Nature vs. Nurture – What do twins tell us about back pain?

See the MRI’s here?  It’s an office worker on left and truck driver on right. Twin siblings 56 years old. They show high degrees of similarity in disc degeneration despite high differences in their lifetime physical exposure to loading.

The findings of the Twin Spine Study, an ongoing research program started in 1991, have led to a dramatic paradigm shift in the way disc degeneration is understood.  In the past, the factors most commonly suspected of accelerating degenerative changes in the discs were various occupational physical loading conditions, such as handling of heavy materials, postural loading and vehicular vibration.

Drawing on information from 600 participants in the population-based Finnish Twin Cohort–147 pairs of identical and 153 pairs of fraternal male twins–the Twin Spine Study has turned around the “injury model” approach to disc degeneration.

Researchers from Canada, Finland, the United States and the United Kingdom compared identical twin siblings who differed greatly in their exposure to a suspected risk factor for back problems; for example, one of the twins had a sedentary job while the other had heavy occupational physical demands, or one routinely engaged in occupational driving while the other did not. The studies yielded startling results, suggesting that genetics play a much larger role in disc degeneration than we previously thought. 

The findings indicated that while physical loading–handling heavy loads, bending, twisting and static work in awkward postures–appears to influence disc degeneration, the effects are very modest. The Twin Spine Study is far from over: having found evidence that genetics may play an overlooked role in disc degeneration, the team of North American and European is now working to identify the specific genes and biological mechanisms influencing disc degeneration and back pain problems; understanding how degeneration progresses over time; and differentiating normal, inconsequential changes from degenerative changes that lead to pain.

What’s the take home point here?  I think it’s not that your life can be a physical loading free for all and the stressors you put on your spine don’t matter — they do.  Trauma and repetitive strain can certainly have an effect on the degenerative process.  However, family history is more likely than once thought to be a risk factor for spinal problems — or resistance to spinal problems.  In other words, if you are among the 20% of the population who does not experience some form of low back pain in their lifetime, thank your genetics (and your parents).


Dr. Brett L. Kinsler is a chiropractor serving the greater Rochester NY area.


Types of Doctors for Patients With Back Pain

Back pain is one of the most common reasons for patient visits to a doctor’s office and patients often wonder who they should see for back pain treatment.  Below is a list of some of the most common types of doctors seen for back pain and what one might expect on a visit:

Family Physicians, General Practitioners, Internists

These are the most frequently visited physicians for low back pain. The medical doctor may be called upon to make an initial diagnosis. After taking the history, the medical doctor can review the systems of the body to determine the cause of pain and determine any risk factors. This group is experienced in the treatment of acute low back pain, they are able to rule out the serious problems such as organic disease, cancer and infection. In the absence of high risk factors listed above, this group of physicians may elect to treat low back pain with medications, ergonomic recommendations and chiropractic or physical therapy referral.  If the patient’s symptoms fail to respond, they will often perform additional testing or imaging and/or refer the patient to a specialist.

Chiropractors, Chiropractic Physicians

Chiropractic is the largest non-surgical and drugless healing profession and is the third largest healthcare profession in the United States after medicine and dentistry. Many patients with low back pain obtain relief using chiropractic care. The Agency For Health Care Policy Reform says that chiropractic treatment and exercise is often the most beneficial form of treatment for acute low back pain. Chiropractors perform manipulative treatments or spinal adjustments and treatments which may also include passive modalities like cold laser therapy, electrical stimulation, ultrasound, stretching, exercise, rehabilitation and nutritional counseling. Chiropractors do not prescribe medications and do order special diagnostic testing when needed.


This group of medical doctors specializes in the treatment of musculoskeletel injuries as low back pain. They are medical doctors who practice physical therapy, physical medicine and rehabilitation.  The therapy they prescribe often includes exercise, therapeutic modalities and hot and cold packs. They prescribe medications and order other laboratory or diagnostic testing as indicated. They may also include physical therapists and occupational therapists as part of the treatment plan and sometimes have them as part of their staff.  Some physiatrists work in pain management clinics (see below).


These physicians specialize in the treatment of disorders of the nervous system. They perform detailed neurological exams, and order tests to diagnosis causes of pain and weakness.

Pain Management Specialists

Pain Specialists and Anesthesiologists see patients who fail to improve under the more conservative approaches but for whom surgery is not an option. Their treatments may include medications and injections,  nerve blocks, implantable pain devices or stimulators. Pain Psychologists are also included in this group for the evaluation and treatment of the psychological component of low back pain. 

Neurosurgeons and Orthopedic Surgeons

These physicians concentrate in the surgical treatment of low back and lower extremity pain. Spinal attempts to maintain or enhance stability to the lumbar spine, while taking pressure off of the nerves to relieve pain and increase function.

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