Causes of low back pain (LBP) in women without pregnancy, in relation to different age groups during the reproductive period, are primarily treated as musculoskeletal disorders: A retrospective study

Causes of low back pain (LBP) in women without pregnancy, in relation to different age groups during the reproductive period, are primarily treated as musculoskeletal disorders: A retrospective study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Causes of low back pain (LBP) in women without pregnancy, in relation to different age groups during the reproductive period, are primarily treated as musculoskeletal disorders: A retrospective study U. S. Bilkish, DR. MD. JAHANGIR HOSSAIN, Chowdhury Foyzur Rob, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3940336/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 12 May, 2024 Read the published version in MOJ Orthopedics & Rheumatology → Version 1 posted You are reading this latest preprint version Abstract Introduction: Low back pain (LBP) is a musculoskeletal disorder of several causes that can mess up the spine. [11] It is characterized by pain, stiffness or muscle tension and is usually localized in the lumber region. – During their working years, people frequently experience low back pain. Approximately 84% of adults experience LBP once or more during their lifetime. [1, 3, 6, 8] In Bangladesh, wt. related prevalence of LBP is 18.5% and age group 18-34 years prevalence are 10.5% and >55 years 27.8%, average 19.2%, which is more in women 27.2% than men. [1] Pain in the Soft tissue of the back is extremely common among adults and often affects individuals during their working years. LBP in women, is strongly linked to hormonal,- and reproductive factors, the work environment and lifestyle. [3] Females frequently experience lower abdominal and back pain at reproductive age, usually due to PMS, PMDD, dysmenorrhea, endometriosis, pregnancy, menopause, muscle spasms, arthritis, UTI, PID, HTN, DM, obesity, multiple C/S tracts and lower abdominal operations, all of which cause RAD, osteoporosis, vertebral and intervertebral disc diseases (PLID, herniation, slipping etc.). [9, 10] The L 4 and L 5 neural arches are involved in the transmission of a considerable load. Therefore, the joints between the articular facets of L 4 and L 5 ,- are sites of LBP. Low back pain (LBP) was diagnosed by history and clinical examination according to the Pain Scale. To determine the cause of HELLP syndrome/causes by routine investigations and sometimes abdominal ultrasonography (USG), magnetic resonance imaging (MRI) is needed. [3, 8] Treatment of LBP depends on the cause. When a definite lesion is not found, The patient should be informed and reassured about the treatment of LBP. [3] Purpose/Objective of the study: To identify the causes of LBP and prevalence in women of reproductive age except for pregnant individuals and establish referral guidelines. Methodology: This was a retrospective (observational) cross sectional study jointly conducted by Orthopedics and Gynecology Expertise in the North-East region, named the Sylhet Division of Bangladesh. Female patients were considered to be of reproductive age for the last three (3) years (2020 - 2022) at the Z & J fellows' medical institution. The data were collected from the medical records of computer databases with preset questionnaires and written informed consent. The 1 st part of the questionnaire consisted of questions about causes of LBP, and the 2 nd part consisted of LBP-related questionnaires. Patients were selected by the inclusion and exclusion criteria. The data were analyzed with SPSS 25.0 statistical software, MS Word and Excel version 2010. Descriptive statistics were analyzed, i.e. frequency, central tendency and dispersion, i.e. range, standard deviation and variance. Tests of “proportions” and “significance” were performed via sample t-test and ANOVA. Statistical data analysis was used to evaluate the correlation of LBP incidence and intensity (%) with – age, BMI, disease status, marital status, obstetric history, working history and posture of reproductive-age women. Summary: LBP has multiple causes. In retrospective studies, there is no way to predict the prevalence of causes; rather, the prevalence of causes, can be determined before patients are affected. In our study, we found the causes of LBP in women: age, BMI, local and systemic diseases, marriage history, obstetric history and working history with posture. The prevalence of LBP was greater in the 41-50 years age group (34.7%) and in the 20-30 years age group (34.2%). Moreover, overweight and obesity are associated with LBP. Overall 5.3% and 12.8% of the participants were overweight and obese, respectively, and were aged >20-30 years with LBP. Patient age, BMI, disease status, marital status, obstetric history and working history had no effect on any of the patients, but some patients had LBP; overweight, obesity, age group and working posture had direct effects on LBP incidence (p>0.05). LBP is more common in women- than in men and may be due to household activities, and a greater frequency of visceral pain during menstruation, pregnancy and labor. Conclusion: Low back pain (LBP) is effect of multiple physical conditions,- that can occur in women of reproductive age except during pregnancy and can disrupt the back tissues of lumbosacral region. Women are more susceptible to LBP , because of menstrual and obstetric factors. A diagnosis was made by meticulous detailed medical history, physical examination and proper investigations. The parameters (causes) , we found that LBP had no effect on any of the patients, but women of reproductive age may suffer from LBP due to differences in cause. Message of the article: LBP in women of reproductive age except pregnancy is multifactorial effect of back tissues, especially lumber region. LBP has a major socioeconomic impact on patients and leads to disability. Proper evaluations are mandatory to identify the causes of the underlying pathology of pain generators before starting treatment. Patients were referred to an apposite medical person when they met the relevant guidelines; ⅰ) the findings were suggestive of serious medical and psychological issues; ⅱ) activity limitations and impairments in body functions were reported; and ⅲ) symptoms were not resolved with interventions. Low back pain (LBP) Women of reproductive age LBP in women without pregnancy Retrospective Cross-sectional study. Overweight Obesity Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction (Background) Low back pain (LBP) is a musculoskeletal disorder of several causes that can mess up the spine. [11] It is characterized by pain, stiffness or muscle tension, and is usually localized in the lumber region. During their working years, people frequently experience low back pain. Approximately 84% of adults experience LBP once or more during their lifetime. [1, 3, 6, 8] Pain in the soft tissue of the back is extremely common among adults and often affects individuals during their working years. LBP in women, is strongly linked to hormonal and reproductive factors, the work environment and lifestyle. [3] It is a major sickness that causes individuals severe consequences for health care resources. [2, 3, 7, 15] In 2020, approximately 10% of the population worldwide suffered from LBP. A study of the Global Burden of Disease (GBD) in 2021 showed that LBP became under resourced and overburdened in social and health care systems in Asia and Africa. Chronic LBP has a greater effect on the socioeconomic condition of populations. The incidence of chronic LBP is approximately 23%, and 11-12% of the population becomes disabled due to LBP. [1] LBP is associated with personal, social and financial compulsion worldwide. The National Health Care Services costs for LBP were approximately 5 billion pounds (£) in the UK annually and 134 billion US$ in 2016 in the U.S. but the United States, National Institute of Health (NIH) was able to decrease the costs of LBP by 69 million US$ in 2023. LBP and other musculoskeletal diseases are the leading causes of disability, but there is no specific mention of these disorders in the context of WHO noncommunicable diseases (NCDs) or the NCD 2030 Countdown. [2] In Bangladesh, 18.5% and 19.4% weight-related LBP outbreaks are associated with age, respectively. LBP is more common in females than in males. [1] The WHO and NIAMS (NIH) classify LBP according to the duration of low back pain (LBP) as follows: ⅰ) acute back pain that occurs suddenly and lasts a few days to a few weeks; ⅱ) s ubacute back pain that occurs suddenly or over time and lasts 4-12 weeks; and ⅲ) chronic back pain that occurs quickly or slowly and lasts more than 12 weeks and continues daily. [4, 6, 11, 13, 37] Pain is probably dull, constant to sudden, and sharp and may radiate to the lower limb/limbs. [13] In France, 90% of patients recover from pain within two (2) weeks, 15] another study reported that approximately 80% of cases of back pain lasted less than one week. [32] There are various causes of LBP, including gynecological, vascular, neurological, psychological, spine (spondylogenic) or disc pathology as well as traumatic, but the cause may be undiagnosed and enclosed by the term “mechanical or postural back pain”. These may be mechanical or structural abnormalities of the spine, inflammatory conditions and/or other medical conditions. Pathology can include the spine, disc, muscle, ligament or tendon on the back or nerve compression. [3, 37] LBP during pregnancy may be defined as recurrent or continuous pain for more than a week from the lumber spine as a result of different nonspecific causes. This type of pain is typically due to weight gain and psychological and prolonged postures, such as – sitting, standing or repeated lifting. During pregnancy, LBP was associated with hypermobility, high BMI, absence of menstruation and previous H/O back pain. [6] Younger pregnant women more frequently experience back pain with multiple pregnancies and severe physical or psychological work [39]. A total of 80.8% of the pregnant women felt pain in the lumber region, and 49.1% of the pain originated in the sacroiliac joints. [38] Females frequently experience lower abdominal pain with back pain at reproductive age, usually due to menstrual cycle related factors (e.g., PMS, PMDD and dysmenorrhea), endometriosis, pregnancy, menopause, muscle spasms, arthritis, UTI, PID, HTN, DM, obesity, multiple C/S and lower abdominal operations cause RAD; uterine prolapse usually occurs after 50 years of age; intrauterine contraceptive device use; osteoporosis, vertebra and intervertebral disc disease (PLID, herniation, slipping etc.). [9, 10] Women are more affected than men by low back pain (LBP), [3, 8] and strong thinking has shown that this difference is due to the female reproductive system. The female musculature and ligament support are weaker than those of men; furthermore, pelvic girdle muscles and ligaments undergo strain during pregnancy and labor and suboptimally regain their normal state after delivery. [3] The incidence of LBP is greater in married women than in unmarried women. More vaginal deliveries and live births are associated with LBP. [41] A greater number of abortions is also directly associated with back pain. [40] The incidence of LBP in women associated with pregnancy, gynecological factors and other diseases is -66%, 35% and 24%, respeptively of women suffer during pregnancy, and 51% experience LBP during menstruation. [11, 40] Women who underwent cesarean delivery (CD) had a 4.5 fold greater risk of rectus abdominis diastasis (RAD). 24.6% incidence of LBP in RAD. [6] Obesity, pregnancy, number of live births, CD, RAD, abortion, infection, inflammation, HTN, DM, spondylogenic and discogenic factors, trauma, working environment, posture and psychological effects are risk factors for LBP in women during their reproductive age. Low back pain (LBP) was diagnosed by history and clinical examination according to the Pain Scale. To determine the cause of HELLP syndrome/causes by routine blood and urine tests and sometimes abdominal ultrasonography (USG), magnetic resonance imaging (MRI) is needed. [3, 8] Treatment of LBP depends on the cause. When a definite lesion is not found, the patient should be informed and reassure about the treatment of LBP. [3] Materials And Methods This was a retrospective (observational) cross sectional study jointly conducted by Orthopedics and Gynecology Expertise in the North-East region, named the Sylhet Division of Bangladesh; the study included female patients during the reproductive period without pregnancy for the last three (3) years (2020 - 2022) at the Z & J fellows' medical institution. The total population in this area is 9.5 million. The main occupations in tea gardens, agriculture and day labor. The data were collected from the medical records of computer databases with preset questionnaires and written informed consent. The 1 st part of the questionnaire consisted of: height, weight, BMI, medical history (HTN, DM, UTI, PID, RAD, arthritis, PLID, renal stone, and psychological), marital history (marital status, marital age and marriage duration), obstetrical history (no. of pregnancies, no. of live births, no. of abortion, no. of NVD and no. of CD and lower abdominal operations), working history (housewife, day laborer, official and student) and main posture during work (sitting, standing, bending and lifting). The 2 nd part of the questionnaire consisted of LBP related questions: location, intensity, radiating to the leg, duration, past H/O LBP and frequency, aggravating factors, relieving factors, and H/O stop working during episodes of LBP. A total 750 patients were found to have low back pain during this period, and 415 patients were included in the study. The inclusion criteria were as follows: ⅰ) female, ⅱ) within the reproductive period and ⅲ) aged 18 to 55 years. The exclusion criteria were as follows: ⅰ) pregnant and ⅱ) malignant. The data were analyzed with SPSS 25.0 statistical software, MS Word and Excel version 2010. Descriptive statistics were analyzed, i.e. - frequency, central tendency (mean, median and mode) and dispersion (range, standard deviation and variance). Tests of “proportions” and “significance” were performed via sample t-test and ANOVA. Statistical data analysis was used to evaluate the correlation of LBP incidence and intensity (%) with age, BMI, disease status, marital status, obstetric history, working history and posture of reproductive age women. Data analysis: In the northeastern region of Bangladesh, at the Sylhet Division in the last three (3) years (2020-22), we included 415 reproductive-aged women with low back pain (LBP) without pregnancy. The age limit of the patients was 20 to 55 years. The mean age (±SD) was 36.12 (±9.578) years (n=415). The height ranged from 138-162 cm and their weight ranged from 42-79 kg, the mean height (±SD) was 154.10 (±4.100) cm and weight (±SD) was 59.07 (±6.646) kg. The minimum BMI was -20.0 kg/m 2 and the maximum -34.7 kg/m 2 , the mean (±SD) BMI was 24.879 (±2.832)kg/m 2 . According to BMI the patients (n-415) were classified as follows: normal wt. -81.9%, overweight -5.3% and obese -12.8%. There were more than 7.3% obese individuals in the 20-30 age group. The marital status of the patients was as follows: married -75.2%; > one marriage -5.1%; widowed -4.1%; and unmarried -15.7%. The marriage age of the patients from 18-26 years, mean (±SD) was 21.67 (±2.107) years; Marriage duration was 1-36 years, mean (±SD) was 16.77 (±9,372) years; No. of pregnancy was from 0-6, mean (±SD) was 2.54 (±1.252); No. of live birth was from 0-3, mean (±SD) was 2.33 (±2.388); No. of abortion was 0-3, mean (±SD) was 0.33 (±0.575) and No. of NVD was from 0-5, mean (±SD) was 2.13 (±0.986). RAD due to CD and lower abdominal operations were -8% (minimum -1 and maximum 4), (n=415); CD -2.9%, >1 CD -1.4%, LA operations -2.9% and both CD & LA operations -0.7%. [Figure 2] The medical history of the patients (n=415) was as follows: HTN -10.4%; DM -12.5%; UTI -39.8%; PID -14%; RAD -7.7%; arthritis -8%; PLID -1.7%; renal stones -0.7% and psychological disorders -5.3%. The working