Inter-Segmental Muscle Weakness As A Cause Of Lower Back Pain

by Dr. Jeremiah Davis

Today I will be talking about a common precursor to lower back pain called inter-segmental muscle weakness. Say what? First it is helpful to understand how our body’s musculoskeletal system works. The musculoskeletal system is what gives form and shape to our bodies. It is the structure that enables us to move around. It also offers vital protection for our organs.

The musculoskeletal system is made up of several different types of tissues including bone, muscle, cartilage, ligaments and other types of connective tissue. The bones (a total of 206 in the adult human body) form the support which allow our bodies to retain their shape and bear weight. The intersection of two bones in the body is called a joint. Joints are the hinges which the muscles act on to create the forces necessary to move our bodies. A joint is held together by tough band of tissue called a ligament. So far we have the levers (bones) and the leverage/force (muscles), but there still remains one more element which coordinates all of the various firings of muscle in order to move our bodies with a smooth and fluid motion. The last element is the nervous system. Messages are transmitted down from the brain and spinal cord (central nervous system) to the body’s peripheral nerves which connect to the various muscles of the body. The brain controls the timing, firing, and force of muscle contractions so that humans can move as gracefully as a ballerina or exert as much force as an Olympic weight lifter. While this system is functioning properly, these are some of the high end results. But what happens if the system fails?

One possible reason for injury could be inter-segmental muscle weakness. Strong muscles are important. Which muscles you choose to strengthen is an equally important choice. Like most things in life, balance is key. When it comes to inter-segmental muscle weakness, there are two types of muscles: global and local. The global muscles are those major muscle groups that you see people working on at the gym. Examples include: biceps and triceps (some muscles of the upper arms) or quadriceps and hamstrings (some muscles of the lower leg). Core strengthening is the fad today. The problem here is when people think of core muscles they think of the abdominal muscles. These would fall under the “global movers” category. The problem with focusing only on abs is that the smaller muscles which support each of the segments of the spine do not get strengthened as readily when doing crunches.

If you or someone else has ever said things like, I bent over to tie my shoe or pick up my child’s toy and then my back went out, you have experienced the consequences of inter-segmental muscle weakness. The global movers are strong, but the little local muscles that stabilize the spine get overpowered and then the spinal segment shifts slightly. In response the muscles tighten up to protect the spine. The inflammatory process is set into motion and the end result is pain. Furthermore, once there is injury, this can change how the muscles fire in the future. In order for the spine to remain stable the spinal muscles must first contract, then the arms and legs can move. When an injury occurs, the spinal muscles (local muscles) don’t contract until after the extremity muscles (global movers) move. When the spine is not stable it is at risk for injury.

This is why you can be physically fit, have a good workout regimen, and still get injured. Some of our patients in the construction industry will say: “I am strong, so how did this happen?” While this is true, they did not have a good balance of strength between the various muscle groups. Fortunately this problem is preventable. Your doctor can work with you to give you exercises to strengthen the proper muscles so that your spine can be protected. Once you have mastered the basics your doctor can give you additional exercises to further strengthen your body.

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Recipe of the Month



1 Tbsp. extra-virgin olive oil
1 red bell pepper, chopped
1 green bell pepper, chopped
1 yellow bell pepper, chopped
1 onion, chopped
2 cloves garlic, minced
1 lb. ground beef
Kosher salt Freshly ground black pepper
6 c. chicken broth
1 (28-oz.) can crushed tomatoes
1 (14-oz.) can fire-roasted diced tomatoes
2 tsp. dried oregano
1 c. white rice (or brown rice)
Shredded white cheddar, for serving.
Freshly chopped parsley, for serving


  1. In a large pot over medium heat, heat oil. Add bell peppers and onion and cook until soft, about 7 minutes.
  2. Add garlic and cook until fragrant, about a minute.
  3. Add ground beef and season with salt and pepper. Cook until no longer pink. Drain fat and return to heat.
  4. Add broth, crushed tomatoes, diced tomatoes, and oregano. Bring to a boil, then reduce heat to a simmer.
  5. Add rice and simmer, covered, until rice is tender, about 40 minutes, adding water if necessary. Season with salt and pepper to taste.
  6. Garnish with cheddar and parsley before serving.

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