Predicting Sciatica in Adulthood: The Role of Adolescent
Sports, Smoking, and Overweight
Among adults, low back disorders including nonspecific low back pain (LBP) and sciatica are prevalent health problems that place a considerable burden on the healthcare system.
In Finland, the costs associated with sick leave due to low back disorders rose by 43% from 1995 to 2005, reaching over €100 million in 2005. A population-based survey called Health 2000 revealed that approximately 10% of individuals aged 30 and above suffer from chronic low back disorders.
Furthermore, the survey indicated a 4.7% prevalence rate of physician-diagnosed sciatica. Sciatica is characterized by its persistence and severity, resulting in worse outcomes and increased healthcare resource utilization compared to localized LBP. It also leads to longer periods of illness absence and greater levels of disability when compared to nonspecific LBP.
Genetics play a major role in disc degeneration, LBP, and disc herniations. As people age, environmental factors become more influential in causing LBP. Overweight/obesity, smoking, and mechanical loading of the spine increase the risk of sciatica and non-specific LBP.
To study the preventive aspects of low back disorders, the influence of lifestyle factors during adolescence on the development of LBP, sciatica, or operated sciatica in adulthood has been investigated.
A study reported by literature has examined the role of sports participation, particularly high-risk sports, sports club membership, smoking, and overweight/obesity at the age of 14 as potential predictors of hospitalizations for these conditions later in life.
Lifestyle factors at the age of 14 have been found to predict hospitalizations due to sciatica or LBP in adulthood. Among females, overweight/obesity has been associated with an increased risk of second-time hospitalization for surgical treatment of sciatica.
Among males, current smoking has been associated with an increased risk of both first-time hospitalization with conservative treatment and second-time hospitalization for surgical treatment of sciatica. Furthermore, the risk of discectomy by the age of 45 has been found to be 2.6 times higher among males than among females.
Smoking has been found to elevate the risk of hospitalization for low back pain (LBP) in males, including both conservative care and surgical treatment. Both former and current smoking are associated with a higher prevalence of LBP in both males and females.
The incidence of LBP is consistently higher among males, with a more pronounced relationship between smoking and LBP observed in adolescents. Additionally, smoking during adolescence is connected to an increased likelihood of hospitalizations for LBP in adulthood. While a correlation exists between smoking and sciatica, it is weaker compared to the association between smoking and LBP.
Smoking has been linked to low back symptoms through its impact on blood circulation around the intervertebral discs, potentially making them more susceptible to degeneration. Additionally, smoking is associated with psychosomatic symptoms in girls. The increased probability of hospitalizations for low back disorders among smokers may also be influenced by distress or anxiety.
Overweight/obesity in females was associated with a second-time hospitalization for surgical treatment of sciatica. This is concerning given the increasing prevalence of overweight and obesity among Finnish adolescents. Obesity has been linked to a higher incidence of low back pain (LBP) in meta-analyses.
Cross-sectional studies indicate that both overweight and obesity are associated with LBP, with a stronger association observed in women. However, cohort studies suggest that men have a similar or higher likelihood of experiencing LBP. The gender difference observed in our study may be influenced by hormonal factors or variations in body fat distribution and lean body mass.
Obese females may experience higher hospitalization rates for low back pain (LBP) or sciatica due to factors such as increased susceptibility to accidental injuries or excessive mechanical load. Adipocytes release proinflammatory substances, leading to systemic inflammation and spinal pain.
Overweight individuals are more prone to disc degeneration and vertebral endplate changes associated with LBP. Obesity can also affect LBP through decreased spinal mobility or the development of atherosclerosis.
It has been found that males have experienced a 2.6 times higher risk of discectomy compared to females. This finding aligns with previous research showing a similar gender difference in lumbar discectomy rates.
The obligatory military service for males in Finland, which involves physically demanding activities, may contribute to this disparity. Physical activity has also been associated with self-reported sciatica and low back pain, but further research is needed to understand its impact on hospitalizations for low back disorders.
Accessibility to hospital treatment and regional variations in surgical rates may impact the generalizability of our findings. Additionally, our study focused on patients with severe symptoms requiring hospitalization, limiting the applicability to individuals with milder symptoms.
The limited number of adults who experienced multiple hospitalizations for low back pain or sciatica may have impacted our ability to find significant associations.
Our analysis focused on the first conservative hospitalization, and we did not account for other conservative hospitalizations. Furthermore, we were unable to test for other potentially influential variables, such as military service or exposure to physical workload, that could contribute to the risk.
In conclusion, overweight in adolescence increases the risk of second-time surgical hospitalization for sciatica in adulthood among females. Smoking in adolescence is also associated with hospitalization for low back pain (LBP) or sciatica in adulthood among males.
Further research is needed to better understand the impact of modifiable lifestyle factors during adolescence. By identifying these risk factors, we can potentially implement preventive measures and reduce the financial burden on healthcare services.
I am Vedant Vaksha, Fellowship trained Spine, Sports and Arthroscopic Surgeon at Complete Orthopedics. I take care of patients with ailments of the neck, back, shoulder, knee, elbow and ankle. I personally approve this content and have written most of it myself.
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