history (n=415) were as following: housewife -42.2%; day laborer -28.2%; official -16.6% and student -13% and their main working posture: standing -26.5%; sitting -54.5%; bending -10.6% and lifting -8.4%. [Table 4] The prevalence of disease on LBP was -6.5% for HTN and -10.5% for DM, in the 41-50 years age group; 28% for UTI, in the 20-30 years age group; 8.5% for PID, in the 31-40 years age group; 3.5% for RAD, in both 31-40 and 41-50 years age group; 4.5% for arthritis, in the 41-50 years age group; 1% for PLID, in the 41-50 years age group; 0.5% for renal stone, in the 41-50 years age group; and 3.2% for psychological disorders, in the 20-30 years age group. [Figure 3] We estimated the incidence of LBP with a 95% confidence interval (CI) and set p<0.05 for all statistically significant relationships. [Table 3] [P0.05 is not significant, which indicates that the parameters have an effect on LBP in every patient (H 1 )] One sample t-test revealed the following: patient age, age at marriage, duration of marriage, no. of pregnancy, no. of live births, no. of abortions, no. of vaginal deliveries, working history, posture while working, patient BMI and medical history; all p-values (supplemental 2-tailed) were 0.000. The p-value was <0.05. Therefore, these patient parameters had no effect on LBP in any of the patients, but for some patients, they had an effect on the 95% confidence interval. [Table-1] Paired sample t-tests were used to analyze patient age and medical history. The t-value was 66.996, and the p-value (supplemented 2-tailed) was 0.000. The p-value was <0.05. Therefore, patient age has no effect on any disease, but for some patients, age has an effect on the 95% confidence interval. One way ANOVA revealed that for the patients (HTN, DM, UTI, PID, RAD, arthritis, PLID, renal stone, and psychological disorders), the mean disease incidence was 32.499 (SD=9.882), the F-value was 2.056, and the p-value (Sig.) was 0.001. The p-value was <0.05. Therefore, patient disease has no effect on LBP in any of the patients, but in some patients, it has an effect on the 95% confidence interval. Two way ANOVA (Tests of Between-Subjects Effects): Medical history (diseases), age groups, BMI groups and age groups-BMI groups; the F-values are 0.862, 0.781 and 3.260, and the p-values (Sig.) are 0.461, 0.459, and 0.012. The p-value was >0.05 for age group and BMI group but was <0.05 for age group and BMI group. Therefore, disease status was related to patient age and BMI, as indicated by the 95% confidence intervals (CIs). However, age group and BMI had on any of the patients, and the 95% confidence intervals were also calculated for some patients. All of these parameters are related to the prevalence of LBP. Paired sample t-tests were used to analyze patient working history and main Posture during work; the “t” value was -0.077, and the p-value (supplemented 2-tailed) was 0.938. The p-value was >0.05. Therefore, working history and posture affect low back pain with a 95% confidence interval. [Table -2] Pathophysiology of LBP : LBP arises from many potential anatomical structures, i.e., nerve roots, muscles, fascial structures, bones, joints, intervertebral discs (IVDs), abdominal and pelvic viscera. [20] The complex anatomy of lumbar spine is made up of a strong vertebral body. IVDs are linked by joint capsules, ligaments, tendons and muscles; all of these structures are potential sources of LBP generation. [17, 20] The lumbar spine carries most of the body wt. which triggers symptoms of both movement and inactivity. [32] Pain may worsen after standing or sitting for prolonged periods of time. Structural damage , degenerative changes (due to pressure load, diminished blood supply by vessel atherosclerosis) and the accumulation of pain stimuli (i.e.- nitric oxide release from granulation tissue and inflammatory cell infiltration) in lumber region tissues are the causes of LBP. The dorsal root ganglia are thought to be the main modulators of LBP. [17] Body load (wt.) transmission through the vertebral column is another precipitating cause of LBP. The weights of the upper limbs and thoracic cases were transmitted through the ribs to the posterior column of the cervical vertebra via the costotransverse joints and ligaments. The weight is transmitted through 3 columns (one anterior and two posterior) in the cervical region whereas the weight in the thoracolumbar region passes through 2 columns (one anterior and one posterior, and both columns are run parallel to each other following the thoracolumbar curvature). In the thoracic region, wt. passed from the posterior to the anterior column due to anterior concavity of the spine through inclined pedicles, and in the lumber region, for the posterior concavity, the compressive weight dispatches from the anterior to posterior column. Therefore, the compressive force in the curvilinear thoracolumbar column tends to deviate toward the gravitational line, which is related to pathological disorders of the spine and LBP. [35] The neural arch at the L 4 and L 5 levels is involved in the transmission of a considerable load. Therefore, the joints between the articular facets of L 4 and L 5, are sites of LBP. Prevalence of LBP (Global & Local) : Low back pain (LBP) is one of the most common physical problems and has a high socioeconomic impact, leading to working disability and poor quality of life. [13, 42] The prevalence of LBP is approximately 23% in adults and the annual incidence is approximately 15%. [1, 17] LBP is influenced by psychological factors, such as stress, depression and/or anxiety. [20] According to a global review in 2000, the prevalence of LBP ranged from 12-33%. 29.4% for males and 35.3% for females. [6, 43] The average prevalence of LBP is 61.5% among women in Finland, Poland, Spain and India. [46] The incidence of back pain in one (1)-month period was reported to be 29%. Of these 20% were considered chronic, and 40% were disable. [45] In Bangladesh, the weight related prevalence of LBP is 18.5% and that of individuals aged 18-34 years, incidence are 10.5%; aged >55 years, incidence are 27.8%, and average 19.2%, which is more in women 27.2% than men. [1] Trauma is the major cause of acute LBP, but chronic and persistent LBP are more prevalent with systemic diseases and psychological factors, such as – stress and limited health care education. [1, 48] LBP in women can be divided into 2 main categories: ⅰ) Musculoskeletal and Nervous system causes, such as trauma, poor mobility, posture, sciatica and arthritis; and ⅱ) other organ system based conditions, such as reproductive, kidney, infection and inflammation. [36] Discussion Low back pain can be caused by invasion of many local and systemic disease effects into back musculoskeletal structures. The etiology of LBP is multifactorial. [3, 4] Pain is likely a dull, constant to sudden, sharp pain that may radiate to the lower limb. The pain attack may be sudden, acute, gradually aggravated or recurrent. Twenty-one percent of women develop long term LBP due to a lack of healthy lifestyles (HLSs). [56] Lifestyle factors, i.e. nonsmoking, physical activity, diet and moderate alcohol consumption, influence the risk of several diseases, e.g. - cancer, DM and CVD. HLS has a positive influence on the development and prognosis of LBP in women, but there is no clear association in men. [56] LBP is more common in women, probably due to household activities; a greater frequency of visceral pain during menstruation, pregnancy and labor, and a lower pain threshold than in men because the gonadal steroid hormones estradiol and testosterone are moderately sensitive to pain and analgesia. [44] Low back pain in women is linked to hormonal and reproductive factors e.g. menstruation, use of contraceptives (hormones and intrauterine devices), hysterectomy, pregnancy, obstetric history and systemic diseases. Approximately 69% of women experienced menarche at 12-14 years of age. Menarche at the age ≤11 years and an irregular or prolonged menstrual cycle were associated with chronic LBP. [5] Premenstrual syndrome (PMS) starts before menstruation and ends after the cycle. Many women develop LBP during PMS; Nikhil Jain, neurosurgeon, University of Louisville in Kentucky, said the correlation is not fully understood but a linked to hormonal change during menstruation and mental stress. [9] Premenstrual dysmorphic disorder (PMDD) is the same PMS, but the conditions are more severe. There is a family H/O depression, and the brain reacts abnormally to hormonal changes during the period. [9, 10] Dysmenorrhea is painful menstruation. The patient experienced pain in the lower abdomen, lower back, hips and legs. When endometrial tissue grows outside the uterus in other pelvic organs, this disease is called endometriosis, and can cause pain in the pelvis and lower back experienced in menstrual cycle, during and after sex, even during urination. Low back pain is common during pregnancy due to a shift in the center of gravity. Rahul Shah, MD, spine surgeon, New Jersey, [9] reported weight gain; hormonal and mechanical changes during pregnancy and labor cause muscle and ligament relaxation and lead to, sacroiliac joint dysfunction. Huang noted that this pain is the main cause of LBP. [9] Additionally, sleep disturbance and mood changes during pregnancy are the result of LBP. [11] A study in the Netherlands showed that 10% of women suffer chronic LBP at the onset of pregnancy. [5] Back pain is common in patients with premenstrual syndrome. During menopause, a dramatic decrease in estrogen causes osteoporosis and mood changes, leading to LBP. Muscle spasm in the back causes LBP due to strain resulting from exercise, dehydration, heavy lifting or sudden absurd twists and turning of the body, as explained by Jake Magel, physiotherapist, University of Utah. Salt Lake City. LBP indicates that pain occurs in the back between the lower costal margin and above the inferior gluteal folds. [1, 13] Pain can be specific or nonspecific. Specific LBP can be caused by disease, structural problems in the spine or pain radiating from another part of the body. There was nonspecific LBP due to unidentified causes, which was approximately 90%. [13] Table: 3 Parameter statistics for women of reproductive age (without pregnancy) with LBP. Causes of LBP (parameters) Percentage (%) with range (N) Mean (±SD) with 95% Cl P-value Age 20-54 yrs. N = 415 36.12 (±9.578) (Sig. 2-tailed) P = 0.000 Age groups: 20-30 yrs. 34.2% 2.08 (±0.916) P = 0.461 31-40 yrs. 27.2% 41-50 yrs. 34.7% >50 yrs. 3.9% Height 138-162 cm, N = 415 154.10 (±4.100) - Weight 42-79 kg, N = 415 59.07 (±6.646) - BMI 20-34.7 kg/m 2 , N = 415 24.879 (±2.833) (Sig. 2-tailed) P = 0.000 BMI groups: Normal wt. 81.9% N = 415 2.31 (±0.685) P= 0.459 Over Wt. 5.3% Obesity 12.8% Diseases: HTN 10.4% N = 415 3.62 (±1.920) P = 0.001 DM 12.5% UTI 39.8% PID 14% RAD 7.7% Arthritis 8% PLID 1.7% Renal stone 0.7% Psychological 5.3% Marital status: Unmarried 15.7% N = 415 1.3 (±0.764) (Sig. 2-tailed) P = 0.000 Married 75.2% >1 married 5.1% Widow 4.1% Age of marriage 18-26 yrs. (N = 350) 21.67 (±2.107) (Sig. 2-tailed) P = 0.000 Duration of marriage 1-36 yrs. (N = 350) 16.77 (±9.372) Obstetric history: No. of pregnancy 0-6 (N = 350) 2.54 (±1.252) (Sig. 2-tailed) P = 0.000 No. of live birth 0-3 (N = 350) 2.33 (±2.388) No. of abortion 0-3 (N = 350) 0.33 (±0.575) No. of NVD 0-5 (N = 350) 2.13 (±0.986) Lower abdominal operation: CD 2.9% N = 33 2.18 (±1.044) (Sig. 2-tailed) P = 0.000 >1 CD 1.4% LA operation 2.9% Both CD & LA operation 0.7% Working history: Housewife 42.2% N = 415 2.00 (±1.054) (Sig. 2-tailed) P = 0.000 Day laborer 28.2% Official 16.6% Student 13% Working posture: Standing 26.5% N = 415 2.01 (±0.843) (Sig. 2-tailed) P = 0.938 Sitting 54.5% Bending 10.6% Lifting 8.4% The risk and incidence of LBP increase with age. Individuals aged 40-49 years are more vulnerable to LBP globally. [1, 46] Among women aged 20-59 years, the prevalence of chronic LBP was 8.9% and among women aged 50-59 years, the prevalence of LBP was 42% on average in China, Russia, S. Africa and India [5, 46] In our study, the prevalence of LBP was 34.7% in the 41-50 years age group and 34.2% in the 20-30 years age group. The mean age (±SD) was 36.12 (±9.578) years (n=415). A Brazilian study reported that the incidence of LBP in individuals aged 20-35 years was 26.4% and that in individuals aged 36-59 years was 32.7% in 2019. [58] Several studies have shown that overweight and obesity increase LBP development, severity and disability. A BMI ≥25 kg/m 2 is a risk factor for LBP, and a BMI ≥30 kg/m 2 is 1.22 times greater in women. [45, 46, 50] The incidence of LBP was significantly greater in women with a BMI ≥30 kg/m 2 than in those with a BMI ≥20-29 kg/m 2 . [3] Globally, approximately 20-25% of adults are obese. [29] We calculated BMI using the BMI calculator in accordance with the International System of Units (SI). BMI was calculated as body weight in kg divided by height in cm; the unit is kg/m 2 and BMI varies according to age. BMI: 18.5-25, normal; 25-30, overweight and above 30, obese. [23] Obesity (OB) results from a poor lifestyle and can lead to LBP. Loss of body trunk and lower limb muscle mass and central OB are risk factors for LBP. [24] Our study revealed that 5.3% of overweight and 12.8% individuals aged 20-30 years with LBP were obese. [Figure 1] Body wt. increases direct vertebral compressive load and anterior acting loads. These loads act through muscles of the back that produce joint reaction forces, which lead to back pain. A body weight of 65±10 kg was significantly associated with increased LBP. [3] OWs and OBs increase the risk of LBP. [26, 27] LBP was more common among married women (78%) and unmarried women (22%). [14] Patients who are married at a late age (30-34), have ≥2 children or have ≥2 abortions are at risk of LBP. [3] A Brazilian study reported, LBP in married women was 43.6%%, unmarried 23.6% and widow women 32.7%. [58] Patients marital status were: married -(75.2%), unmarried –(15.7%), married more than once –(5.1%) and widowed –(4.1%). The prevalence of stress urinary incontinence (SUI) was 60% in the LBP group. Overall 78% of the adult women reported urinary incontinence (UI) due to LBP. [55] The incidence of SUI is greater in married women with LBP, and there are associations between SUI and both core muscle endurance (CME) and LBP in married women. [55] The incidence of LBP was greater among the late marriage age group, which was observed between 32-34 years of age; this was because the obstetric risk was greater. [3] In this study 17.8% of the patients were married at the age of 23 years, 13.3% were married at the age of 20 years, and the mean (±SD) was 21.67 (±2.107) years. In our study, for patients with a marriage duration ranging from 1-36 years, the mean (±SD) was 16.77 (±9,372) years. Use of contraceptives: Many health care professionals believe there is an association between oral contraceptive use and LBP, but there is no scientific evidence supporting this association. The use of oral contraceptives, increases relaxin levels, causing laxity of ligaments and joints, and leading to LBP. [5] The use of intrauterine contraceptive devices may lead to LBP. LBP was more common among women who were married at a later age (30-34), had ≥2 children or had ≥2 abortions. [3] No. of pregnancy: Relaxin is a hormone produced during pregnancy. Increased relaxin levels during pregnancy can cause laxity of ligaments and joints, leading to LBP. [5] Ligaments and joint laxity due to hormonal changes, weight (wt.) gain and a shift in the center of gravity cause lumbar spine hyperlordosis with anterior tilting of the pelvis. Vascular changes may lead to compromised metabolic demand in back tissues, all of which occur during pregnancy and lead to LBP. [16] In this study, the women with LBP had 0-6 pregnancies per H/o and the mean (±SD) was 2.54 (±1.252) times. There was an association between a greater number of live births and LBP. [5] Approximately 74% of women take their 1 st baby between 20-30 years of age. A first birth at a young age (fibromyalgia), especially at younger than 20 years of age, [5] Late maternal age; ≥ 2 children (pelvic joint syndrome) and a long length of time between childbirths were associated with LBP in middle aged women. [3, 5] The number of live births in our study ranged from 0-3 and the mean (±SD) was 2.33 (±2.388). There were 2 live births (35.9%) and 3 live births (24.8%) in the LBP group. A study revealed a linear association between the number of live births and chronic LBP. [5, 41] The number of abortions ranged from 0-3, and the mean (±SD) was 0.33 (±0.575). A total of 19.5% of women who suffered from LBP after one abortion, were included in this study. The incidence of LBP observed in ≥ 2 abortions was 80%, with one occurring in 51.3% of women and 26.3% occurring in women without abortion in an Indian study. [3] The prevalence of LBP was 60% in women who underwent ≥2 vaginal deliveries, 46.15% in women who underwent one delivery and 12.5% in women who did not delivery. [3] In our study, two (36.6%) and three (24.6%) patients in the NVD cohort had LBP. Numbrs of NVDs 0-5, and the mean number of NVDs was 2.13 (±0.986). Rectus abdominis diastasis (RAD) is a condition; in which rectus abdominis muscles are separated by more than 2 cm. The prevalence of RAD is 30-46.5% in pregnant and postpartum women. Pregnancy, abdominal surgery and heavy lifting status are potential factors for developing RAD. In women, RAD development is 1.9 times greater than that in men, and one set occurs earlier. Women who underwent cesarean delivery (CD) or a lower abdominal operation had a 4.5 times greater risk of RAD than did those, who did not. The prevalence of LBP in women with RAD is 24-69%. [52] Adhesions of abdominal and pelvic viscera were noted in CD patients and abdominal surgery patients. RAD onset occurred more often in patients aged 30-40 years. In our study, LBP developed in 2.9% of CD patients, 2.9% of LA operation patients and 7.7% of RAD patients. RAD development in the 31-40 year age group was 3.5%, and that in the 41-50 year age group was 3.7%. A total of 24.6% of the RAD patients were diagnosed with LBP in 2021 in a study by Harvard Medical School, Boston. [6, 52] A Brazilian study was published in 2019; LBP was associated with HTN -(42.8%), DM -(19.1%), depression -(11.1%) and renal disease -(8.2%). [58] LBP and comorbid conditions such as hypertension, diabetes etc. is vice versa. LBP causes inactivity and a lack of exercise, resulting in weight gain and the subsequent development and enhancement of HTN and DM. In contrast, HTN exacerbates disc degeneration. A study at Hong Kong University revealed that 35.5% of HTN patients had moderate to severe disc degeneration. [49, 51] Cardiovascular risk factors (cholesterol, triglyceride) are associated with LBP. [50] HTN and DM cause atherosclerosis of the lumber vessels. Both of these conditions are highly causes of LBP. In our study, the prevalence of LBP due to HTN was -(10.4%); among those aged 41-50 years, -6.5% had LBP due to HTN. [Figure 3] LBP in diabetes patients is multifactorial. Diabetes causes peripheral vascular diseases and neuropathy, and leads to chronic LBP. Diabetes causes obesity due to metabolic disturbance. OB exacerbates persistent inflammatory conditions. Moreover OA cartilage is more reactive to proinflammatory stress. DM causes multifactorial effects and disc degeneration; and leads to LBP. [28] LBP with DM occurs in 12.5% of women during the reproductive period. The prevalence of LBP in patients aged 41-50 years, was greater (10.5%) in this study. Urinary tract infection (UTI) causes LBP. [19, 31] UTI causes LBP and groin pain in women. [36] In our study, the prevalence of LBP in women with UTIs was -39.8%, and the prevalence in women aged 20-30 years was -28%. UTIs are more common in nulliparous women. [59] UTI is the leading cause of acute pelvic pain and occurs in approximately 20% of women each year. Gram-negative bacteria, especially - E. coli , are 80% of all UTIs. [53, 54, 59] The major mediator of urinary bladder inflammation is lipopolysaccharide (LPS)/ endotoxin in the outer membrane of gram-negative bacteria. Post-UTI pain can be caused by the “O”-antigen. [53] LBP is the primary symptom reported by patients with confirmed UTIs; the prevalence of UTIs during gestation was 37.5%, and the prevalence of LBP in patients aged 20-29 years was 67%. [54] Approximately 48% of women have at least one episode of UTIs; women are more susceptible to UTs because they have a shorter urethra and urethral meatus close to vagina and anus. The UTI prevalence in patients with previous NVD was 72%, whereas that in patients with CD was 28%. Approximately 80% of women had UTIs with no experience of abortion, 8% had one abortion, and 12% had ≥2 abortions. The prevalence of LBP in women diagnosed with UTIs was -84.8%. [54] Approximately 60% of women suffer at least one tine UTI during their life, 20-30% have repeated infections, and the UTI incidence is 16.8% among adults in Bangladesh. UTI is a risk factor for urinary incontinence (UI). [57] There are associations between LBP and SUI, core muscle endurance (CME) and LBP in married women. [55] Pelvic inflammatory disease (PID) is inflammation of the upper genital tract in women due to infection and 85% of infections caused by STD. [25, 36] PID is more common in women aged 15-25 years. It causes LA pain and pelvic discomfort. Eighteen percent of patients develop chronic pain due to inflammation, scarring and adhesion from the infection process. [25] Inflammation is a sequela of infection and causes acute LBP. [19] PID causes chronic pelvic pain, scarring and adhesion, which leads to the development of LBP. The present study showed that 14% of women had LBP due to PID; the age range from 31-40 years was more prevalent at -8.5%. LBP without medical or psychological problems, with clinical findings of ⅰ) mobility impairment in the lumbar region, ⅱ) radiating pain to the lower limb and ⅲ) a positive straight leg raising (SLR) test is a clear indication of LBP due to PLID. [4] The prevalence of PLID is 60% for males and 40% for females. The incidence was greater in the 36-45 years age group (49.42%). The lumbar spine carries most of the body weight. PLID most commonly occurs at L3/4 is 39% and at L4/5 is 18%. [33] A study in Bangladesh showed that the prevalence of LBP due to PLID is 1.9% in men and 7.6% in women. MRI revealed that posterior bulging of the intervertebral disc at the L4/5 level was due to facet-flaval hypertrophy. [34] In our study, the incidence of PLID was -1.7%, and that of more common diseases in the 41 to 50 years age group was -1%. Arthritis causes LBP; age, overweight status and pressure on joints can lead to arthritis. Overall, 26.2% of osteoarthritis patients have a lifetime incidence of LBP. [51] Degenerative spondylolisthesis typically occurs at L4-L5 and is more common in women. [16] In OA, degenerative changes cause LBP. According to the Arthritis Foundation, approximately 20% of people have LBP. Lumber OA is very common, affecting approximately 30% of males and 28% of females; aged 55-64 years in the USA. [32] In this study, the prevalence of arthritis was 8% and patients aged 41-50 years were mostly affected (approximately 4.7%). Renal stones (both kidney and ureteric stones) cause severe acute LBP. [31] When kidney stones move to the bladder, they are typically painful to the back and side and can radiate to the groin. [36] The incidence of LBP was -0.7% due to renal stones and the prevalence in the 41-50 years age group was 0.5% in this study. There is an association between LBP and depression. [46] Psychological factors, i.e. job satisfaction, social relations and mental overstrain have been associated with LBP. [12] Sleep problems, low mood and increased mental distress are effects of LBP and vice versa. [13] There were significant associations between disability and depression, anxiety, insomnia and sleep quality. Fifty four percent of patients reported poor sleep quality with LBP, and 30% had insomnia. [14] Psychological factors, i.e. fear, low mood, expectation of passive treatment and negative pain beliefs, are risk factors for LBP. It is proposed that physiological pain resulting from organic insult; may have negative effects on emotions and cognitive function; conversely, a negative emotional state can lead to increased pain through the central pain pathway. [30] Chronic LBP has both organic and psychological factors. In our study, the incidence of LBP in women of reproductive age other than pregnancy was -5.3% and the incidence was greater in the 20-30 years age group (by -3.2%). [Figure 3] Working posture has a strong association with LBP incidence. Back pain in certain postures is due to the creation of high stress on spine structures. [7] Patients who work in a standing position for long periods of time are more susceptible to LBP. [3] Patients with tissue trauma and muscle spasm are more likely to be in the standing position after long term work. Approximately 83% of gynecologists suffer from back pain while performing surgery in a sitting position,, and 78% experience back pain while performing surgery in standing position. [18] In our study, 42.2% of the women housewives, 28.2%, 16.6% and 13% were day laborers, officials and students, respectively. The main working postures were standing -26.5%; sitting -54.5%; bending -10.6% and lifting -8.4%. LBP prevalence during work at sitting posture was 67.3%, standing 74.5% reported in Brazilian study in 2019. [58] In Bangladesh, there is a positive incidence of LBP in housewives. [1] In the USA, LBP was significantly related to occupation in a study of people involved in lifting, carrying, pulling, pushing and twisting. In EU countries, the effect of LBP involves heavy weightlifting (≥25 kg). [1, 3, 47] We found that the incidence of LBP is greater among housewives and individuals who are working in a sitting position. [Figure 4] The Roland Morris Disability Questionnaire provides a tool for measuring the level of disability experienced by a person suffering from LBP; it is widely used to measure the outcome of LBP. The questionnaire consists of 24 statements, ⅰ) physical ability/activity -15, ⅱ) sleep/rest -3, ⅲ) psychological -2, ⅳ) household management -2, ⅴ) eating -1 and ⅵ) pain frequency -1. [21] The Roland–Morris Disability Questionnaire score has a moderate to strong correlation with pain intensity. The Oswestry Disability Index (ODI) is the gold standard for measuring disability and quality of life (QoL) impairment in adults with LBP. The ODI criteria for assessing functional impairment were pain intensity; ease of personal care; lifting, working, sitting, standing and sleeping; sexual life; social life and traveling. The index consists of 10 questions, which are scored from 0 to 5, and the total score is multiplied by 2; to convert the total score into a percentage. Scores are as follows: 0-20, minimal disability; 21-40, moderate disability; 41-60, severe disability; 61-80, crippling back pain; and 81-100, bedbound or exaggeration of symptoms. [22] The Bangla Health Assessment Questionnaire-Disability Index (HAQ-DI), was used to determine disability scores in Bangladesh. [1] All of the above indices are used to survey for LBP in generalized or specific populations. However, all the data in this study were obtained from patients treated by us. Therefore, we measured pain intensity and disability by the Numeric and Categorical Pain Scale and clinical examination. The number 0-10 is the NRS score. 0=none, mild=1-3, moderate=4-6, severe=7-10. On the categorical scale, no pain, hurts a little, hurts slightly more, hurts even more, hurts a whole lot and hurts worst according to facial expression. The diagnosis was made according to detailed medical and working history, careful physical examination; and proper investigations, i.e. routine blood and urine tests, X-ray, USG, CT, MRI etc. LBP was classified, and the underlying cause/causes were determined. Proper evaluations are obligatory to identify the causes of the underlying pathology of pain generators before starting treatment. [19, 20] Approximately 80% of LBP cases persist for less than a week; if the duration is more than what is considered chronic. [32] The treatment plan was established according to the cause of LBP, and was explained and confirmed. Patient education and medications, i.e. NSAIDs and muscle relaxants, are beneficial. Bed rest should be avoided if possible. [19] Patients were referred to an apposite medical person when ⅰ) findings were suggestive of serious medical and psychological ⅱ) activity limitations and impairments in body functions were reported and ⅲ) symptoms were not resolved with interventions; we followed the LBP clinical practice guidelines of the American Physical Therapy Association (APTA). [4] Summary This retrospective, cross-sectional study was jointly conducted by Orthopedics and Gynecology Expertise in the North–East region of Bangladesh; among female patients of reproductive age for the last 3 years (2020 - 2022) at the Z&J fellows' medical institution. LBP has multiple causes. Retrospective studies are less expensive and faster. The retrospective studies in which the subjects were similar overall ( LBP in women of reproductive age without pregnancy ) but differed in particular in characteristics (i.e age, BMI, marital history, disease, obstetric history and occupation with posture ) within a specific time limit (cross-sectional study) were included. In retrospective studies, there is no way to predict the prevalence of causes; rather, the prevalence of causes, can be determined before patients are affected. In our study, we investigated the causes of LBP in women of reproductive age other than pregnant women: including age, BMI, local and systemic diseases, marriage history, obstetric history and working history with posture. The prevalence of LBP was greater in the 41-50 years age group (34.7%) and in the 20-30 years age group (34.2%). Moreover, overweight and obesity are associated with LBP. Overall, 5.3% and 12.8% of the patients were overweight and obese, respectively, and were aged 20-30 years with LBP. Patient age, BMI, disease status, marital status, obstetric history and working history had no effect on any of the patients, but some patients had LBP; overweight, obesity, age group and working posture had direct effects on LBP incidence (p>0.05). LBP is more common in women, possibly due to household activities; a greater frequency of visceral pain during menstruation, pregnancy and labor and a lower pain threshold than in men because the gonadal steroid hormones estradiol and testosterone are moderately sensitive to pain and analgesia. Conclusion Low back pain (LBP) results from multiple physical conditions (both local and systemic) in women of reproductive age except for pregnant women. LBP disrupts the back tissues of the lumbosacral region. A diagnosis is made by a meticulous and detailed history of marriage, obstetric, medical and working care, etc… as well as by careful physical examination and proper investigations. Women are more susceptible to LBP, because of menstrual and obstetric factors. The parameters (data/causes) revealed that LBP had no effect on any of the patients, but women of reproductive age may suffer from LBP due to differences in cause. Limitations There are many publications on LBP, among the general population, occupations, global prevalence, different countries, and even pregnancy status. However, we found few publications on LBP in women during the reproductive period except during pregnancy. Therefore, we cannot compare our findings with those of others. Abbreviations BMI, body mass index; CD, cesarean delivery; CM, centimeter; CVD, cardiovascular disease; DM, diabetes; HLS, healthy lifestyle; H/O, history of; IVD, intervertebral disc; Kg, kilogram; LA, lower abdomen; LBP, low back pain; NVD, normal vaginal delivery; OA, osteoarthritis; OB, obesity; OW, overweight; PMS, premenstrual syndrome; PMDD, premenstrual dysphoric disorder; PID, pelvic inflammatory disease; PLID, prolapse lumber intervertebral disc; RAD, rectus abdominis diastasis; STD, sexually transmitted disease; SUI, stress urinary incontinence; UI, urinary incontinence; UTI, urinary tract infection; Wt., weight; Declarations Ethical approval: The research article was approved by local ethical committee, formed by Z and J fellows’ Medical Institution. Reference no.: ZJFMI.Syl-011/2023, dated: 15.12.2023. Consent: We obtain written permission from of Z&J fellows` medical institution for publication. All patients signed a written informed consent form for the use of their information in the publication of all media. Data and Materials: We declare that all the collected data are original and collected by the authors from our patient computer database. All data generated and analyzed during the study, findings are included into the manuscript and also available from the corresponding author on reasonable request. No others person/institutions are not involved in the data and findings. Conflict of interest: There are no conflicts of interest associated with this publication. Funding: We are the authors who declare that we are free from all kinds of payments or benefits from others, even from our Z and J fellows’ medical institution. All expenses were provided by the authors. Author’s contributions: 1a) Assist. Professor U. S. Bilkish; Writing, editing, data collection and review the manuscript, 1b) J. 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Rosen and David J Klumpp, HHS Public Access, Int J Urol. 2014 April ; 21(0 1): 26–32. doi:10.1111/iju.12309. Urinary tract infection during gestation and its correlation with low back pain versus nursing interventions. Simone Regina Alves de Freitas Barros, Rev Dor. São Paulo, 2013 abr-jun;14(2):88-93. The Prevalence and Association of Stress Urinary Incontinence, Core Muscle Endurance, and Low Back Pain among Married Women in Saudi Arabia: A Case-Control Study Ahmad H. Alghadir , Cynthia Tse, Amir Iqbal , Mariam Al-Khater, and Ghadeer Al-Rasheed, Hindawi BioMed Research International Volume 2021, Article ID 5533241, 7 pages https://doi.org/10.1155/2021/5533241 Does a healthy lifestyle behavior influence the prognosis of low back pain among men and women in a general population? A population-based cohort study. Tony Bohman, Lars Alfredsson, Irene Jensen, Johan Hallqvist, Eva Vingård, Eva Skillgate, l. BMJ Open 2014;4:e005713. doi:10.1136/bmjopen-2014-005713 OCCURRENCE OF URINARY TRACT INFECTION IN ADOLESCENT AND ADULT WOMEN OF SHANTY TOWN IN DHAKA CITY, BANGLADESH. Sabita Rezwana Rahman, M Firoz Ahmed, Aleya Begum, Ethiop J Health Sci. Vol. 24, No. 2 April 2014 Low back pain and some associated factors: is there any difference between genders? Thiago Paulo Frascareli Bentoa, Caio Vitor dos Santos Genebraa, Nicoly Machado Maciel, Guilherme Porfírio Cornelio, Sandra Fiorelli Almeida Penteado Simeão, Alberto de Vitta, Brazilian Journal of Physical Therapy 2020;24(1):79---87,https://doi.org/10.1016/j.bjpt.2019.01.012, https://www.journals.elsevier.com/brazilian-journal-of-physical-therapy Urinary Tract Infection in Pregnancy and Its Effects on Maternal and Perinatal Outcome: A Retrospective Study. Lekshmi Balachandran, Leena Jacob, Reem Al Awadhi, Lamia O. Yahya, Khlood M. Catroon, Lakshmi P. Soundararajan, Saleema Wani, Sara Alabadla, Yassmin A. Hussein, DOI: 10.7759/cureus.21500 Additional Declarations No competing interests reported. Supplementary Files 1.LBParticledatainspssat1125p.mon22.11.23.sav 4.CodebookforLBPat1125p.mon22.11.23.xlsx 5.LBPCodebookforSPSSat1125p.mon22.11.23.xlsx 5.1LBPCodebookforSPSSt1125p.mon22.11.23.xlsx Cite Share Download PDF Status: Published Journal Publication published 12 May, 2024 Read the published version in MOJ Orthopedics & Rheumatology → Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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M","lastName":"Bodrudduza","suffix":""}],"badges":[],"createdAt":"2024-02-08 15:14:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3940336/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3940336/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.15406/mojor.2024.16.00667","type":"published","date":"2024-05-13T00:00:00+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":51334119,"identity":"d7a1abe9-6b33-4f97-96b0-1756cfa97bc4","added_by":"auto","created_at":"2024-02-19 18:26:19","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":64084,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-3940336/v1/1c3881b0d54a85b7d4f13123.png"},{"id":51334121,"identity":"63068c88-69bd-47e7-9730-6f03958ddb6f","added_by":"auto","created_at":"2024-02-19 18:26:20","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":36614,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-3940336/v1/fce35082be6a1533c400cf15.png"},{"id":51334126,"identity":"5e802faa-78db-4aa5-aba9-e4d5214c05fc","added_by":"auto","created_at":"2024-02-19 18:26:22","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":89607,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-3940336/v1/a0f4873eb278bb8fca86825a.png"},{"id":51334125,"identity":"07585de6-b2ef-4dd2-a3ac-2673aaa07d01","added_by":"auto","created_at":"2024-02-19 18:26:22","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":59476,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-3940336/v1/09cc2781e9525a65d5059b35.png"},{"id":56971723,"identity":"73076012-b3e7-4dd6-a398-65f73102d46d","added_by":"auto","created_at":"2024-05-23 00:31:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1143806,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3940336/v1/dd979eff-17c5-4fd4-bdaf-1891b6517865.pdf"},{"id":51334122,"identity":"8b23317d-f3e6-4c53-84d4-6dd747a956bf","added_by":"auto","created_at":"2024-02-19 18:26:20","extension":"sav","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":18482,"visible":true,"origin":"","legend":"","description":"","filename":"1.LBParticledatainspssat1125p.mon22.11.23.sav","url":"https://assets-eu.researchsquare.com/files/rs-3940336/v1/cd7087f08b28b801d513f16e.sav"},{"id":51334117,"identity":"f63da463-df51-44a5-8341-87521e5b7bad","added_by":"auto","created_at":"2024-02-19 18:26:18","extension":"xlsx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":50386,"visible":true,"origin":"","legend":"","description":"","filename":"4.CodebookforLBPat1125p.mon22.11.23.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-3940336/v1/04fbd7a3c5ff7c6e71214bb8.xlsx"},{"id":51334128,"identity":"7d9a8a18-4fe6-43c7-aad2-8b6c7ea55575","added_by":"auto","created_at":"2024-02-19 18:26:25","extension":"xlsx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":49506,"visible":true,"origin":"","legend":"","description":"","filename":"5.LBPCodebookforSPSSat1125p.mon22.11.23.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-3940336/v1/8975a98f01531d99c139aa17.xlsx"},{"id":51334123,"identity":"73c988d2-a49a-4004-9a20-855e521a2875","added_by":"auto","created_at":"2024-02-19 18:26:20","extension":"xlsx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":76472,"visible":true,"origin":"","legend":"","description":"","filename":"5.1LBPCodebookforSPSSt1125p.mon22.11.23.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-3940336/v1/0c4f3ec00c23be2188f758a2.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Causes of low back pain (LBP) in women without pregnancy, in relation to different age groups during the reproductive period, are primarily treated as musculoskeletal disorders: A retrospective study","fulltext":[{"header":"Introduction (Background)","content":"\u003cp\u003eLow back pain (LBP) is a musculoskeletal disorder of several causes that can mess up the spine. [11] It is characterized by pain, stiffness or muscle tension, and is usually localized in the lumber region. During their working years, people frequently experience low back pain. Approximately 84% of adults experience LBP once or more during their lifetime. \u0026nbsp;[1, 3, 6, 8] Pain in the soft tissue of the back is extremely common among adults and often affects individuals during their working years. LBP in women, is strongly linked to hormonal and reproductive factors, the work environment and lifestyle. [3]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIt is a major sickness that causes individuals severe consequences for health care resources. [2, 3, 7, 15] In 2020, approximately 10% of the population worldwide suffered from LBP. A study of the Global Burden of Disease (GBD) in 2021 showed that LBP became under resourced and overburdened in social and health care systems in Asia and Africa. Chronic LBP has a greater effect on the socioeconomic condition of populations. The incidence of chronic LBP is approximately 23%, and 11-12% of the population becomes disabled due to LBP. [1]\u003c/p\u003e\n\u003cp\u003eLBP is associated with personal, social and financial compulsion worldwide. The National Health Care Services costs for LBP were approximately 5 billion pounds (\u0026pound;)\u0026nbsp;in the UK annually and 134 billion US$\u0026nbsp;in 2016 in the U.S. but the United States, National Institute of Health (NIH) was able to decrease the costs of LBP by 69 million US$\u0026nbsp;in 2023. LBP and other musculoskeletal diseases are the leading causes of disability, but there is no specific mention of these disorders in the context of WHO noncommunicable diseases (NCDs) or the NCD 2030 Countdown. [2] In Bangladesh, 18.5% and 19.4% weight-related LBP outbreaks are associated with age, respectively. LBP is more common in females than in males. [1]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe WHO and NIAMS (NIH) classify LBP according to the duration of low back pain (LBP) as follows: ⅰ) \u003cstrong\u003eacute back pain\u003c/strong\u003e that occurs suddenly and lasts a few days to a few weeks; ⅱ) s\u003cstrong\u003eubacute back pain\u003c/strong\u003e that occurs suddenly or over time and lasts 4-12 weeks; and ⅲ) \u003cstrong\u003echronic back pain\u003c/strong\u003e that occurs quickly or slowly and lasts more than 12 weeks and continues daily. [4, 6, 11, 13, 37] Pain is probably dull, constant to sudden, and sharp and may radiate to the lower limb/limbs. [13] In France, 90% of patients recover from pain within two (2) weeks, 15] another study reported that approximately 80% of cases of back pain lasted less than one week. [32]\u003c/p\u003e\n\u003cp\u003eThere are various causes of LBP, including gynecological, vascular, neurological, psychological, spine (spondylogenic) or disc pathology as well as traumatic, but the cause may be undiagnosed and enclosed by the term \u0026ldquo;mechanical or postural back pain\u0026rdquo;. These may be mechanical or structural abnormalities of the spine, inflammatory conditions and/or other medical conditions. Pathology can include the spine, disc, muscle, ligament or tendon on the back or nerve compression. [3, 37]\u003c/p\u003e\n\u003cp\u003eLBP during pregnancy may be defined as recurrent or continuous pain for more than a week from the lumber spine as a result of different nonspecific causes. This type of pain is typically due to weight gain and psychological and prolonged postures, such as \u0026ndash; sitting, standing or repeated lifting. During pregnancy, LBP was associated with hypermobility, high BMI, absence of menstruation and previous H/O back pain. [6] Younger pregnant women more frequently experience back pain with multiple pregnancies and severe physical or psychological work [39]. A total of 80.8% of the pregnant women felt pain in the lumber region, and 49.1% of the pain originated in the sacroiliac joints. [38]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFemales frequently experience lower abdominal pain with back pain at reproductive age, usually due to menstrual cycle related factors (e.g., PMS, PMDD and dysmenorrhea), endometriosis, pregnancy, menopause, muscle spasms, arthritis, UTI, PID,\u0026nbsp;HTN, DM, obesity, multiple C/S and lower abdominal operations cause RAD; uterine prolapse usually occurs after 50 years of age;\u0026nbsp;intrauterine contraceptive device use;\u0026nbsp;osteoporosis, vertebra and intervertebral disc disease (PLID, herniation, slipping etc.). [9, 10]\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWomen are more affected than men by low back pain (LBP), [3, 8] and strong thinking has shown that this difference is due to the female reproductive system. The female musculature and ligament support are weaker than those of men; furthermore, pelvic girdle muscles and ligaments undergo strain during pregnancy and labor and suboptimally regain their normal state after delivery. [3] The incidence of LBP is greater in married women than in unmarried women. More vaginal deliveries and live births are associated with LBP. [41] A greater number of abortions is also directly associated with back pain. [40] The incidence of LBP in women associated with pregnancy, gynecological factors and other diseases is -66%, 35% and 24%, respeptively of women suffer during pregnancy, and 51% experience LBP during menstruation. [11, 40] Women who underwent cesarean delivery (CD) had a 4.5 fold greater risk of rectus abdominis diastasis (RAD). 24.6% incidence of LBP in RAD. [6]\u003c/p\u003e\n\u003cp\u003eObesity, pregnancy, number of live births, CD, RAD, abortion, infection, inflammation, HTN, DM, spondylogenic and discogenic factors, trauma, working environment, posture and psychological effects are risk factors for LBP in women during their reproductive age.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLow back pain (LBP) was diagnosed by history and clinical examination according to the Pain Scale. To determine the cause of HELLP syndrome/causes by routine blood and urine tests and sometimes abdominal ultrasonography (USG), magnetic resonance imaging (MRI) is needed. [3, 8] Treatment of LBP depends on the cause. When a definite lesion is not found, the patient should be informed and reassure about the treatment of LBP. [3] \u0026nbsp;\u003c/p\u003e"},{"header":"Materials And Methods","content":"\u003cp\u003eThis was a retrospective (observational) cross sectional study jointly conducted by Orthopedics and Gynecology Expertise in the North-East region, named the Sylhet Division of Bangladesh; the study included female patients during the reproductive period without pregnancy for the last three (3) years (2020 - 2022) at the Z \u0026amp; J fellows\u0026apos;\u0026nbsp;medical institution. The total population in this area is 9.5 million. The main occupations in tea gardens, agriculture and day labor. The data were collected from the medical records of computer databases with preset questionnaires and written informed consent.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe 1\u003csup\u003est\u003c/sup\u003e part of the questionnaire consisted of:\u003c/strong\u003e height, weight, BMI, medical history (HTN, DM, UTI, PID, RAD, arthritis, PLID, renal stone, and psychological), marital history (marital status, marital age and marriage duration), obstetrical history (no. of pregnancies, no. of live births, no. of abortion, no. of NVD and no. of CD and lower abdominal operations), working history (housewife, day laborer, official and student) and main posture during work (sitting, standing, bending and lifting).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe 2\u003csup\u003end\u003c/sup\u003e part of the questionnaire consisted of LBP related questions:\u003c/strong\u003e location, intensity, radiating to the leg, duration, past H/O LBP and frequency, aggravating factors, relieving factors, and H/O stop working during episodes of LBP.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA total 750 patients were found to have low back pain during this period, and 415 patients were included in the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe inclusion criteria were as follows:\u003c/strong\u003e ⅰ) female, ⅱ) within the reproductive period and ⅲ) aged 18 to 55 years.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe exclusion criteria were as follows:\u003c/strong\u003e ⅰ) pregnant and ⅱ) malignant.