Comprehensive Analysis of Chronic Low Back Pain: Morphological and Functional Impairments, Physical Activity Patterns, and Epidemiology in a German Population-Based Cross-Sectional Study

Low back pain (LBP) is the leading cause of disability worldwide. While studies often focus on the relationship between magnetic resonance imaging (MRI) findings and symptoms or the link between pain and disability, comprehensive assessments that incorporate both structural and functional impairments are lacking. This study prospectively includes standardized questionnaires, medical histories, clinical exams, and lumbar-pelvic MRI. Participants were grouped by pain status, physical activity, structural impairments (e.g., Pfirrmann, Krämer, Fujiwara, Meyerding), and posture/mobility deviations. Data were analyzed using the Kruskal-Wallis test. Of the 1262 participants, 392 (31%) reported chronic low back pain (cLBP), 226 (18%) had intermittent low back pain (iLBP), and 335 (27%) were pain-free. Significant differences were observed in high physical activity levels based on WHO criteria (cLBP: 79%, iLBP: 78%, no-BP(2): 86%, <i>p</i> = 0.020, η² = 0.008). Morphological impairments were more prevalent in cLBP (75%) and iLBP (76%) compared to no-BP(2) (55%) (<i>p</i> = 0.000, η² = 0.043). Functional impairments showed similar patterns (cLBP: 42%, iLBP: 51%, no-BP(2): 38%, <i>p</i> = 0.014, η² = 0.010). Participants with functional impairments tended to be younger. Consequently, the current classification system for diagnostics needs to incorporate alternative categories to more accurately differentiate types of back pain, which could enhance therapeutic outcomes.