Truck Drivers and Lower Back Pain

It is widely recognized that people who drive for a living suffer more commonly from low back problems. Truck drivers are the most common occupation seen in a chiropractic office. (The second most common is a nurse).

We've always supposed the reason for the increased incidence of back pain amongst truckers is the endless hours of sitting. And I believe that this is one of the main reasons; however, other factors come into the causative equation as well: the constant exposure to low frequency vibration, the simple lack of activity, the poor diet we all experience while traveling, the strenuous work of pulling on chains and tarps, cranking up dolly wheels, jumping up and down from trailers and cabs, the list goes on.

You see, it is a lot to expect lower back muscles to perform sudden heavy or ballistic activities following long periods of rest. That is why so many backaches and pains occur soon after arising from bed. Muscles and joints require a warm-up of stretching and range-of-motion movements before they can be safely used for work. By work here I mean sometimes any type of daily activity, because even the actions of dressing oneself has been known to create back, shoulder and neck pain. Its not that the human body is fail or poorly put-together, it's just that preparedness is important. Spinal joints especially are designed to be flexible and mobile and inactivity is detrimental to the ligaments and muscles that act on them.

In the light of this discussion, I was interested to read a study reported in the highly respected medical periodical The Lancet (2002:360(9343) pp.1369-1374) recently that examined this phenomenon of truck drivers and low back problems. The basic assumption of the article was that those who drove for a living would suffer greater degrees and incidence of spinal disc degeneration. What the authors did was examine sets of identical twins who had led distinctly lives behind the wheel. They studied 45 twin sets from Finland one of whom drove for a living (trucking or perhaps in sales) for at least 5 years, while the other twin drove the same amount, as one would expect. The actual difference was the driving group sat drove 5 times longer than the non-driving group. Other factors such as repetitive lifting, smoking and long-term postural habits were taken into consideration.

After being examined by MRI to determine the degree of spinal problems that the respective twins' lifestyles had caused, conclusions were drawn. Guess what? No significant difference could be found. The authors therefore concluded that a career in driving did not cause spinal disc degeneration any more than any other job. Yet the fact remains that back pain is common in truck drivers and others who spend their days on the roads.

Whether the pain of so much driving is caused by muscle fatigue, ligamentous damage, changes in the local spinal nerves or blood circulation, or some other factor, is still somewhat of a mystery. What is evident to any chiropractor is that these people are at greater risk of pain and periodic disability, and that they need to spend more time than the average flexing and stretching out the negative effects of all that sedentary time and exposure to vibration.

Due to the huge prevalence of low back pain and its enormous costs to society, lots of other studies are being done to discover what exactly is at the root of our spinal 'Achilles heel' and what can be done to help. For certain, many of the back problems that I am called upon to help every day are functional in nature, not structural. That is one of the false assumptions of this Lancet study, and for that matter most of the conventional wisdom on the spine: medical thinking assumes that the structure of the spine determines its function, whereas chiropractic largely views the opposite: function as determining structure. This is just one more example of the falsity of Newtonian reductionism that dominates medicine and which is causing the failure of modern health care today.