Expert: Scott F. Gillman, DC, DACBSP - 3/31/2007

Question
hello Dr. Gillman

I have a concern, I've been having lower back pain since I was 20, ever since I improperly lifted heavy weight off the ground. This has been going on for 7 years. Although I can perform normal activities without trouble. The moment I start to put slight strain on my lower back, I notice that a few moments later that I have a pain in the lower lumbar area. I take it that my condition is common, but I'm also in dental school training to be a health professional. Since good posture is important and maintaining back health is very important, I would like to know how I can get rid of or even reduce my condition.

Thanks

Answer
Dear Jason,

Yes. You are correct in that your back condition is very common.  There has been evidence of sudden migration of lumbar intervertebral discs upon loaded flexion of the trunk.  See McGill, et.al. for discussion on this.  A similar concept of segmental buckling (a giving out) of a spinal joint system also has been discussed by Triano (Biomechanics of spinal manipulative therapy. Spine Journal: Official Journal of the North American Spine Society. 1(2):121-30, 2001 Mar-Apr.)  Once there is injury to discs, it's difficult to prevent the recurrence of back pain, or to prevent degenerative changes (see: Modic M, J.of Radiology).  It could be that you do not have any disc problems at all, and you simply have a mixed bag of posturally strained muscles and fascia and/or dysfunctional joints.  We know that people with chronic back pain develop smaller cross-sectional diameters of some of the lower back paraspinal muscles, multifidi to be specific.  Whether this is the cause of their back pain or a neuromotor atrophy, or both, is under discussion.   Therefore, I would suggest you find an evidence-based chiropractor and get a thorough examination.  Treatment, including a combination of joint manipulation, soft tissue methods, exercise advice (a regular gym program is quite good advice), and ergonomic advice (students to a lot of sitting...with lumbar spines loaded up in flexion) would likely be helpful.  

I hope this answered your questions.

Good Luck! (with your back and with dental school)

Dr. G
www.drgillman.com