Why lower back pain is becoming everyone’s problem

What’s the one thing linking cricket World Cup winner Jasprit Bumrah, double Olympic medal-winning javelin thrower Neeraj Chopra, and you? Lower back issues. According to the Global Burden of Diseases, Injuries, and Risk Factors Study 2021, lower back pain is the most prevalent health problem in the world today. A systematic analysis of the Global Burden of Disease Study 2021, published in June 2023 in The Lancet Rheumatology, found that low back pain affected 619 million people globally in 2020. And since no one is getting younger, it’s worth noting that its prevalence increases with age, with peak rates observed at around 85 years.

Low back pain was defined as “pain between the 12th ribs and the gluteal muscles that lasted a day or more”. India is no stranger to lower back issues plaguing its citizens. “Walk into any orthopaedic clinic in an Indian city today and lower back pain will likely top the list of complaints. It cuts across age groups, occupations, and income levels in a way few conditions do,” says Dr Vishal Peshattiwar, head of spine surgery at the Kokilaben Dhirubhai Ambani Hospital in Mumbai.

With modern lifestyles becoming more sedentary and work increasingly desk-bound, lower back pain is set to become even more widespread. The Lancet analysis projects that the number of people affected will rise to 843 million by 2050. Data also shows that Indians are grappling with significant back issues. A systematic review pooling findings from 97 Indian studies found that roughly 48% of the population experiences low back pain at any given time, while lifetime prevalence rises to as high as 66%—meaning most people will deal with it at some stage of their lives, notes Peshattiwar.

In India, the numbers are rising due to bad lifestyles in our towns and cities, says Dr Rahul Gupta, senior director and head of the department for neuroscience and spine surgery, Fortis Hospital, Noida. “Minimal exercise, poor nutrition, constantly racing against time, lack of proper sleep, bad posture, and no precautions during work or daily activities lead to gradually progressive trauma to the spine,” he explains.

WHAT'S CAUSING INDIA'S BACK PAIN PROBLEM

A large part of the story is how drastically daily life has changed. The human spine is built for movement and variety—not for being held static in a compromised position for six or eight hours. Continuous compression on the discs, without adequate movement, accelerates fatigue and tissue stress. The muscles of the upper back connect to the lower back, which connects to the glutes, and the glutes to the hamstrings, explains Indra C H, a yoga expert at the fitness chain Cult.

“When someone sits in a hunched posture for long periods, this entire chain of muscles gradually becomes strained. But the lower back tends to hurt more than the upper back or glutes because of the spine’s structure. The upper back naturally has an outward curve, while the lower back has a mild inward arch. When we constantly sit hunched over, we force the spine out of its natural curvature. Over time, this unnatural positioning places stress on the lower back, leading to pain. Often, the weaker or more vulnerable part of the body is the first to experience discomfort—which is why the lower back is so commonly affected,” says Indra.

Office workers sit for seven, eight—sometimes 10 hours a day—hunched over laptops or scrolling on phones. The muscles that support the spine gradually weaken from disuse, and the lumbar region ends up absorbing stress it was never meant to carry alone, says Peshattiwar. Stress, along with lifestyle choices such as smoking and alcohol use, adds to the deterioration of spine health. India’s rising obesity rates are also adding to the load—literally. Every extra kilogram of body weight increases the mechanical demand on spinal discs and surrounding structures, accelerating wear and tear over time.

This is a health problem that cuts across socio-economic status, class and gender, even though data shows a higher prevalence among women than men. “The irony is that opposite extremes create the same problem. Desk workers and those working from home often neglect healthy ergonomics and suffer early spinal degeneration. On the other hand, farmers, construction workers and manual labourers spend years repeatedly bending, lifting heavy loads with poor technique, and straining the same spinal structures from the other direction,” he adds. Epidemiological research consistently identifies sedentary behaviour, poor posture and repetitive strain among the leading drivers of back pain.

FLAWED FURNITURE DESIGN

One of the biggest culprits behind lower back pain is the furniture we use. It contributes far more to the problem than most people realise, points out Peshattiwar, adding that it’s not just the furniture itself but also how people use it—and for how long. “Laptops propped up on coffee tables, dining chairs pressed into service as office chairs, sofas that look comfortable but offer no spinal support whatsoever—these setups became the norm during the pandemic, and the habits have largely stuck. None of them support the natural inward curve of the lumbar spine, and the body adapts to whatever position it is held in for long enough,” he says.

That said, there are simple, practical fixes such as using a chair with proper lumbar support and a desk at the right height. Furniture, both at home and in the office, should be ergonomically designed. Old and worn-out furniture can also alter spinal alignment, placing added stress on ligaments, joints and muscles, says Gupta. “The quality of the mattress you sleep on is equally important. Sleeping on a firm surface with a 3–5-inch-thick cotton or coir mattress is ideal,” he adds, though he does not recommend sleeping on the floor without a mattress.

THE FIX LIES IN MOVEMENT AND POSTURE

When it comes to lower back pain, no single fix works in isolation. Along with proper furniture, consistent movement is one of the most effective ways to manage,and even prevent it, say doctors and fitness experts. A few habits can make a disproportionate difference, notes Peshattiwar.

“The spine does not work in isolation. It relies on a web of surrounding muscles including the core, abdominals and deep back muscles to distribute load and maintain stability. When these muscles are under-conditioned, the spine compensates, and over time that compensation leads to strain and back pain. Strengthening these supporting muscles changes the equation. Flexibility work and regular movement also improve circulation to spinal tissues and reduce the stiffness that makes minor injuries feel far worse than they are,” he adds.

What’s equally important is keeping an eye on your weight, as spinal load increases with body mass. Posture during desk work also deserves far more attention than it typically gets. Sitting with a rounded back for hours compresses the discs unevenly and, over time, creates the conditions for chronic pain. Ergonomic seating, screens positioned at eye level, and movement breaks every 30 to 60 minutes are simple but effective preventive measures. Lifting mechanics matter too, especially for those whose work involves manual handling. Hinging at the knees rather than the waist, and keeping loads close to the body, helps take the strain off the lumbar spine in situations where the risk of injury is highest.

A review published in the Indian Journal of Occupational and Environmental Medicine found that most back pain cases are mechanical in nature and respond well to movement, guided exercise and physiotherapy often better than they do to rest. “Exercise is the single most important factor in reducing and eliminating back pain. The spine is strong enough to maintain our upright posture and flexible enough to support everyday movement,” says Gupta. Walking, yoga, targeted stretching and physiotherapy-led strengthening programmes consistently emerge as the most practical and effective approaches. In short: move.

Shrenik Avlani is a writer and editor and the co-author of The Shivfit Way, a book on functional fitness.