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Q. I've had back pain off and on for years. Why does it keep coming back?

A. It is estimated that 80 percent of the population will have a significant episode of back pain. This is not a simple backache, but pain that limits participation in leisure, recreation, or work activities. After a person has had an episode like this, there is a 90 percent likelihood that the pain will happen again. This is called recurring back pain. This can happen when starting a new or seasonal activity, when lifting incorrectly, or from using 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 the low back. With time or treatment the bulge may get smaller, and the pain goes 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 the ligament has been stretched, it looses its ability to hold the joint stable. The abdominal and low-back muscles also provide support for the lumbar spine, much like guide-wires hold the mast of a ship. If the abdominal muscles are weak from postural changes or from not being exercised, the unstable vertebra may be source of recurring pain. Daily activities put extra strain on the unstable joint leading to extra wear and tear. It's 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 a lumbar stabilization training program.

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