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe data were analyzed with SPSS 25.0 statistical software, MS Word and Excel version 2010. Descriptive statistics were analyzed, i.e. - frequency, central tendency (mean, median and mode) and dispersion (range, standard deviation and variance). Tests of \u0026ldquo;proportions\u0026rdquo; and \u0026ldquo;significance\u0026rdquo; were performed via sample t-test and ANOVA. Statistical data analysis was used to evaluate the correlation of LBP incidence and intensity (%) with age, BMI, disease status, marital status, obstetric history, working history and posture of reproductive age women. \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData analysis:\u003c/strong\u003e In the northeastern region of Bangladesh, at the Sylhet Division in the last three (3) years (2020-22), we included 415 reproductive-aged women with low back pain (LBP) without pregnancy. The age limit of the patients was 20 to 55 years. The mean age (\u0026plusmn;SD) was 36.12 (\u0026plusmn;9.578) years (n=415). The height ranged from 138-162 cm and their weight ranged from 42-79 kg, the mean height (\u0026plusmn;SD) was 154.10 (\u0026plusmn;4.100) cm and weight (\u0026plusmn;SD) was 59.07 (\u0026plusmn;6.646) kg. The minimum BMI was -20.0 kg/m\u003csup\u003e2\u003c/sup\u003e and the maximum -34.7 kg/m\u003csup\u003e2\u003c/sup\u003e, the mean (\u0026plusmn;SD) BMI was 24.879 (\u0026plusmn;2.832)kg/m\u003csup\u003e2\u003c/sup\u003e. According to BMI the patients (n-415) were classified as follows: normal wt. -81.9%, overweight -5.3% and obese -12.8%. There were more than 7.3% obese individuals in the 20-30 age group.\u003c/p\u003e\n\u003cp\u003eThe marital status of the patients was as follows: married -75.2%; \u0026gt; one marriage -5.1%; widowed -4.1%; and unmarried -15.7%.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe marriage age of the patients from 18-26 years, mean (\u0026plusmn;SD) was 21.67 (\u0026plusmn;2.107) years; Marriage duration was 1-36 years, mean (\u0026plusmn;SD) was 16.77 (\u0026plusmn;9,372) years; No. of pregnancy was from 0-6, mean (\u0026plusmn;SD) was 2.54 (\u0026plusmn;1.252); No. of live birth was from 0-3, mean (\u0026plusmn;SD) was 2.33 (\u0026plusmn;2.388); No. of abortion was 0-3, mean (\u0026plusmn;SD) was 0.33 (\u0026plusmn;0.575) and No. of NVD was from 0-5, mean (\u0026plusmn;SD) was 2.13 (\u0026plusmn;0.986). RAD due to CD and lower abdominal operations were -8% (minimum -1 and maximum 4), (n=415); CD -2.9%, \u0026gt;1 CD -1.4%, LA operations -2.9% and both CD \u0026amp; LA operations -0.7%. [Figure 2]\u003c/p\u003e\n\u003cp\u003eThe medical history of the patients (n=415) was as follows: HTN -10.4%; DM -12.5%; UTI -39.8%; PID -14%; RAD -7.7%; arthritis -8%; PLID -1.7%; renal stones -0.7% and psychological disorders -5.3%.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe working history (n=415) were as following: housewife -42.2%; day laborer -28.2%; official -16.6% and student -13% \u0026nbsp;and their main working posture: standing -26.5%; sitting -54.5%; bending -10.6% and lifting -8.4%. [Table 4]\u003c/p\u003e\n\u003cp\u003eThe prevalence of disease on LBP was -6.5% for HTN and -10.5% for DM, in the 41-50 years age group; 28% for UTI, in the 20-30 years age group; 8.5% for PID, in the 31-40 years age group; 3.5% for RAD, in both 31-40 and 41-50 years age group; 4.5% for arthritis, in the 41-50 years age group; 1% for PLID, in the 41-50 years age group; 0.5% for renal stone, in the 41-50 years age group; and 3.2% for psychological disorders, in the 20-30 years age group. [Figure 3]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe estimated the incidence of LBP with a 95% confidence interval (CI) and set p\u0026lt;0.05 for all statistically significant relationships. [Table 3] [P\u0026lt;0.05 is significant, which indicates that the parameters have no effect on LBP in every patient; however, for some patients have the effect (H\u003csub\u003e0\u003c/sub\u003e), p\u0026gt;0.05 is not significant, which indicates that the parameters have an effect on LBP in every patient (H\u003csub\u003e1\u003c/sub\u003e)]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cimg src=\"https://myfiles.space/user_files/122228_c8a1650c59388082/122228_custom_files/img1708351876.png\"\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOne sample t-test\u003c/strong\u003e revealed the following: patient age, age at marriage, duration of marriage, no. of pregnancy, no. of live births, no. of abortions, no. of vaginal deliveries, working history, posture while working, patient BMI and medical history; all p-values (supplemental 2-tailed) were 0.000. The p-value was \u0026lt;0.05. Therefore, these patient parameters had no effect on LBP in any of the patients, but for some patients, they had an effect on the 95% confidence interval. [Table-1] \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePaired sample t-tests\u003c/strong\u003e were used to analyze patient age and medical history.\u0026nbsp;The t-value was 66.996, and the p-value (supplemented 2-tailed) was 0.000. The p-value was \u0026lt;0.05. Therefore, patient age has no effect on any disease, but for some patients, age has an effect on the 95% confidence interval.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOne way ANOVA\u003c/strong\u003e revealed that for the patients\u0026nbsp;(HTN, DM, UTI, PID, RAD, arthritis, PLID, renal stone, and psychological disorders), the mean disease incidence was 32.499 (SD=9.882), the F-value was 2.056, and the p-value (Sig.) was 0.001. The p-value was \u0026lt;0.05. Therefore, patient disease has no effect on LBP in any of the patients, but in some patients, it has an effect on the 95% confidence interval.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTwo way ANOVA (Tests of Between-Subjects Effects):\u003c/strong\u003e Medical history (diseases), age groups, BMI groups and age groups-BMI groups; the F-values are 0.862, 0.781 and 3.260, and the p-values (Sig.) are 0.461, 0.459, and 0.012. The p-value was \u0026gt;0.05 for age group and BMI group but was \u0026lt;0.05 for age group and BMI group. Therefore, disease status was related to patient age and BMI, as indicated by the 95% confidence intervals (CIs). However, age group and BMI had on any of the patients, and the 95% confidence intervals were also calculated for some patients. All of these parameters are related to the prevalence of LBP.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cimg src=\"https://myfiles.space/user_files/122228_c8a1650c59388082/122228_custom_files/img1708351900.png\"\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePaired sample t-tests\u003c/strong\u003e were used to analyze patient working history and main Posture during work; the \u0026ldquo;t\u0026rdquo; value was -0.077, and the p-value (supplemented 2-tailed) was 0.938. The p-value was \u0026gt;0.05. Therefore, working history and posture affect low back pain with a 95% confidence interval. [Table -2]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003ePathophysiology of LBP\u003c/u\u003e\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLBP arises from many potential anatomical structures, i.e., nerve roots, muscles, fascial structures, bones, joints, intervertebral discs (IVDs), abdominal and pelvic viscera. [20] The complex anatomy of lumbar spine is made up of a strong vertebral body. IVDs are linked by joint capsules, ligaments, tendons and muscles; all of these structures are potential sources of LBP generation. [17, 20] The lumbar spine carries most of the body wt. which triggers symptoms of both movement and inactivity. [32] Pain may worsen after standing or sitting for prolonged periods of time.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStructural damage\u003c/strong\u003e, \u003cstrong\u003edegenerative changes\u003c/strong\u003e (due to pressure load, diminished blood supply by vessel atherosclerosis) and the \u003cstrong\u003eaccumulation of pain stimuli\u003c/strong\u003e (i.e.- nitric oxide release from granulation tissue and inflammatory cell infiltration) in lumber region tissues are the causes of LBP. The dorsal root ganglia are thought to be the main modulators of LBP. [17] Body load (wt.) transmission through the vertebral column is another precipitating cause of LBP. The weights of the upper limbs and thoracic cases were transmitted through the ribs to the posterior column of the cervical vertebra via the costotransverse joints and ligaments. The weight is transmitted through 3 columns (one anterior and two posterior) in the cervical region whereas the weight in the thoracolumbar region passes through 2 columns (one anterior and one posterior, and both columns are run parallel to each other following the thoracolumbar curvature). In the thoracic region, wt. passed from the posterior to the anterior column due to anterior concavity of the spine through inclined pedicles, and in the lumber region, for the posterior concavity, the compressive weight dispatches from the anterior to posterior column. Therefore, the compressive force in the curvilinear thoracolumbar column tends to deviate toward the gravitational line, which is related to pathological disorders of the spine and LBP. [35] The neural arch at the L\u003csub\u003e4\u003c/sub\u003e and L\u003csub\u003e5\u003c/sub\u003e levels is involved in the transmission of a considerable load. Therefore, the joints between the \u003cstrong\u003earticular facets of L\u003csub\u003e4\u003c/sub\u003e and L\u003csub\u003e5,\u003c/sub\u003e\u003c/strong\u003e are sites of LBP. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003ePrevalence of LBP (Global \u0026amp; Local)\u003c/u\u003e\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLow back pain (LBP) is one of the most common physical problems and has a high socioeconomic impact, leading to working disability and poor quality of life. [13, 42] The prevalence of LBP is approximately 23% in adults and the annual incidence is approximately 15%. [1, 17] LBP is influenced by psychological factors, such as stress, depression and/or anxiety. [20]\u003c/p\u003e\n\u003cp\u003eAccording to a global review in 2000, the prevalence of LBP ranged from 12-33%. 29.4% for males and 35.3% for females. [6, 43] The average prevalence of LBP is 61.5% among women in Finland, Poland, Spain and India. [46] The incidence of back pain in one (1)-month period was reported to be 29%. Of these 20% were considered chronic, and 40% were disable. [45] In Bangladesh, the weight related prevalence of LBP is 18.5% and that of individuals aged 18-34 years, incidence are 10.5%; aged \u0026gt;55 years, incidence are 27.8%, and average 19.2%, which is more in women 27.2% than men. [1]\u003c/p\u003e\n\u003cp\u003eTrauma is the major cause of acute LBP, but chronic and persistent LBP are more prevalent with systemic diseases and psychological factors, such as \u0026ndash; stress and limited health care education. [1, 48] LBP in women can be divided into 2 main categories: ⅰ) Musculoskeletal and Nervous system causes, such as trauma, poor mobility, posture, sciatica and arthritis; and ⅱ) other organ system based conditions, such as reproductive, kidney, infection and inflammation. [36]\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eLow back pain can be caused by invasion of many local and systemic disease effects into back musculoskeletal structures. The etiology of LBP is multifactorial. [3, 4] Pain is likely a dull, constant to sudden, sharp pain that may radiate to the lower limb. The pain attack may be sudden, acute, gradually aggravated or recurrent. Twenty-one percent of women develop long term LBP due to a lack of healthy lifestyles (HLSs). [56] Lifestyle factors, i.e. nonsmoking, physical activity, diet and moderate alcohol consumption, influence the risk of several diseases, e.g. - cancer, DM and CVD. HLS has a positive influence on the development and prognosis of LBP in women, but there is no clear association in men. [56]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLBP is more common in women, probably due to household activities; a greater frequency of visceral pain during menstruation, pregnancy and labor, and a lower pain threshold than in men because the gonadal steroid hormones estradiol and testosterone are moderately sensitive to pain and analgesia. [44]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLow back pain in women is linked to hormonal and reproductive factors e.g. menstruation, use of contraceptives (hormones and intrauterine devices), hysterectomy, pregnancy, obstetric history and systemic diseases.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eApproximately 69% of women experienced menarche at 12-14 years of age. Menarche at the age \u0026le;11 years and an irregular or prolonged menstrual cycle were associated with chronic LBP. [5] Premenstrual syndrome (PMS) starts before menstruation and ends after the cycle. Many women develop LBP during PMS; Nikhil Jain, neurosurgeon, University of Louisville in Kentucky, said the correlation is not fully understood but a linked to hormonal change during menstruation and mental stress. [9] Premenstrual dysmorphic disorder (PMDD) is the same PMS, but the conditions are more severe. There is a family H/O depression, and the brain reacts abnormally to hormonal changes during the period. [9, 10] Dysmenorrhea is painful menstruation. The patient experienced pain in the lower abdomen, lower back, hips and legs. When endometrial tissue grows outside the uterus in other pelvic organs, this disease is called endometriosis, and can cause pain in the pelvis and lower back experienced in menstrual cycle, during and after sex, even during urination.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLow back pain is common during pregnancy due to a shift in the center of gravity. Rahul Shah, MD, spine surgeon, New Jersey, [9] reported weight gain; hormonal and mechanical changes during pregnancy and labor cause muscle and ligament relaxation and lead to, sacroiliac joint dysfunction. Huang noted that this pain is the main cause of LBP. [9] Additionally, sleep disturbance and mood changes during pregnancy are the result of LBP. [11] A study in the Netherlands showed that 10% \u0026nbsp;of women suffer chronic LBP at the onset of pregnancy. [5]\u003c/p\u003e\n\u003cp\u003eBack pain is common in patients with premenstrual syndrome. During menopause, a dramatic decrease in estrogen causes osteoporosis and mood changes, leading to LBP.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMuscle spasm in the back causes LBP due to strain resulting from exercise, dehydration, heavy lifting or sudden absurd twists and turning of the body, as explained by Jake Magel, physiotherapist, University of Utah. Salt Lake City.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLBP indicates that pain occurs in the back between the lower costal margin and above the inferior gluteal folds. [1, 13] Pain can be specific or nonspecific. Specific LBP can be caused by disease, structural problems in the spine or pain radiating from another part of the body. There was nonspecific LBP due to unidentified causes, which was approximately 90%. [13]\u003c/p\u003e\n\n\u003cp\u003eTable: 3 Parameter statistics for women of reproductive age (without pregnancy) with LBP.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.526315789473685%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCauses of LBP (parameters)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ewith range (N)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean (\u0026plusmn;SD)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ewith 95% Cl\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.526315789473685%\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\"\u003e\n \u003cp\u003e20-54 yrs. N = 415\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\"\u003e\n \u003cp\u003e36.12 (\u0026plusmn;9.578)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\"\u003e\n \u003cp\u003e(Sig. 2-tailed)\u003c/p\u003e\n \u003cp\u003eP = 0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.526315789473685%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge groups:\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.526315789473685%\"\u003e\n \u003cp\u003e20-30 yrs.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\"\u003e\n \u003cp\u003e34.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\" rowspan=\"4\"\u003e\n \u003cp\u003e2.08 (\u0026plusmn;0.916)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\" rowspan=\"4\"\u003e\n \u003cp\u003eP = 0.461\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"56.86274509803921%\"\u003e\n \u003cp\u003e31-40 yrs.