Patients with lumbar disc herniations and sciatica come to my office in pain and seeking treatment. After we discuss the options, including medication, injections, physical therapy and surgery, they often ask how they could have ruptured a disc. We discuss the natural history of disc degeneration and disc rupture, the genetics of disc degeneration, activity levels, core strengthening and body weight.
Most patients know their body weight plays a big role in their physical health. They also acknowledge that the less weight they carry around, the healthier they feel. Increases in body weight will increase the stress on the lower back, discs, and muscles, leading to increased back pain. Now there are studies that corroborate this point.
Oxford University (Eur Spine J, 2024 Mar) evaluated the MRIs of 1684 adult patients with an average age of 51 and an average BMI of 27.2kg/m2. They found that every 10 years in age and 5kg/m2 of body weight produced a significant increase in degenerative disc disease. These patients also showed a marked increase in spinal stenosis. Looking specifically at disc herniations, they found that as patients’ age increased, the risk of disc herniation decreased, but as BMI increased, patients were more likely to have a disc herniation. They concluded that weight loss should be part of low back pain management and should decrease the risk of disc herniation. As we get older, the discs have more arthritis, become stiffer and decrease the risk of herniating the soft central portion of the disc, the nucleus polposis.
A normal BMI is between 18.5 and 25. Those with a BMI 25 are considered overweight and those over 30 BMI are considered obese. That translates into a person who is 5’ 10” being overweight if they weigh 174 pounds. We promote a healthy diet and physical exercise to improve weight and core strength in an effort to decrease the subsequent deterioration of the spinal discs.
Interestingly, after surgery, the same risk factors apply. We may have fixed the pain related to the disc herniation but not the underlying cause. Surgeons at Zagazig University, Egypt (World Neurosurgery online 21 January 2026,) followed 286 patients with single-level disc herniation surgery over the course of 10 years. They had a re-herniation rate of 0f 9.8% after surgery with 64.3% of the re-herniation patients having a BMI > 25. They calculated that every 1kg/m2 of BMI over normal had a 38% increase in the risk for recurrent disc herniation.
We cannot prevent all accidents or change our genetics, but we can all work on our weight and strength to improve our lower backs and decrease the risk of a disc herniation.
To make an appointment with Dr. Jeffrey Carlson, call Orthopaedic & Spine Center at 757-596-1900, or use our online scheduling tool.