The Correlation Between Metabolic Dysfunction and Low Back Pain

Low back pain is the number one reason people visit a physical therapist. There are so many reasons why low back pain occurs, and pain can be extremely complicated. This article will just explore one way back pain can happen, and I think it’s grossly overlooked. 

Let’s start this discussion with what metabolic dysfunction is. Metabolism is your body’s ability to convert food into energy. We generally have 2 fuel sources (there are more) that our body prefers to use. That’s lipids (fats) and carbohydrates (glucose). Generally speaking, carbs are easier for our body to utilize and when we need energy quickly, our bodies will use carbs. Particularly when we are in a sympathetic state. The problem is that our modern lifestyle tends to keep many of us in a stressed, sympathetic state. Then our metabolic system is chronically drawing on carbs for energy. 

What happens next is that we become poorly adapted to draw energy from fat sources. This is what is called “metabolic inflexibility”. The toggle switch is no longer working well. We start getting an accumulation of fats, triggering chronic inflammation and insulin resistance. Then as we get a spillover effect, the body will start putting fats where it can. Namely our liver, heart, kidneys, pancreas, and skeletal muscles. This is a process known as ectopic lipid deposition.

This is where there is overlap with back pain. In 2022, there was a study published that showed a correlation between low back pain and morphology of the paraspinal muscles. Paraspinal muscles are a group of three muscles that line the vertebrae and create spinal stability. Subjects with smaller paraspinals and “fatty infiltrates” were more likely to have back pain. What is going on here? 2 things: Firstly, the muscles are weaker and theoretically decreasing spinal stability. The body is running the process of ectopic lipid deposition, i.e. the fatty infiltrates. 

You can think of the body as having two modes, sympathetic and parasympathetic. When we are in a sympathetic state, it is catabolic; in other words breaking things down. When we are in a parasympathetic state, it is anabolic; building things back up. Parasympathetic state is highest when we are sleeping. So, if we live a stressed life, sleep poorly, and don’t exercise much, we get a chronic state of breaking down muscle, and putting on fat. This is the link between back pain and lifestyle. 

So if you get an MRI of your back, and you see the words “fatty infiltrates” on it, pay attention. It could be a clue that you are developing metabolic syndrome. Some blood work would be a good idea at this point. Keep in mind that traditional bloodwork picks up on disease processes when they already have occurred. Functional medicine aims to catch it before it happens. If you want to learn more, let’s get on a free consult call. 

Reference:

Seyedhoseinpoor T, Taghipour M, Dadgoo M, Sanjari MA, Takamjani IE, Kazemnejad A, Khoshamooz Y, Hides J. Alteration of lumbar muscle morphology and composition in relation to low back pain: a systematic review and meta-analysis. Spine J. 2022 Apr;22(4):660-676. doi: 10.1016/j.spinee.2021.10.018. Epub 2021 Oct 27. PMID: 34718177.

Squatting and Back Pain

Have low back pain when squatting? There can be several reasons for this, but the first thing I check is your ankles. Limited ankle range of motion can alter how you squat and change your center of gravity, placing more strain on your low back. 

If you can’t squat deep without your heels raising or your feet turning out, chances are you are missing some ankle range of motion. The body loves to compensate, and just how it chooses to do it dictates where symptoms may develop. 

For example, if you squat and feel like you’re going to fall backwards, you will likely bend forward at the waist as a counter to the feeling of falling backwards. Like so:

That may be all well and good, but once you start loading this position with some weight, your back will have to work extra hard to get that weight back up. A quick test to see if the ankles are the problem is to take them out of the picture by buying back some range of motion and elevating your heels. You can stand on some plates or on something like shown below. If, with heels elevated, you can be closer to upright in your torso, chances are it’s your ankles to blame. See below:

So the short term fix would be to elevate your heels, or just not squat as deep. However, if you want to get into a deep squat (which I recommend for knee health), then you should prioritize mobilizing your ankles and getting some range of motion restored.

Here are two of my favorite exercises for this: