Australian Institute of Health and Welfare 2019. Back problems. Cat. no. PHE 231. Canberra: AIHW. Viewed 20 September 2019, https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/back-problems
Australian Institute of Health and Welfare. (2019). Back problems. Retrieved from https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/back-problems
Back problems. Australian Institute of Health and Welfare, 30 August 2019, https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/back-problems
Australian Institute of Health and Welfare. Back problems [Internet]. Canberra: Australian Institute of Health and Welfare, 2019 [cited 2019 Sep. 20]. Available from: https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/back-problems
Australian Institute of Health and Welfare (AIHW) 2019, Back problems, viewed 20 September 2019, https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/back-problems
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Back problems are a range of conditions related to the bones, joints, connective tissue, muscles and nerves of the back. Back problems are a significant cause of disability and lost productivity.
Almost 2 in 5 (38%) people with back problems said pain "moderately" interfered with daily activities in 2017–18
2nd leading cause of disease burden overall in Australia 2015, accounting for 4.1% of Australia’s total disease burden
1 in 6 Australians (16%) had back problems in 2017–18. That’s 4.0 million people
Risk factors increase the chance of developing a chronic condition. Back problems share a number of risk factors with other chronic diseases, such as:
Other factors such as exposure to whole body vibration  and mechanical exposures (such as placing unequal stress on the spine by twisting while lifting heavy objects or poor posture during work activities)  may increase the risk of developing back problems, in particular low back pain.
Risk factors can also affect quality of life, and often complicate treatment and management options . Managing these risk factors helps to manage the progression and health burden of back problems, and can reduce the risk of developing further complications and other chronic diseases.
Risk factors are defined in Box 1.
According to self-reported data from the 2017–18 National Health Survey (NHS), people with back problems are more likely to be current daily smokers, insufficiently physically active and obese, compared with those without back problems (Figure 1).
Source: AIHW analysis of (ABS 2019)  (Data table).
People with back problems were more likely to be or have been a smoker:
People with back problems were slightly less likely than people without back problems to report engaging in the recommended levels of moderate or vigorous physical activity. For adults with back problems, 60% were insufficiently physically active compared with 53% of those without back problems (Figure 3).
Exercise and physical activity are important for the prevention and management of back problems. The relationship between physical activity and back problems is affected by the nature and intensity of the physical activities undertaken. Both too little and too much activity increases the risk of chronic lower back pain . Moderate to strong risk factors for lower back pain include heavy manual workload and repetitive lifting, with stronger associations for flexed, rotated or awkward positions of the spine .
People with back problems were more likely to be obese (40%) compared with people without back problems (29%). People with back problems were less likely to be overweight, or underweight/in the normal range compared with people without back problems (Figure 4).
Note: Body weight category is based on Body Mass Index (BMI) for persons whose height and weight was measured and imputed. In 2017–18, 33.8% of respondents aged 18 years and over did not have a measured Body Mass Index (BMI). For these respondents, imputation was used to obtain BMI. For more information see Appendix 2: Physical measurements in the 2017–18 National Health Survey .
For people with back problems, the prevalence of risk factors varies by age.
The prevalence of smoking among people with back problems decreased with increasing age. Older people (aged 65 and over) with back problems were less likely to report current daily smoking (9%) than those aged 45–64 (20%) or 18–44 (21%).
There was an increase with increasing age in the prevalence of insufficient physical activity or obesity for people with back problems. Insufficient physical activity increased significantly from 51% at age 18–44 to 60% at age 45–64 and 75% at age 65 and over. Obesity increased significantly from 32% at age 18–44 to 45% at ages 45–64 and 43% at 65 and over (Figure 4).
A similar pattern is observed in the prevalence of smoking, insufficient physical inactivity and obesity for people without back problems.
Risk factors analysis is based on people aged 18 and over. This age group was selected due to the available data in the ABS National Health Survey (NHS) and to ensure consistency with other AIHW risk factor reports [9, 10].
The risk factor data presented here were obtained at one point in time, based on self‑reported data from the NHS (with the exception of BMI, which was measured). When interpreting self-reported data, it is important to recognise that it relies on respondents providing accurate information.
It is not possible to attribute cause and effect to self-reported risk factors and back problems. Risk factors present at the time of the survey may or may not have contributed to the presence of back problems. Similarly, the presence of back problems may not be directly related to the number of risk factors a person has.
The risk factor definitions used in the ABS 2017–18 National Health Survey are described below in Box 1.
Refers to the frequency of smoking of tobacco, including manufactured (packet) cigarettes, roll-your-own cigarettes, cigars and pipes, but excluding chewing tobacco, electronic cigarettes (and similar) and smoking of non-tobacco products. Categorised as:
A respondent who reported at the time of interview that they smoked cigarettes, cigars or pipes, less frequently than daily.
Source: (ABS 2018) National Health Survey: Glossary, 2017–18 .
Australia’s Physical Activity and Sedentary Behaviour Guidelines (the Guidelines) are a set of recommendations outlining the minimum levels of physical activity required for health benefits, as well as the maximum amount of time one should spend on sedentary behaviours to achieve optimal health outcomes . Please see the Physical activity web topic page for more information.
In 2017–18, the ABS National Health Survey collected information for the first time on physical activity at work. Therefore all results for adults include physical activity at work.
Based on the guidelines, insufficient physical activity is defined as:
For the purpose of calculating activity time, vigorous activity time is multiplied by a factor of two.
Muscle strengthening activities are not included in this analysis.
Source: (AIHW 2019) Insufficient activity report .
Body Mass Index (BMI) is a simple index of weight-for-height that is commonly used to classify underweight, normal weight, overweight and obesity. It is calculated from height and weight information, using the formula weight (kg) divided by the square of height (m). To produce a measure of the prevalence of underweight, normal weight, overweight or obesity in adults, BMI values are grouped according to the table below.
30.00 – 34.99
In 2017–18, 33.8% of respondents aged 18 years and over did not have a measured Body Mass Index (BMI). For these respondents, imputation was used to obtain BMI .
Source: (ABS 2018) National Health Survey: Glossary, 2017–18 ; (ABS 2019) National Health Survey: Users’ Guide, 2017–18 .
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