Chronic back pain affects millions of people across Europe and is the leading cause of disability in the region. When back pain lasts longer than three months, it is classified as chronic, often reducing a person’s quality of life and adding significant costs to the healthcare system.
To better understand why some people develop this persistent pain, researchers at the Technical University of Munich (TUM) have used advanced imaging and artificial intelligence (AI) to study the role of muscle quality.
In a new study published in The Lancet Regional Health – Europe, the TUM team analyzed whole-body MRI scans from nearly 30,000 people who participated in the German National Cohort (NAKO). Their goal was to investigate whether there is a connection between back muscle composition—specifically, the amount of fat within muscles—and chronic back pain.
The researchers found a clear pattern: people with more fat in their back muscles and less muscle mass overall were more likely to report chronic back pain. In contrast, those with stronger, leaner muscles in the back had a lower chance of experiencing ongoing pain.
These results remained consistent even after adjusting for age, gender, physical activity levels, and common medical conditions like diabetes, high cholesterol, osteoporosis, and arthritis.
Dr. Sebastian Ziegelmayer, a scientist and physician at TUM University Hospital, explained that back pain is often influenced by many factors, including how active people are, what they eat, and other daily habits.
But until now, the quality of back muscles has been largely overlooked in diagnosis and treatment. He believes this new approach—looking closely at muscle composition—could help identify who is at higher risk and lead to better prevention strategies.
To gather their data, the researchers used AI to examine the MRI scans and separate the fatty tissue from the actual muscle tissue in each participant’s back. Out of 27,518 participants aged 19 to 74, about 22% reported having chronic back pain.
The analysis showed that people with more intermuscular fat—fat located between the muscles—were more likely to suffer from long-term pain.
Interestingly, the study also highlighted the importance of physical activity. People who exercised according to World Health Organization (WHO) guidelines—about 150 minutes of moderate to intense activity per week—had the lowest rates of chronic back pain.
However, both too little exercise and excessive exercise were linked to a higher risk of back pain. This suggests that moderate, consistent activity is key for maintaining healthy muscles and preventing pain.
Still, the researchers caution that their study has limitations. Because the data came from only one point in time, they can only show an association—not a direct cause.
In other words, they cannot say for sure whether fatty back muscles cause chronic back pain, or whether people with back pain simply move less, leading to weaker and fattier muscles. More long-term studies are needed to understand how these factors interact over time.
Dr. Ziegelmayer hopes this research will encourage more focus on muscle composition in medical checkups and inspire future studies that explore not just biology, but also psychological and mechanical factors that contribute to chronic pain. The ultimate goal is to create more personalized treatment plans that address each person’s unique risk factors.
By combining advanced imaging, artificial intelligence, and lifestyle analysis, this study offers new insights into how we can better understand and manage one of the most widespread and costly health conditions in the modern world.
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The research findings can be found in The Lancet Regional Health – Europe.
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