Abstract
Lower back pain (LBP) is one of the most common and costly medical problems today [1, 2]. Pain is usually transitory and can arise from the intervertebral discs, bones, ligaments and muscles of the spine. Risk factors for LBP include genetic, environmental, psychosocial and biomechanical influences [3]. However, although 85% of LBP cases have no clear etiology, 97% may be due to musculoskeletal issues [4]. Lumbar curvature (lordosis) is one factor that generates shearing between adjacent vertebrae and at intervertebral joints. People with high degrees of lumbar lordosis, including pregnant women, can experience excessive shearing (Fshear) and compression (Fcompression) forces between lumbar vertebrae, most often between the last lumbar and the sacrum [3, 5]. In addition to other factors, including age-related spinal degeneration, high levels of Fshear and Fcompression can lead to painful muscle strain, joint capsule pain, disc herniation, inflammation (spondylitis), bone degeneration (spondylolysis) and vertebral displacement (spondylolisthesis) [3–5]. Evolutionary perspectives
Highlights
Lower back pain (LBP) is one of the most common and costly medical problems today [1, 2]
The only two known complete lumbar spines from early hominins show the same sexually dimorphic pattern present in modern humans, with males having fewer wedge-shaped, lordotic vertebrae than females [5]. But this suggests selection for decreased Fshear in pregnant hominin females who exaggerate lordosis to cope with increased fetal mass. Another hypothesis is that some cases of LBP are the result of a recent mismatch, in which the modern human spine is poorly adapted to recent environmental conditions
Support for this comes from evidence that decreased back muscle strength and endurance strongly correlate with LBP [3]
Summary
Lower back pain (LBP) is one of the most common and costly medical problems today [1, 2]. Induced LBP is often thought be a consequence of trade-offs in the spine due to selection for bipedalism from a quadrupedal ancestor. The costs of increased Fshear due to lordosis were offset by the benefits of positioning the upper body’s center of mass over the hips, stabilizing the trunk and decreasing the costs of upright posture.
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