment,” researchers have developed extracellular matrices derived from mesenchymal stem cells modified using CRISPR technology . By reactivating genes characteristic of early developmental stages, these cells act as biofactories for personalized fetal matrices.
According to the Portuguese team, this platform could offer standardized, safe, and patient-specific materials , reducing batch-to-batch variability, donor dependence, and the risk of diseases associated with animal-derived matrices. The idea is that, through a minimally invasive application, these matrices will help regenerate damaged intervertebral discs. Complementary research, such as a cellular atlas of the lumbar spinal cord , expands our understanding of these structures.
Although still an emerging line of research, it opens the door to more durable regenerative therapies for discogenic lower back pain. Furthermore, the molecules involved could have future applications in other tissues, such as cartilage, skin, or even the heart and lungs.
Epidemiological data, clinical studies, and new lines of research paint a clear picture: lower back pain is very common, has multiple causes, and significantly impacts quality of life . However, effective tools exist to reduce its impact. Maintaining a healthy weight, paying attention to posture, staying active, sleeping in suitable conditions, seeking timely medical advice, and, when necessary, utilizing physiotherapy and available medical treatments are key steps to prevent back pain from becoming the Achilles' heel for so many people.
