Q. I've had back pain off and on for years. Why does it keep coming back?
A. It is estimated that 80% of people will have a significant episode of back pain. This is not a simple backache, but pain that limits your ability to participate in leisure, recreation, or work activities. After you have had a pain episode like this, there is a 90% chance that the pain will happen again. This is called recurring back pain. It can happen when you are starting a new or seasonal activity, when you lift incorrectly, or when you use awkward postures. If a weak disc has started to bulge, these types of activities can put extra pressure on the weakened disc, expanding the bulge. The bulge can bring on the pain by putting pressure on the joints, nerves, or ligaments of your low back. With time or treatment, the bulge may get smaller and the pain may go away.
Back pain that comes and goes can also happen when the muscles or ligaments are not able to control the movement of a spinal vertebra, leading to spinal instability. Ligaments connect bone to bone, helping to limit the amount of movement of a joint. If a ligament has been stretched, it loses its ability to hold the joint stable. Your abdominal and low-back muscles provide support for your lumbar spine much like guide-wires hold the mast of a ship. If your abdominal muscles are weak from postural changes or from not being exercised, the unstable vertebra can cause recurring pain. Daily activities can put extra strain on unstable joints, leading to extra wear and tear. It is like driving around with loose lug nuts on the wheel of your car. After a while you start to notice abnormal wear and tear. Whether the problem is from a weakened disc or from a spinal instability, you may benefit from physical therapy to strengthen and stabilize your lumbar spine.