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.13725490196079%\"\u003e\n \u003cp\u003e27.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"56.86274509803921%\"\u003e\n \u003cp\u003e41-50 yrs.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.13725490196079%\"\u003e\n \u003cp\u003e34.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"56.86274509803921%\"\u003e\n \u003cp\u003e\u0026gt;50 yrs.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.13725490196079%\"\u003e\n \u003cp\u003e3.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.526315789473685%\"\u003e\n \u003cp\u003eHeight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\"\u003e\n \u003cp\u003e138-162 cm, N = 415\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\"\u003e\n \u003cp\u003e154.10 (\u0026plusmn;4.100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.526315789473685%\"\u003e\n \u003cp\u003eWeight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\"\u003e\n \u003cp\u003e42-79 kg, N = 415\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\"\u003e\n \u003cp\u003e59.07 (\u0026plusmn;6.646)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.526315789473685%\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\"\u003e\n \u003cp\u003e20-34.7 kg/m\u003csup\u003e2\u003c/sup\u003e, N = 415\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\"\u003e\n \u003cp\u003e24.879 (\u0026plusmn;2.833)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\"\u003e\n \u003cp\u003e(Sig. 2-tailed)\u003c/p\u003e\n \u003cp\u003eP = 0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.526315789473685%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI groups:\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.526315789473685%\"\u003e\n \u003cp\u003eNormal wt.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\"\u003e\n \u003cp\u003e81.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\" rowspan=\"3\"\u003e\n \u003cp\u003eN = 415\u003c/p\u003e\n \u003cp\u003e2.31 (\u0026plusmn;0.685)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\" rowspan=\"3\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eP= 0.459\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"56.86274509803921%\"\u003e\n \u003cp\u003eOver Wt.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.13725490196079%\"\u003e\n \u003cp\u003e5.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"56.86274509803921%\"\u003e\n \u003cp\u003eObesity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.13725490196079%\"\u003e\n \u003cp\u003e12.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.526315789473685%\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiseases:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.526315789473685%\"\u003e\n \u003cp\u003eHTN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\"\u003e\n \u003cp\u003e10.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\" rowspan=\"9\"\u003e\n \u003cp\u003eN = 415\u003c/p\u003e\n \u003cp\u003e3.62 (\u0026plusmn;1.920)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\" rowspan=\"9\"\u003e\n \u003cp\u003eP = 0.001\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"56.86274509803921%\"\u003e\n \u003cp\u003eDM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.13725490196079%\"\u003e\n \u003cp\u003e12.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"56.86274509803921%\"\u003e\n \u003cp\u003eUTI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.13725490196079%\"\u003e\n \u003cp\u003e39.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"56.86274509803921%\"\u003e\n \u003cp\u003ePID\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.13725490196079%\"\u003e\n \u003cp\u003e14%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"56.86274509803921%\"\u003e\n \u003cp\u003eRAD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.13725490196079%\"\u003e\n \u003cp\u003e7.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"56.86274509803921%\"\u003e\n \u003cp\u003eArthritis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.13725490196079%\"\u003e\n \u003cp\u003e8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"56.86274509803921%\"\u003e\n \u003cp\u003ePLID\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.13725490196079%\"\u003e\n \u003cp\u003e1.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"56.86274509803921%\"\u003e\n \u003cp\u003eRenal stone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.13725490196079%\"\u003e\n \u003cp\u003e0.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"56.86274509803921%\"\u003e\n \u003cp\u003ePsychological\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.13725490196079%\"\u003e\n \u003cp\u003e5.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.526315789473685%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status:\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.526315789473685%\"\u003e\n \u003cp\u003eUnmarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\"\u003e\n \u003cp\u003e15.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\" rowspan=\"4\"\u003e\n \u003cp\u003eN = 415\u003c/p\u003e\n \u003cp\u003e1.3 (\u0026plusmn;0.764)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\" rowspan=\"4\"\u003e\n \u003cp\u003e(Sig. 2-tailed)\u003c/p\u003e\n \u003cp\u003eP = 0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"56.86274509803921%\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.13725490196079%\"\u003e\n \u003cp\u003e75.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"56.86274509803921%\"\u003e\n \u003cp\u003e\u0026gt;1 married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.13725490196079%\"\u003e\n \u003cp\u003e5.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"56.86274509803921%\"\u003e\n \u003cp\u003eWidow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.13725490196079%\"\u003e\n \u003cp\u003e4.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.526315789473685%\"\u003e\n \u003cp\u003eAge of marriage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\"\u003e\n \u003cp\u003e18-26 yrs. (N = 350)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\"\u003e\n \u003cp\u003e21.67 (\u0026plusmn;2.107)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\" rowspan=\"2\"\u003e\n \u003cp\u003e(Sig. 2-tailed)\u003c/p\u003e\n \u003cp\u003eP = 0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.726027397260275%\"\u003e\n \u003cp\u003eDuration of marriage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.136986301369863%\"\u003e\n \u003cp\u003e1-36 yrs. (N = 350)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.136986301369863%\"\u003e\n \u003cp\u003e16.77 (\u0026plusmn;9.372)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.526315789473685%\"\u003e\n \u003cp\u003e\u003cstrong\u003eObstetric history:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.526315789473685%\"\u003e\n \u003cp\u003eNo. of pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\"\u003e\n \u003cp\u003e0-6 (N = 350)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\"\u003e\n \u003cp\u003e2.54 (\u0026plusmn;1.252)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\" rowspan=\"4\"\u003e\n \u003cp\u003e(Sig. 2-tailed)\u003c/p\u003e\n \u003cp\u003eP = 0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.726027397260275%\"\u003e\n \u003cp\u003eNo. of live birth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.136986301369863%\"\u003e\n \u003cp\u003e0-3 (N = 350)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.136986301369863%\"\u003e\n \u003cp\u003e2.33 (\u0026plusmn;2.388)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.726027397260275%\"\u003e\n \u003cp\u003eNo. of abortion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.136986301369863%\"\u003e\n \u003cp\u003e0-3 (N = 350)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.136986301369863%\"\u003e\n \u003cp\u003e0.33 (\u0026plusmn;0.575)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.726027397260275%\"\u003e\n \u003cp\u003eNo. of NVD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.136986301369863%\"\u003e\n \u003cp\u003e0-5 (N = 350)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.136986301369863%\"\u003e\n \u003cp\u003e2.13 (\u0026plusmn;0.986)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.526315789473685%\"\u003e\n \u003cp\u003e\u003cstrong\u003eLower abdominal operation:\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.526315789473685%\"\u003e\n \u003cp\u003eCD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\"\u003e\n \u003cp\u003e2.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\" rowspan=\"4\"\u003e\n \u003cp\u003eN = 33\u003c/p\u003e\n \u003cp\u003e2.18 (\u0026plusmn;1.044)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\" rowspan=\"4\"\u003e\n \u003cp\u003e(Sig. 2-tailed)\u003c/p\u003e\n \u003cp\u003eP = 0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"56.86274509803921%\"\u003e\n \u003cp\u003e\u0026gt;1 CD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.13725490196079%\"\u003e\n \u003cp\u003e1.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"56.86274509803921%\"\u003e\n \u003cp\u003eLA operation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.13725490196079%\"\u003e\n \u003cp\u003e2.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"56.86274509803921%\"\u003e\n \u003cp\u003eBoth CD \u0026amp; LA operation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.13725490196079%\"\u003e\n \u003cp\u003e0.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.526315789473685%\"\u003e\n \u003cp\u003e\u003cstrong\u003eWorking history:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.526315789473685%\"\u003e\n \u003cp\u003eHousewife\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\"\u003e\n \u003cp\u003e42.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\" rowspan=\"4\"\u003e\n \u003cp\u003eN = 415\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;2.00 (\u0026plusmn;1.054)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\" rowspan=\"4\"\u003e\n \u003cp\u003e(Sig. 2-tailed)\u003c/p\u003e\n \u003cp\u003eP = 0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"56.86274509803921%\"\u003e\n \u003cp\u003eDay laborer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.13725490196079%\"\u003e\n \u003cp\u003e28.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"56.86274509803921%\"\u003e\n \u003cp\u003eOfficial\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.13725490196079%\"\u003e\n \u003cp\u003e16.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"56.86274509803921%\"\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.13725490196079%\"\u003e\n \u003cp\u003e13%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.526315789473685%\"\u003e\n \u003cp\u003e\u003cstrong\u003eWorking posture:\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.526315789473685%\"\u003e\n \u003cp\u003eStanding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\"\u003e\n \u003cp\u003e26.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\" rowspan=\"4\"\u003e\n \u003cp\u003eN = 415\u003c/p\u003e\n \u003cp\u003e2.01 (\u0026plusmn;0.843)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.157894736842106%\" rowspan=\"4\"\u003e\n \u003cp\u003e(Sig. 2-tailed)\u003c/p\u003e\n \u003cp\u003eP = 0.938\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"56.86274509803921%\"\u003e\n \u003cp\u003eSitting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.13725490196079%\"\u003e\n \u003cp\u003e54.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"56.86274509803921%\"\u003e\n \u003cp\u003eBending\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.13725490196079%\"\u003e\n \u003cp\u003e10.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"56.86274509803921%\"\u003e\n \u003cp\u003eLifting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.13725490196079%\"\u003e\n \u003cp\u003e8.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe risk and incidence of LBP increase with age. Individuals aged 40-49 years are more vulnerable to LBP globally. [1, 46] Among women aged 20-59 years, the prevalence of chronic LBP was 8.9% and among women aged 50-59 years, the prevalence of LBP was 42% on average in China, Russia, S. Africa and India [5, 46] In our study, the prevalence of LBP was 34.7% in the 41-50 years age group and 34.2% in the 20-30 years age group. The mean age (\u0026plusmn;SD) was 36.12 (\u0026plusmn;9.578) years (n=415). A Brazilian study reported that the incidence of LBP in individuals aged 20-35 years was 26.4% and that in individuals aged 36-59 years was 32.7% in 2019. [58]\u003c/p\u003e\n\u003cp\u003eSeveral studies have shown that overweight and obesity increase LBP development, severity and disability. A BMI \u0026ge;25 kg/m\u003csup\u003e2\u003c/sup\u003e is a risk factor for LBP, and a BMI \u0026ge;30 kg/m\u003csup\u003e2\u003c/sup\u003e is 1.22 times greater in women. [45, 46, 50] The incidence of LBP was significantly greater in women with a BMI \u0026ge;30 kg/m\u003csup\u003e2\u003c/sup\u003e than in those with a BMI \u0026ge;20-29 kg/m\u003csup\u003e2\u003c/sup\u003e. [3] Globally, approximately 20-25% of adults are obese. [29] We calculated BMI using the BMI calculator in accordance with the International System of Units (SI). BMI was calculated as body weight in kg divided by height in cm; the unit is kg/m\u003csup\u003e2\u003c/sup\u003e and BMI varies according to age. BMI: 18.5-25, normal; 25-30, overweight and above 30, obese. [23] Obesity (OB) results from a poor lifestyle and can lead to LBP. Loss of body trunk and lower limb muscle mass and central OB are risk factors for LBP. [24] Our study revealed that 5.3% of overweight and 12.8% individuals aged 20-30 years with LBP were obese. [Figure 1] Body wt. increases direct vertebral compressive load and anterior acting loads. These loads act through muscles of the back that produce joint reaction forces, which lead to back pain. A body weight of 65\u0026plusmn;10 kg was significantly associated with increased LBP. [3] OWs and OBs increase the risk of LBP. [26, 27]\u003c/p\u003e\n\n\u003cp\u003eLBP was more common among married women (78%) and unmarried women (22%). [14] Patients who are married at a late age (30-34), have \u0026ge;2 children or have \u0026ge;2 abortions are at risk of LBP. [3] A Brazilian study reported, LBP in married women was 43.6%%, unmarried 23.6% and widow women 32.7%. [58] Patients marital status were: married -(75.2%), unmarried \u0026ndash;(15.7%), married more than once \u0026ndash;(5.1%) and widowed \u0026ndash;(4.1%). The prevalence of stress urinary incontinence (SUI) was 60% in the LBP group. Overall 78% of the adult women reported urinary incontinence (UI) due to LBP. [55] The incidence of SUI is greater in married women with LBP, and there are associations between SUI and both core muscle endurance (CME) and LBP in married women. [55]\u003c/p\u003e\n\u003cp\u003eThe incidence of LBP was greater among the late marriage age group, which was observed between 32-34 years of age; this was because the obstetric risk was greater. [3] In this study 17.8% of the patients were married at the age of 23 years, 13.3% were married at the age of 20 years, and the mean (\u0026plusmn;SD) was 21.67 (\u0026plusmn;2.107) years.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn our study, for patients with a marriage duration ranging from 1-36 years, the mean (\u0026plusmn;SD) was 16.77 (\u0026plusmn;9,372) years.\u003c/p\u003e\n\u003cp\u003eUse of contraceptives: Many health care professionals believe there is an association between oral contraceptive use and LBP, but there is no scientific evidence supporting this association. The use of oral contraceptives, increases relaxin levels, causing laxity of ligaments and joints, and leading to LBP. [5] The use of intrauterine contraceptive devices may lead to LBP. \u0026nbsp;\u003c/p\u003e\n\n\u003cp\u003eLBP was more common among women who were married at a later age (30-34), had \u0026ge;2 children or had \u0026ge;2 abortions. [3]\u003c/p\u003e\n\u003cp\u003eNo. of pregnancy: Relaxin is a hormone produced during pregnancy. Increased relaxin levels during pregnancy can cause laxity of ligaments and joints, leading to LBP. [5] Ligaments and joint laxity due to hormonal changes, weight (wt.) gain and a shift in the center of gravity cause lumbar spine hyperlordosis with anterior tilting of the pelvis. Vascular changes may lead to compromised metabolic demand in back tissues, all of which occur during pregnancy and lead to LBP. [16] In this study, the women with LBP had 0-6 pregnancies per H/o and the mean (\u0026plusmn;SD) was 2.54 (\u0026plusmn;1.252) times.