April 6, 2022

Too Many Birthdays

I once had a patient tell me that their primary doctor tells patients their condition is caused by too many birthdays!

I must admit, I have used this line many times in my own clinic. After reviewing an MRI and explaining a spinal condition to a patient, many will wonder why this is happening to them. “Too many birthdays,” I’ll reply. Some will also swear they know the exact moment when it all started, forever associating their back pain with some event in their past. They might confidently say, “Doc, this all started in 1972 when I pulled my back changing a tire.” But the reality is, a single isolated incident hasn’t caused their back pain. Our spines are incredibly complex support systems that naturally wear away over time and are even more vulnerable if certain conditions run in our families.

The spine is an amazing structure. Composed of 24 separate vertebrae and the sacrum, it protects the fragile spinal cord and accommodates bending and twisting. Unfortunately, gravity and time are not kind to the spine. The human ability to walk upright puts more stress on our spine compared to mammals. In the span of 2.4 million years, humans evolved to live to the age of 45. This was the average lifespan at the turn of the 20th century, and it was hard work getting there. With the advent of innovations like sanitation, antibiotics, and advances in healthcare, the average lifespan grew to 80 years. Unfortunately, our discs in the spine can start degenerating in our teenage years, leading to painful spinal conditions like spinal stenosis (pinched nerves) by the time we enter our Golden Years. This might sound dismal, but don’t fret! Most spinal conditions can be managed with a healthy lifestyle including good nutrition, not smoking, regular exercise, stretching and activity modification.

Yes, getting older sucks. Many of my patients tell me, “I thought these were supposed to be the golden years.” But while each additional birthday contributes to spinal degeneration, many other factors are at play, too. Our genetic makeup is also a factor when it comes to spine health–sometimes, we might be predisposed to lower back pain or brittle bones.

‍Indeed, just as we inherit many health conditions from our descendants, spinal conditions are no different. Scoliosis, which twists and curves the spine, is hereditary. Spondylolisthesis, a painful condition causing shifting vertebrae, is also inherited. Wearing of the discs, analogous to a tire losing its tread, is also caused by genetics. As a result, I often tell patients that they can blame their parents for their back pain.

‍But the fate of our spine doesn’t solely rest on genetic makeup or old age. Environmental factors like trauma, smoking and bad posture can damage discs, leading to premature degeneration. Studies of twins confirm that the causes of disc degeneration are both genetic and due to environmental exposure 1 .

In the end, we can’t change our parents and we can’t stop having birthdays. Luckily, we can develop healthy habits at an early age to survive our wearing-down spine. Personally, I try to eat an anti-inflammatory diet as much as possible. Sadly, typical American diets often contain too much sugar, gluten, dairy, alcohol and red meats. These foods all add chronic inflammation to our bodies, inevitably leading to pain. Adding foods like kale, berries, fatty fish, broccoli, avocados, turmeric, extra virgin olive oil, green tea, dark chocolate and certain nuts like walnuts can further decrease inflammation through their anti-oxidative effects. I also exercise regularly, with an emphasis on aerobic conditioning and core strengthening exercises. Endorphins derived from exercise are the bodies’ natural pain killers. Keeping the core strong also helps to stabilize painful discs, shielding them from stress. Even just 30 minutes of exercise each day can improve your overall well being; simple activities like walking, climbing stairs and biking improves cardio-respiratory health, reduces inflammation and releases endorphins. And I don’t just follow this lifestyle myself–I often recommend changes in diet and activity to my patients, especially when we diagnose their condition early-on. Modifying your lifestyle can improve overall quality of life, but it can also help combat the natural effects of aging and environmental factors. We might not be able to change our genes or reverse the aging process, but we can try to take control of our health in other important ways.

As we grow older, we should take steps to care for our spine health; no one wants to hear that they’re getting old, or that their body is breaking down. So hopefully when the time comes and I tell a patient they have simply had too many birthdays, it will put a smile on their face.

Genetic and environmental effects on disc degeneration by phenotype and spinal level: a multivariate twin study

Michele C Battié, Tapio Videman, Esko Levälahti, Kevin Gill, Jaakko Kaprio

Spine 33 (25), 2801-2808, 2008

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