Question
I am a 35 year old male. With no major trauma in my medical history. Within the past few years, I've been having back pain every few months. This last episode was so severe I was unable to walk for a few days. I saw a doctor at the occurance of each episode, and each time I was told it was a lumbar strain.
This last time, I was finally given an x-ray and was told that I had old compression fractures in L1 and L3. It has been a few weeks now, and I can walk, but I can't seem to stand or sit or remain in any one position for any length of  time without this wierd painful "numbing" sensation returning. The doctor is a work comp doctor and only seems concerned with me going back to work. I want to get back to work, but I'm in the construction industry, and I'm getting tired of my back going out every few months. My main concern is if there are no major injuries in my past,(car accident, falls, ect} what caused the compression fractures? Why are the "episodes" becoming progressivly worse? What can I do to prevent this from happening again?                                      

          Bill

Answer
Dear Bill,

Old compression fractures at L1 and L3 are really meaningless to me without knowing the extent of the fracture and how much vertebral body height remains.  Also is there any nerve root encroachment due to the loss of vertebral body height...this would be more meaningful.

The original cause of the fractures is probably due to a weakened bone structure that resulted in the partial collapse of the vertebra when under a compressive load...carrying heavy weight, or repetitive jumping etc...  The injuries could be from childhood...there is really no way to tell for sure.  

The bottom line is that you may want to have your bone density checked even though you are yound for this problem.  The most common way to do this is with a dexa scan, but realize that bone loss may be present even if not found on the scan.  X-ray is a poor medium to check for bone loss because it takes approximately 30% bone loss before is shows up well on x-ray.  There are actually testing procedures in place now to have your urine tested for metabolic waste products that are highly reliable in assessing you current levels of bone loss, and then recommending custom formulations to help prevent any further loss.  (I can get you more information if you are interested)

Anyway, the best way to prevent these from happening again is to get a proper assessment of the problem, your spinal structure, and a good rehab program to promote stability of the low back.  You must have some level of deconditioning which is contributory to your chronic problems.  Unfortunately the work comp doctors are usually worthless, and could care less about you as a patient as they are usually working for the insurance companies.

I would recommend that you evaluate your work status and then your physical status...are you inn the best physical shape to continue in your chosen profession without creating more damage to your back.  This includes your weight, diet, nutritional status, functional strength, and your level of stability.  You may need to schedule an exam with another doctor who is not affiliated with the work comp system for a reliable assessment.  I would suggest that a chiropractor would be your best choice for this as the medical professionals are not usually trained as well in low back problems or nutrition and wellness...they are trained more in pathological and severe trauma conditions. remember that every episode will leave the tissue weaker than before unless you address the problem, and rehab the area.

If you have any further comments or questions, or need any information on nutritional analysis, feel free to follow-up with me.   

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net