Is adiposity associated with back and lower limb pain? A systematic review

Waruna L. Peiris, Flavia M. Cicuttini, Sultana Monira Hussain, Mahnuma M. Estee, Lorena Romero, Tom A. Ranger, Jessica L. Fairley, Emily C. McLean, Donna M. Urquhart

Research output: Contribution to journalReview ArticleResearchpeer-review

9 Citations (Scopus)


Background Back and lower limb pain have a major impact on physical function and quality of life. While obesity is a modifiable risk factor for musculoskeletal pain, the role of adiposity is less clear. This systematic review aimed to examine the relationship between both adiposity and its distribution and back and lower limb pain. Methods A systematic search of electronic databases was conducted to identify studies that examined the association between anthropometric and/or direct measures of adiposity and site specific musculoskeletal pain. Risk of bias was assessed and a best evidence synthesis was performed. Results A total of 56 studies were identified which examined 4 pain regions, including the lower back (36 studies), hip (two studies), knee (13 studies) and foot (eight studies). 31(55%) studies were assessed as having low to moderate risk of bias. 17(30%) studies were cohort in design. The best evidence synthesis provided evidence of a relationship between central adiposity and low back and knee pain, but not hip or foot pain. There was also evidence of a longitudinal relationship between adiposity and the presence of back, knee and foot pain, as well as incident and increasing foot pain. Conclusions This systematic review provides evidence of an association between both body fat and its central distribution and low back and knee pain, and a longitudinal relationship between adiposity and back, knee and foot pain. These results highlight the potential for targeting adiposity in the development of novel treatments at these sites.

Original languageEnglish
Article numbere0256720
Number of pages41
JournalPLoS ONE
Issue number9
Publication statusPublished - Sept 2021

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