Pain in the back may develop at any age although it reaches its greatest frequency in adult life, being less frequent in younger people and also in old age. However, within the large group of disorders which may cause back pain there are certain conditions which are more likely to develop in certain age groups. For example, bursting of an intervertebral disc - the so-called Slipped’ disc - is most frequent at about 40-45 years. On the other hand ankylosing spondylitis usually appears in a much younger age group, commonly between 15 and 25 years.

Although the frequency of back pain is relatively constant over a wide span of adult ages the proportion of people severely disabled by back pain virtually trebles in frequency in late middle age compared with young adults. It is disturbing that recently there has been an increasing incidence of backache reported in schoolchildren. It is not clear whether this is a real increase or simply that more attention is being paid to complaints that were previously ignored. An increase in the frequency of back pain in children is unwelcome but nevertheless it would also be of interest as it should be relatively easy to identify the factors responsible and therefore to develop long-term solutions.

A comparison of the incidence of back pain between the sexes produces surprising results. If the survey is conducted on the whole population it has been found that back pain occurs more frequently in women than in men. The reasons for this are not at all clear. It may be that women are more prone to spinal problems. There is a suggestion that child-bearing might be responsible as we know that during pregnancy back pain may be produced because of the weight of the pregnant uterus and the increasing looseness of the spinal ligaments.

However, the greatest frequency in females occurs in those over 50 years old, making that explanation less likely, although it remains possible that the spine has been damaged to a certain extent during pregnancy leading to problems in later life. Another chauvinistic suggestion is that women feel pain more readily and complain more than men; in other words they have a lower pain threshold. This suggestion inevitably arouses indignation, probably with good reason.

However, if surveys are based on industry then there is a reversal of the situation and back pain appears more frequently in males. Each year there are 627 working days lost per 1000 males at work but only 347 per 1000 females. The reason for this is that males more commonly undertake heavier work. Not only may the job lead to a greater incidence of back pain but workers with back problems could probably continue in light work but not in heavy manual duties.

The risk of back pain is also related to one’s body shape to a certain extent. There seems to be a higher incidence in those who are taller and heavier than the rest of us. As most of the body load is transmitted through the spine it seems likely that such people’s backs undergo excessive stresses so that they are more readily damaged.

Although back pain usually is associated with stiffness of the spine there is an interesting group of back sufferers whose spine, and indeed all their joints, are more flexible than normal. Such people are probably born extremely supple and remain so throughout their lives but the excessive movements which occur may eventually lead to damage and back pain. They have been described as having the -loose-back syndrome’. Ballet dancers are known to develop wear and tear forms of arthritis and it has been thought that this is simply due to them overtaxing their joints.

However, we now find that ballet dancers have excessively mobile joints. In other words they have become good dancers because their joints are so supple; the joints have not been made supple by their dancing. This suppleness combined with the extremes of movement can eventually lead to pre?mature wear and tear in the joints in the same way as the loose-back syndrome.

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