Women with Back Pain… The Silent Majority? Part 1

By Published On: August 17, 2017Categories: NJ Pain Management

Because humans are bipeds—that is, two-legged animals—our spines tend to experience greater loads than those our four-legged friends. This leads to men and women experiencing degenerative conditions such as osteoarthritis much earlier in life compared with lions, tigers, and bears (and your dog or cat). Also, the majority of us (about 90%) have one leg that’s shorter than the other (average 5.2mm or ¼ inch), which can tilt the pelvis downward on the side with the shorter leg, which increases the risk for both back pain and neck pain. Fortunately, this can be rectified with a heel lift in the shoe. However, women also face unique anatomical, physiological, and social challenges when it comes to back pain…

Females have a wider pelvis, which aids in childbearing. This results in a greater Q-angle or “knock-knee” measurement in females than males (the “normal” angles are <22 degrees and <18 degrees, respectively). The greater the Q-angle, the less stable the pelvis, as it's similar to folding the legs of a card table inward, which makes the table unsteady.

Another obvious anatomical difference includes breast size (weight and mass). Large breasts can place a great deal of stress on the mid-back as well as the neck and low back. Wearing a high-quality support bra or having a breast reduction may be appropriate management options for this population.

Hormone levels and variability represents a physiological difference between genders, as levels vary significantly more throughout a woman’s life than a man’s. This is particularly true of estrogen, especially from the time menstruation starts (called menarche), sometime between ages 9-14 years, and menopause. Menopause typically occurs between 49-52 years of age, which is triggered by a decrease in hormone production by the ovaries. (Note: a total hysterectomy— which includes removal of the ovaries—creates premature menopause.)

During adolescence, growth spurts are common and idiopathic scoliosis or an abnormal curvature of the spine can develop. The term “idiopathic” means the cause is unknown, and why women are three-times more likely to develop scoliosis than men is also a mystery. Treatment may range from a “wait and watch” approach to specific manual therapies and posture correction options that may include heel lifts for a short leg, foot orthotics for hyper-pronation of the ankles, as well as specific exercises for forward head carriage. Bracing may be needed if curves exceed 40 degrees although this varies on a case-by-case basis.

We will continue this important discussion next month—stay tuned!

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