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThere was an association between a greater number of live births and LBP. [5] Approximately 74% of women take their 1\u003csup\u003est\u003c/sup\u003e baby between 20-30 years of age. A first birth at a young age (fibromyalgia), especially at younger than 20 years of age, [5] Late maternal age; \u0026ge; 2 children (pelvic joint syndrome) and a long length of time between childbirths were associated with LBP in middle aged women. [3, 5] The number of live births in our study ranged from 0-3 and the mean (\u0026plusmn;SD) was 2.33 (\u0026plusmn;2.388). There were 2 live births (35.9%) and 3 live births (24.8%) in the LBP group. A study revealed a linear association between the number of live births and chronic LBP. [5, 41]\u003c/p\u003e\n\u003cp\u003eThe number of abortions ranged from 0-3, and the mean (\u0026plusmn;SD) was 0.33 (\u0026plusmn;0.575). A total of 19.5% of women who suffered from LBP after one abortion, were included in this study. The incidence of LBP observed in \u0026ge; 2 abortions was 80%, with one occurring in 51.3% of women and 26.3% occurring in women without abortion in an Indian study. [3] \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe prevalence of LBP was 60% in women who underwent \u0026ge;2 vaginal deliveries, 46.15% in women who underwent one delivery and 12.5% in women who did not delivery. [3] In our study, two (36.6%) and three (24.6%) patients in the NVD cohort had LBP. Numbrs of NVDs 0-5, and the mean number of NVDs was 2.13 (\u0026plusmn;0.986). \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRectus abdominis diastasis (RAD) is a condition; in which rectus abdominis muscles are separated by more than 2 cm. The prevalence of RAD is 30-46.5% in pregnant and postpartum women. Pregnancy, abdominal surgery and heavy lifting status are potential factors for developing RAD. In women, RAD development is 1.9 times greater than that in men, and one set occurs earlier. Women who underwent cesarean delivery (CD) or a lower abdominal operation had a 4.5 times greater risk of RAD than did those, who did not. The prevalence of LBP in women with RAD is 24-69%. [52] Adhesions of abdominal and pelvic viscera were noted in CD patients and abdominal surgery patients. RAD onset occurred more often in patients aged 30-40 years. In our study, LBP developed in 2.9% of CD patients, 2.9% of LA operation patients and 7.7% of RAD patients. RAD development in the 31-40 year age group was 3.5%, and that in the 41-50 year age group was 3.7%. A total of 24.6% of the RAD patients were diagnosed with LBP in 2021 in a study by Harvard Medical School, Boston. [6, 52] \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\n\u003cp\u003eA Brazilian study was published in 2019; LBP was associated with HTN -(42.8%), DM -(19.1%), depression -(11.1%) and renal disease -(8.2%). [58]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLBP and comorbid conditions such as hypertension, diabetes etc. is vice versa. LBP causes inactivity and a lack of exercise, resulting in weight gain and the subsequent development and enhancement of HTN and DM. In contrast, HTN exacerbates disc degeneration. A study at Hong Kong University revealed that 35.5% of HTN patients had moderate to severe disc degeneration. [49, 51] Cardiovascular risk factors (cholesterol, triglyceride) are associated with LBP. [50] HTN and DM cause atherosclerosis of the lumber vessels. Both of these conditions are highly causes of LBP. In our study, the prevalence of LBP due to HTN was -(10.4%); among those aged 41-50 years, -6.5% had LBP due to HTN. [Figure 3]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLBP in diabetes patients is multifactorial. Diabetes causes peripheral vascular diseases and neuropathy, and leads to chronic LBP. Diabetes causes obesity due to metabolic disturbance. OB exacerbates persistent inflammatory conditions. Moreover OA cartilage is more reactive to proinflammatory stress. DM causes multifactorial effects and disc degeneration; and leads to LBP. [28] LBP with DM occurs in 12.5% of women during the reproductive period. The prevalence of LBP in patients aged 41-50 years, was greater (10.5%) in this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eUrinary tract infection (UTI) causes LBP. [19, 31] UTI causes LBP and groin pain in women. [36] In our study, the prevalence of LBP in women with UTIs was -39.8%, and the prevalence in women aged 20-30 years was -28%. \u0026nbsp; UTIs are more common in nulliparous women. [59]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eUTI is the leading cause of acute pelvic pain and occurs in approximately 20% of women each year. Gram-negative bacteria, especially -\u003cem\u003eE. coli\u003c/em\u003e, are 80% of all UTIs. [53, 54, 59] The major mediator of urinary bladder inflammation is lipopolysaccharide (LPS)/ endotoxin in the outer membrane of gram-negative bacteria. Post-UTI pain can be caused by the \u0026ldquo;O\u0026rdquo;-antigen. [53]\u003c/p\u003e\n\u003cp\u003eLBP is the primary symptom reported by patients with confirmed UTIs; the prevalence of UTIs during gestation was 37.5%, and the prevalence of LBP in patients aged 20-29 years was 67%. [54] Approximately 48% of women have at least one episode of UTIs; women are more susceptible to UTs because they have a shorter urethra and urethral meatus close to vagina and anus. The UTI prevalence in patients with previous NVD was 72%, whereas that in patients with CD was 28%. Approximately 80% of women had UTIs with no experience of abortion, 8% had one abortion, and 12% had \u0026ge;2 abortions. The prevalence of LBP in women diagnosed with UTIs was -84.8%. [54] Approximately 60% of women suffer at least one tine UTI during their life, 20-30% have repeated infections, and the UTI incidence is 16.8% among adults in Bangladesh. UTI is a risk factor for urinary incontinence (UI). [57] There are associations between LBP and SUI, core muscle endurance (CME) and LBP in married women. [55]\u003c/p\u003e\n\u003cp\u003ePelvic inflammatory disease (PID) is inflammation of the upper genital tract in women due to infection and 85% of infections caused by STD. [25, 36] PID is more common in women aged 15-25 years. It causes LA pain and pelvic discomfort. Eighteen percent of patients develop chronic pain due to inflammation, scarring and adhesion from the infection process. [25] Inflammation is a sequela of infection and causes acute LBP. [19] PID causes chronic pelvic pain, scarring and adhesion, which leads to the development of LBP. The present study showed that 14% of women had LBP due to PID; the age range from 31-40 years was more prevalent at -8.5%. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLBP without medical or psychological problems, with clinical findings of ⅰ) mobility impairment in the lumbar region, ⅱ) radiating pain to the lower limb and ⅲ) a positive straight leg raising (SLR) test is a clear indication of LBP due to PLID. [4] The prevalence of PLID is 60% for males and 40% for females. The incidence was greater in the 36-45 years age group (49.42%). The lumbar spine carries most of the body weight. PLID most commonly occurs at L3/4 is 39% and at L4/5 is 18%. [33] A study in Bangladesh showed that the prevalence of LBP due to PLID is 1.9% in men and 7.6% in women. MRI revealed that posterior bulging of the intervertebral disc at the L4/5 level was due to facet-flaval hypertrophy. [34] In our study, the incidence of PLID was -1.7%, and that of more common diseases in the 41 to 50 years age group was -1%. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eArthritis causes LBP; age, overweight status and pressure on joints can lead to arthritis. Overall, 26.2% of osteoarthritis patients have a lifetime incidence of LBP. [51] Degenerative spondylolisthesis typically occurs at L4-L5 and is more common in women. [16] In OA, degenerative changes cause \u0026nbsp;LBP. According to the Arthritis Foundation, approximately 20% of people have LBP. Lumber OA is very common, affecting approximately 30% of males and 28% of females; aged 55-64 years in the USA. [32] In this study, the prevalence of arthritis was 8% and patients aged 41-50 years were mostly affected (approximately 4.7%). \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRenal stones (both kidney and ureteric stones) cause severe acute LBP. [31] When kidney stones move to the bladder, they are typically painful to the back and side and can radiate to the groin. [36] The incidence of LBP was -0.7% due to renal stones and the prevalence in the 41-50 years age group was 0.5% in this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThere is an association between LBP and depression. [46] Psychological factors, i.e. job satisfaction, social relations and mental overstrain have been associated with LBP. [12] Sleep problems, low mood and increased mental distress are effects of LBP and vice versa. [13] There were significant associations between disability and depression, anxiety, insomnia and sleep quality. Fifty four percent of patients reported poor sleep quality with LBP, and 30% had insomnia. [14] Psychological factors, i.e. fear, low mood, expectation of passive treatment and negative pain beliefs, are risk factors for LBP. It is proposed that physiological pain resulting from organic insult; may have negative effects on emotions and cognitive function; conversely, a negative emotional state can lead to increased pain through the central pain pathway. [30] Chronic LBP has both organic and psychological factors. In our study, the incidence of LBP in women of reproductive age other than pregnancy was -5.3% and the incidence was greater in the 20-30 years age group (by -3.2%). [Figure 3]\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cimg src=\"https://myfiles.space/user_files/122228_c8a1650c59388082/122228_custom_files/img1708352133.png\"\u003e\u003c/p\u003e\n\u003cp\u003eWorking posture has a strong association with LBP incidence. Back pain in certain postures is due to the creation of high stress on spine structures. [7] Patients who work in a standing position for long periods of time are more susceptible to LBP. [3] Patients with tissue trauma and muscle spasm are more likely to be in the standing position after long term work. Approximately 83% of gynecologists suffer from back pain while performing surgery in a sitting position,, and 78% experience back pain while performing surgery in standing position. [18] In our study, 42.2% of the women housewives, 28.2%, 16.6% and 13% were day laborers, officials and students, respectively. The main working postures were standing -26.5%; sitting -54.5%; bending -10.6% and lifting -8.4%. LBP prevalence during work at sitting posture was 67.3%, standing 74.5% reported in Brazilian study in 2019. [58] In Bangladesh, there is a positive incidence of LBP in housewives. [1] In the USA, LBP was significantly related to occupation in a study of people involved in lifting, carrying, pulling, pushing and twisting. In EU countries, the effect of LBP involves heavy weightlifting (\u0026ge;25 kg). \u0026nbsp;[1, 3, 47] We found that the incidence of LBP is greater among housewives and individuals who are working in a sitting position. [Figure 4]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe Roland Morris Disability Questionnaire provides a tool for measuring the level of disability experienced by a person suffering from LBP; it is widely used to measure the outcome of LBP. The questionnaire consists of 24 statements, ⅰ) physical ability/activity -15, ⅱ) sleep/rest -3, ⅲ) psychological -2, ⅳ) household management -2, ⅴ) eating -1 and ⅵ) pain frequency -1. [21] The Roland\u0026ndash;Morris Disability Questionnaire score has a moderate to strong correlation with pain intensity. The Oswestry Disability Index (ODI) is the gold standard for measuring disability and quality of life (QoL) impairment in adults with LBP. The ODI criteria for assessing functional impairment were pain intensity; ease of personal care; lifting, working, sitting, standing and sleeping; sexual life; social life and traveling. The index consists of 10 questions, which are scored from 0 to 5, and the total score is multiplied by 2; to convert the total score into a percentage. Scores are as follows: 0-20, minimal disability; 21-40, moderate disability; 41-60, severe disability; 61-80, crippling back pain; and 81-100, bedbound or exaggeration of symptoms. [22] The Bangla Health Assessment Questionnaire-Disability Index (HAQ-DI), was used to determine disability scores in Bangladesh. [1] All of the above indices are used to survey for LBP in generalized or specific populations. However, all the data in this study were obtained from patients treated by us. Therefore, we measured pain intensity and disability by the Numeric and Categorical Pain Scale and clinical examination. The number 0-10 is the NRS score. 0=none, mild=1-3, moderate=4-6, severe=7-10. On the categorical scale, no pain, hurts a little, hurts slightly more, hurts even more, hurts a whole lot and hurts worst according to facial expression.\u0026nbsp;\u003c/p\u003e\n\n\u003cp\u003eThe diagnosis was made according to detailed medical and working history, careful physical examination; and proper investigations, i.e. routine blood and urine tests, X-ray, USG, CT, MRI etc. LBP was classified, and the underlying cause/causes were determined. Proper evaluations are obligatory to identify the causes of the underlying pathology of pain generators before starting treatment. [19, 20]\u0026nbsp;\u003c/p\u003e\n\n\u003cp\u003eApproximately 80% of LBP cases persist for less than a week; if the duration is more than what is considered chronic. [32] The treatment plan was established according to the cause of LBP, and was explained and confirmed. Patient education and medications, i.e. NSAIDs and muscle relaxants, are beneficial. Bed rest should be avoided if possible. [19] Patients were referred to an apposite medical person when ⅰ) findings were suggestive of serious medical and psychological ⅱ) activity limitations and impairments in body functions were reported and ⅲ) symptoms were not resolved with interventions; we followed the LBP clinical practice guidelines of the American Physical Therapy Association (APTA). [4] \u0026nbsp; \u0026nbsp;\u003c/p\u003e"},{"header":"Summary","content":"\u003cp\u003eThis retrospective, cross-sectional study was jointly conducted by Orthopedics and Gynecology Expertise in the North\u0026ndash;East region of Bangladesh; among female patients of reproductive age for the last 3 years (2020 - 2022) at the Z\u0026amp;J fellows\u0026apos;\u0026nbsp;medical institution. LBP has multiple causes. Retrospective studies are less expensive and faster. The retrospective studies in which the subjects were similar overall (\u003cstrong\u003eLBP in women of reproductive age without pregnancy\u003c/strong\u003e) but differed in particular in characteristics (i.e \u003cstrong\u003eage, BMI, marital history, disease, obstetric history and occupation with posture\u003c/strong\u003e) within a \u003cstrong\u003especific time limit\u003c/strong\u003e (cross-sectional study) were included. In retrospective studies, there is no way to predict the prevalence of causes; rather, the prevalence of causes, can be determined before patients are affected. In our study, we investigated the causes of LBP in women of reproductive age other than pregnant women: including age, BMI, local and systemic diseases, marriage history, obstetric history and working history with posture.