Question
First off I am a waitress and my hip or spine seems to come out of place. I will get a sharp pain in my left or right side around my hip area. It is short and will go away, no constant pain and I can live with it, sometimes it gets really bad if I go to long to see my chiropractor. At this moment I am not in pain but in a few minutes the pain will come and go.I have felt this pain before and I know something is just not in place, I feel it, if you know what I mean.  I have gone to a chiropractor and he has fixed me and made me pain free. About 4 or 5 months later, it will seem to go back out of place. The first time it happen my hip came out or pelvic area on right side and one shoulder was higher than the other. I went back a few months later and he found the problem and fixed one of my vertebrae and spine. I have been a waitress for a few years now and this past Sunday when I worked really hard by bending over and sweeping with a broom and dust pan for a long period of time ( the broom is like a short kids broom and a short dust pan)  that night is when my side started to hurt me. I knew I put something out of whack again. It only seems to happen when I work really hard and sweep really hard.  But I am not sure if that is the cause or not. Also about a year ago, I was in a car wreck, got hit from behind and I think I had whiplash. I do not know if that could be the cause of it either. I do not exercise like I should, but I have always been healthy and active as a child and teen. I am working on being more active and working out. I want to know why it keeps coming out of place, my spine or hip one of the two it seems to be. I want to know how I can prevent this. Will exercise help? Do I need to take more calcium to build strong bones? Or is that it could be I do not exercise like I should. When I stand, I tend to lean on my right foot and put all the weight on the side. I do walk all day at work. I am only 22 years old and I do not want to put up with this anymore. I want to prevent it somehow. I have been fine since August or September of 2010 but that's when our busy months are at work and I bent over a lot more then sweeping. Please let me know what I can do to prevent it and why it may keep coming back out or what I am doing wrong.

I have had no serious injuries in my life or any surgeries. Only a car wreck and stitches at 9 years old. I have lifted some too heavy stuff for me to lift. I am short 5.3 and only 130 pounds. No serious family history with bones or osteoarthritis or any kind of serious disease. I do feel like I should probably stretch more and that might help.

Answer
Dear Beverly,

Your complaint and frustration is quite common. The reason why everything doesn't make sense is because your understanding and belief of what is happening to your lower back is incorrect.  In your question you say that your "back goes out" over and over again. The truth of the matter is that your back does not go out, ever.  What does happen, however, is that you experience joint injury, fixation, muscular spasm and tightness, and possibly even nerve tissue irritation or compression.

In other words, most back pain is the result of micro or macro trauma.... small or large injuries due to physical activities or positions.  These small irritations cause muscle reactions, inflammation, abnormal posture, loss of joint motion, and sometimes neuropathy.  All of these cause pain and discomfort and irritation. You feel better once the inflammation and muscle spams eases up, even though every time the back is injured more and more tissue damage is done that is irreversible.

These are the typical risk factors regarding experiencing significant lower back injury and pain:

1) Past injury or pain... yes, if you have injured your lower back in the past, you are more prone to re-injury.  Muscles, ligaments, discs, and other tissues will heal, but often the scar tissue that is left behind is less functional and less strong.
2) Core muscle weakness. If your stomach and back muscles are weak, you are more likely to suffer injuries to the lower back resulting in pain and disability.
3) inflexibility.  Short hamstrings, for example, put additional stress on the lower back by locking the hips prematurely while bending over to pick something up off the ground.
4) Underlying structural problems or birth defects, such as a spondylolisthesis or hemivertebrae. These are only found during imaging studies, such as x-rays or MRI's.
5) Excessive weight.  If somebody is overweight, the extra stress of the weight on the discs of the spine can be severe over time.
6) Poor work and lifting habits.  Injuries first happen when we do things to hurt ourselves... and then they get worse when we repeat the injury mechanisms over and over again.

My guess, and please understand that it is a guess, is that you have suffered injuries to the lower back at a young age, perhaps even involving the discs between the bones of the lower back segments. The sweeping and physical work that you do places additional stress upon the discs resulting in pain, muscle guarding, and inflammation. You take it easy, and you get adjusted, and you begin to feel better, and then you go right back to the activities that injure your back and that got you into the painful condition in the first place.

Change your thought process. Demand that your chiropractor help you with stretching and strengthening exercises, and ask him to help you to understand what tissues are being injured. Don't let him simply explain that your hip was out or that your lower back was out.  True, there might be joint fixation/dysfunction, but there is nothing "out" of place... unless you have suffered a dislocation and you are paralyzed (Christopher Reeves, for example).  Learn to lift properly, and how to work without injuring your spine.  If you don't, you might suffer from significant spinal injury that could end in spinal surgery... which doesn't fix anything either but does offer some relief at times...

I hope that this helps you to better understand the issues regarding back pain and why it is occurring over and over again for you.  Good luck with your current chiropractor and treatment. Demand that he/she is more active in helping you to prevent injury, and not just treating you once you have injured yourself.

Keith Biggs, DC
http://www.eastmesachiropractor.com
http://www.biggschiropractic.blogspot.com