I had never had a back problem in my life… until the day we moved from one house to another and I loaded and unloaded boxes for a day, a night (the better part of it anyway) and another day. Then the phone rang, and I stretched myself across multiple rows of boxes to grab it. When I tried to straighten up, I found that I couldn’t. So there I was, bent at roughly a right angle and in considerable pain. Luckily for me the injury was fairly minor and things returned to normal in a number of days. But I have never forgotten that sharp pain and how easily it all happened.

It turns out that 20% to 30% of Americans are suffering from lower back pain at any given time. (Millions and millions of us!) Often the pain comes from disc degeneration in the lumbar (lower) spine. Doctors had long assumed that the main causes were activities such as heavy lifting and physically demanding jobs. But guess what? New research shows that people with lumbar disc disease (LDD) usually get it for the same reason that their eyes are brown or blue — it runs in the family. The University of Utah analyzed health and genealogic data for more than one million people in the Utah Population Database and discovered that those who have a first-degree relative (parent or sibling) with LDD are four times more likely to develop it as well!

Given my very personal interest in the topic, I called Peter Moley, MD, a physiatrist (specialist trained in rehabilitation) at the Hospital for Special Surgery in New York City, to learn more. Dr. Moley told me that what at first glance may seem to explain why disc degeneration runs in families — the fact that family members tend to be “built” the same way, having similar physical structures — in fact may have nothing to do with LDD risk. Neither do similar posture habits, he says, because how people stand doesn’t have much effect on the lower spine. The real culprit in family-related disc degeneration lies deeper — some people might have a protein structure that predisposes them to disc injury and eventual degeneration. To understand how that works, we’ll first look at a bit of LDD’s back story (so to speak).

A Problem of Collagen

It is connective tissue made of collagen, called the annulus, that keeps the nucleus of each disc in its proper place in the spine and protects us against injury. Should this nucleus or “center” slip out of place, or bulge forward like a partially squished jelly doughnut, one can suffer with sciatica or other “slipped” disc pain. These collagen fibers not only protect the nucleus but also allow the spine to tolerate the compression force put on it when a person lifts heavy loads… as well as the shearing force that results from making perpendicular motions that angle the spine away from its usual vertical position. (Yes, that was my big mistake!)

Some portions of the spine tolerate compression force better, while others are better able to tolerate shearing, but in either case if the collagen fibers weaken and break down, the person is at high risk for a disc injury. This is where family makeup comes in — before the Utah study, research in Finland and elsewhere had revealed a genetic linkage in the nature of the spine’s collagen and in fact identified two versions of a gene that directly impacts how strong — or weak — the collagen will be. Dr. Moley adds that the Finnish research had shown a high LLD risk among twins, but the sheer size of the University of Utah research revealed a much more powerful association than previously believed. “The risk of having disc degeneration is four times more likely for a first-degree relative and 1.5 times more likely for a third-degree relative, such as a cousin, for instance. It was quite an undertaking to review three generations of medical records and produce this data. It really opened our eyes,” he says.

Stronger at the Core

Dr. Moley stresses the importance of everyone strengthening the lumbar spine area because that is where discs get the greatest pressure and hence the greatest risk for injury — and families at higher risk should, of course, be particularly aware of this need. Most important is that they strengthen the core muscles in the pelvic and abdominal areas. Hip and leg strengthening helps to provide the solid support that the back needs, and back exercises are best done while lying down at first so there is less chance of straining the back. The second critical element in self-preservation is to be sure to practice an exercise program that teaches good body mechanics.

Working with physical therapists, Dr. Moley designs programs for clients to teach them how to move properly. As patients become stronger, they graduate to exercises on their hands and knees, raising an arm and a leg at the same time, for example, and doing the plank, a yoga position similar to holding a push-up, which activates multiple muscles and builds endurance. The final stage includes various standing balance and rotation exercises that further train people to keep their spines well-positioned during movement.

A Program for Life

Dr. Moley notes that 95% of people who complete his programs avoid the need for spinal surgery. If you have lower back pain, he advises calling an orthopedic or spine center to ask specifically for a doctor who specializes in nonsurgical spine work. Be sure you locate the best doctor for you, and don’t be timid if you feel the need for a second opinion. Once the doctor has completed work on your back, you will need to practice your exercises for life. Constant maintenance, yes, but it’s a small price for a strong spine and no more aching back!