\u003c/p\u003e\n\u003cp\u003eThe prevalence of LBP was greater in the 41-50 years age group (34.7%) and in the 20-30 years age group (34.2%). Moreover, overweight and obesity are associated with LBP. Overall, 5.3% and 12.8% of the patients were overweight and obese, respectively, and were aged 20-30 years with LBP. Patient age, BMI, disease status, marital status, obstetric history and working history had no effect on any of the patients, but some patients had LBP; overweight, obesity, age group and working posture had direct effects on LBP incidence (p\u0026gt;0.05). LBP is more common in women, possibly due to household activities; a greater frequency of visceral pain during menstruation, pregnancy and labor and a \u0026nbsp;lower pain threshold than in men because the gonadal steroid hormones estradiol and testosterone are moderately sensitive to pain and analgesia.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eLow back pain (LBP) results from multiple physical conditions (both local and systemic) in women of reproductive age except for pregnant women. LBP disrupts the back tissues of the lumbosacral region. A diagnosis is made by a meticulous and detailed history of marriage, obstetric, medical and working care, etc\u0026hellip; as well as by careful physical examination and proper investigations. Women are more susceptible to LBP, because of menstrual and obstetric factors. The parameters (data/causes) revealed that LBP had no effect on any of the patients, but women of reproductive age may suffer from LBP due to differences in cause.\u003c/p\u003e\n"},{"header":"Limitations","content":"\u003cp\u003eThere are many publications on LBP, among the general population, occupations, global prevalence, different countries, and even pregnancy status. However, we found few publications on LBP in women during the reproductive period except during pregnancy. Therefore, we cannot compare our findings with those of others. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n"},{"header":"Abbreviations","content":"\u003cp\u003eBMI, body mass index; CD, cesarean delivery; CM, centimeter; CVD, cardiovascular disease; DM, diabetes; HLS, healthy lifestyle; H/O, history of; IVD, intervertebral disc; Kg, kilogram; LA, lower abdomen; \u0026nbsp;LBP, low back pain; NVD, normal vaginal delivery; OA, osteoarthritis; OB, obesity; OW, overweight; PMS, premenstrual syndrome; PMDD, premenstrual dysphoric disorder; PID, pelvic inflammatory disease; PLID, prolapse lumber intervertebral disc; \u0026nbsp;RAD, rectus abdominis diastasis; STD, sexually transmitted disease; SUI, stress urinary incontinence; UI, urinary incontinence; UTI, urinary tract infection; Wt., weight; \u0026nbsp;\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval:\u0026nbsp;\u003c/strong\u003eThe research\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003earticle was approved by local ethical committee, formed by Z and J fellows\u0026rsquo; Medical Institution. Reference no.: ZJFMI.Syl-011/2023, dated: 15.12.2023.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent:\u003c/strong\u003e We obtain written permission from of Z\u0026amp;J fellows` medical institution for publication. All patients signed a written informed consent form for the use of their information in the publication of all media.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData and Materials:\u003c/strong\u003e We declare that all the collected data are original and collected by the authors from our patient computer database. All data generated and analyzed during the study, findings are included into the manuscript and also available from the corresponding author on reasonable request. No others person/institutions are not involved in the data and findings.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest:\u003c/strong\u003e There are no conflicts of interest associated with this publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e We are the authors who declare that we are free from all kinds of payments or benefits from others, even from our\u0026nbsp;Z and J fellows\u0026rsquo; medical institution. All expenses were provided by the authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s contributions:\u003c/strong\u003e \u003cstrong\u003e1a)\u003c/strong\u003e \u003cstrong\u003eAssist. Professor\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eU. S. Bilkish;\u0026nbsp;\u003c/strong\u003eWriting, editing, data collection and review the manuscript,\u0026nbsp;\u003cstrong\u003e1b)\u003c/strong\u003e \u003cstrong\u003eJ. Hossain;\u003c/strong\u003e was contribution in main writing and editing the manuscript, data collection and selection, data analysis and interpretation, literature reviews, \u003cstrong\u003e2)\u003c/strong\u003e \u003cstrong\u003eC. F. Rob;\u003c/strong\u003e was contribution in writing and editing the manuscript and data collection, \u003cstrong\u003e3) Professor Kang;\u003c/strong\u003e review and editing the manuscript, \u003cstrong\u003e4) Assist. Professor M. G. Mustofa;\u003c/strong\u003e data collection and review, \u003cstrong\u003e5)\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Chowdhury A. B. M. Bodrudduza;\u003c/strong\u003e data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u0026nbsp;\u003c/strong\u003eThe medical institution Z\u0026amp;J fellows\u0026apos; acknowledge us to publish this manuscript.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eLow backpain in the Bangladeshi adult population: a cross-sectional national survey. Muhammad Shoaib Momen Majumder, Ferdous Hakim, Iftekhar Hussain Bandhan, Mohammad Abdur Razzaque, Ahmad Zahid-Al-Quadir, Shamim Ahmed, Minhaj Rahim Choudhury, Syed Atiqul Haq, MM Zaman, et al. BMJ Open 2022;12:e059192. doi:10.1136/bmjopen-2021-059192\u003c/li\u003e\n \u003cli\u003eThe global epidemic of low back pain, prof. Nebojsa Nick Knezevic, prof. Kenneth D Candido, prof. Johan W S Vlaeyen, prof. Jan Van Zundert, prof. 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Cardiovascular risk factors and low-back pain in a long-term follow-up of industrial employees. Scand J Work Environ Health 2006;32:12\u0026ndash;19.\u003c/li\u003e\n \u003cli\u003eBae Y-H, Shin J-S, Lee J, et al. Association between hypertension and the prevalence of low back pain and osteoarthritis in Koreans: a cross-sectional study. PLoS One 2015;10:e0138790.\u003c/li\u003e\n \u003cli\u003eSperstad JB, Tennfjord MK, Hilde G, Ellstr\u0026ouml;m-Engh M, B\u0026oslash; K. Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain. Br J Sports Med 2016; 50:1092-6.\u003c/li\u003e\n \u003cli\u003eMECHANISMS OF PAIN FROM URINARY TRACT INFECTION John M. Rosen and David J Klumpp, HHS Public Access, Int J Urol. 2014 April ; 21(0 1): 26\u0026ndash;32. doi:10.1111/iju.12309.\u003c/li\u003e\n \u003cli\u003eUrinary tract infection during gestation and its correlation with low back pain versus nursing interventions. Simone Regina Alves de Freitas Barros, Rev Dor. S\u0026atilde;o Paulo, 2013 abr-jun;14(2):88-93.\u003c/li\u003e\n \u003cli\u003eThe Prevalence and Association of Stress Urinary Incontinence, Core Muscle Endurance, and Low Back Pain among Married Women in Saudi Arabia: A Case-Control Study Ahmad H. Alghadir , Cynthia Tse, Amir Iqbal , Mariam Al-Khater, and Ghadeer Al-Rasheed, Hindawi BioMed Research International Volume 2021, Article ID 5533241, 7 pages https://doi.org/10.1155/2021/5533241\u003c/li\u003e\n \u003cli\u003eDoes a healthy lifestyle behavior influence the prognosis of low back pain among men and women in a general population? A population-based cohort study. Tony Bohman, Lars Alfredsson, Irene Jensen, Johan Hallqvist, Eva Ving\u0026aring;rd, Eva Skillgate, l. BMJ Open 2014;4:e005713. doi:10.1136/bmjopen-2014-005713\u003c/li\u003e\n \u003cli\u003eOCCURRENCE OF URINARY TRACT INFECTION IN ADOLESCENT AND ADULT WOMEN OF SHANTY TOWN IN DHAKA CITY, BANGLADESH. Sabita Rezwana Rahman, M Firoz Ahmed, Aleya Begum, Ethiop J Health Sci. Vol. 24, No. 2 April 2014\u003c/li\u003e\n \u003cli\u003eLow back pain and some associated factors: is there any difference between genders? Thiago Paulo Frascareli Bentoa, Caio Vitor dos Santos Genebraa, Nicoly Machado Maciel, Guilherme Porf\u0026iacute;rio Cornelio, Sandra Fiorelli Almeida Penteado Sime\u0026atilde;o, Alberto de Vitta, Brazilian Journal of Physical Therapy 2020;24(1):79---87,https://doi.org/10.1016/j.bjpt.2019.01.012, https://www.journals.elsevier.com/brazilian-journal-of-physical-therapy\u003c/li\u003e\n \u003cli\u003eUrinary Tract Infection in Pregnancy and Its Effects on Maternal and Perinatal Outcome: A Retrospective Study. Lekshmi Balachandran, Leena Jacob, Reem Al Awadhi, Lamia O. Yahya, Khlood M. Catroon, Lakshmi P. Soundararajan, Saleema Wani, Sara Alabadla, Yassmin A. Hussein, DOI: 10.7759/cureus.21500\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Low back pain (LBP), Women of reproductive age, LBP in women without pregnancy, Retrospective, Cross-sectional study. Overweight, Obesity","lastPublishedDoi":"10.21203/rs.3.rs-3940336/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3940336/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction:\u003c/strong\u003e Low back pain (LBP) is a musculoskeletal disorder of several causes that can mess up the spine. [11] It is characterized by pain, stiffness or muscle tension and is usually localized in the lumber region. – During their working years, people frequently experience low back pain. Approximately 84% of adults experience LBP once or more during their lifetime.\u0026nbsp; [1, 3, 6, 8] In Bangladesh, wt. related prevalence of LBP is 18.5% and age group 18-34 years prevalence are 10.5% and \u0026gt;55 years 27.8%, average 19.2%, which is more in women 27.2% than men. [1]\u003c/p\u003e\n\u003cp\u003ePain in the Soft tissue of the back is extremely common among adults and often affects individuals during their working years. LBP in women, is strongly linked to hormonal,- and reproductive factors, the work environment and lifestyle. [3] Females frequently experience lower abdominal and back pain at reproductive age, usually due to PMS, PMDD, dysmenorrhea, endometriosis, pregnancy, menopause, muscle spasms, arthritis, UTI, PID, HTN, DM, obesity, multiple C/S tracts and lower abdominal operations, all of which cause RAD, osteoporosis, vertebral and intervertebral disc diseases (PLID, herniation, slipping etc.). [9, 10] The L\u003csub\u003e4\u003c/sub\u003e and L\u003csub\u003e5\u003c/sub\u003e neural arches are involved in the transmission of a considerable load. Therefore, the joints between \u003cstrong\u003ethe articular facets of L\u003c/strong\u003e\u003csub\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/sub\u003e\u003cstrong\u003e and L\u003c/strong\u003e\u003csub\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003c/sub\u003e,- are sites of LBP. Low back pain (LBP) was diagnosed by history and clinical examination according to the Pain Scale. To determine the cause of HELLP syndrome/causes by routine investigations and sometimes abdominal ultrasonography (USG), magnetic resonance imaging (MRI) is needed. [3, 8] Treatment of LBP depends on the cause. When a definite lesion is not found, The patient should be informed and reassured about the treatment of LBP. [3]\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePurpose/Objective of the study:\u003c/strong\u003e To identify the causes of LBP and prevalence in women of reproductive age except for pregnant individuals and establish referral guidelines.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology:\u003c/strong\u003e This was a retrospective (observational) cross sectional study jointly conducted by Orthopedics and Gynecology Expertise in the North-East region, named the Sylhet Division of Bangladesh. Female patients were considered to be of reproductive age for the last three (3) years (2020 - 2022) at the Z \u0026amp; J fellows' medical institution. The data were collected from the medical records of computer databases with preset questionnaires and written informed consent. The 1\u003csup\u003est\u003c/sup\u003e part of the questionnaire consisted of questions about causes of LBP, and the 2\u003csup\u003end\u003c/sup\u003e part consisted of LBP-related questionnaires. Patients were selected by the inclusion and exclusion criteria. The data were analyzed with SPSS 25.0 statistical software, MS Word and Excel version 2010. Descriptive statistics were analyzed, i.e. frequency, central tendency and dispersion, i.e. range, standard deviation and variance. Tests of “proportions” and “significance” were performed via sample t-test and ANOVA. Statistical data analysis was used to evaluate the correlation of LBP incidence and intensity (%) with – age, BMI, disease status, marital status, obstetric history, working history and posture of reproductive-age women.\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSummary:\u003c/strong\u003e LBP has multiple causes. In retrospective studies, there is no way to predict the prevalence of causes; rather, the prevalence of causes, can be determined before patients are affected. In our study, we found the causes of LBP in women: age, BMI, local and systemic diseases, marriage history, obstetric history and working history with posture. The prevalence of LBP was greater in the 41-50 years age group (34.7%) and in the 20-30 years age group (34.2%). Moreover, overweight and obesity are associated with LBP. Overall 5.3% and 12.8% of the participants were overweight and obese, respectively, and were aged \u0026gt;20-30 years with LBP. Patient age, BMI, disease status, marital status, obstetric history and working history had no effect on any of the patients, but some patients had LBP; overweight, obesity, age group and working posture had direct effects on LBP incidence (p\u0026gt;0.05). LBP is more common in women- than in men and may be due to household activities, and a greater frequency of visceral pain during menstruation, pregnancy and labor.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Low back pain (LBP) is effect of multiple physical conditions,- that can occur in women of reproductive age except during pregnancy and can disrupt the back tissues of lumbosacral region. Women are more susceptible to LBP\u003cdel\u003e,\u003c/del\u003e because of menstrual and obstetric factors. A diagnosis was made by meticulous detailed medical history, physical examination and proper investigations. The parameters (causes) \u003cdel\u003e,\u003c/del\u003e we found that LBP had no effect on any of the patients, but women of reproductive age may suffer from LBP due to differences in cause.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMessage of the article:\u003c/strong\u003e LBP in women of reproductive age except pregnancy is multifactorial effect of back tissues, especially lumber region. LBP has a major socioeconomic impact on patients and leads to disability. Proper evaluations are mandatory to identify the causes of the underlying pathology of pain generators before starting treatment. Patients were referred to an apposite medical person when they met the relevant guidelines; ⅰ) the findings were suggestive of serious medical and psychological issues; ⅱ) activity limitations and impairments in body functions were reported; and ⅲ) symptoms were not resolved with interventions.\u003c/p\u003e","manuscriptTitle":"Causes of low back pain (LBP) in women without pregnancy, in relation to different age groups during the reproductive period, are primarily treated as musculoskeletal disorders: A retrospective study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-19 18:25:34","doi":"10.21203/rs.3.rs-3940336/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"06265136-ac91-466f-b0f0-26777dc562b2","owner":[],"postedDate":"February 19th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-05-23T00:31:09+00:00","versionOfRecord":{"articleIdentity":"rs-3940336","link":"https://doi.org/10.15406/mojor.2024.16.00667","journal":{"identity":"moj-orthopedics-and-rheumatology","isVorOnly":true,"title":"MOJ Orthopedics \u0026 Rheumatology"},"publishedOn":"2024-05-13 00:00:00","publishedOnDateReadable":"May 13th, 2024"},"versionCreatedAt":"2024-02-19 18:25:34","video":"","vorDoi":"10.15406/mojor.2024.16.00667","vorDoiUrl":"https://doi.org/10.15406/mojor.2024.16.00667","workflowStages":[]},"version":"v1","identity":"rs-3940336","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3940336","identity":"rs-3940336","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}