Many people suffer from some form of back pain during their lives. Some suffer serious pain and have to resort to back surgery. The statistics say that at some point in our lives, 80 per cent of us living in the west will suffer from disabling lower back pain.
In the US, back pain is the second most common reason people seek medical care and the most common cause of disability after cardiovascular disease. Despite these statistics, lower back pain has been referred to as the Cinderella of medicine. Medicine has shown a shocking ineptitude for diagnosing and treating back problems, in many cases making them worse.
Many back pain specialists are not shy about speaking up. For example, Gordon Waddell, a renowned Scottish orthopaedic surgeon and author of The Back Pain Revolution (Churchill Livingstone, 1999), doesn’t mince his words. He once remarked that “back surgery has been accused of leaving more tragic human wreckage in its wake than any other operation in history”.
Waddell noted, decades ago, that “dramatic surgical successes unfortunately apply to only some one per cent of patients with low back disorders. Our failure is in the remaining 90 per cent of patients with simple backache, for whom, despite new investigations and all our treatments, the problem has become progressively worse”.
Back pain treatments follow fads relating to theories regarding the cause of the pain. In the early part of the 20th century, sacroiliac joint disease was believed to be the culprit in many cases of back pain. This was followed by treatments including removal of the coccyx, injections for herniated or slipped discs, lengthy bed rest, traction, steroid injections into facet joints and even transcutaneous electrical nerve stimulations – a type of pain relief involving a mild electric current.
In the US, back pain is the second most common reason people seek medical care
The most popular operations now include some form of laminectomy, in which nearby bone and/or ligaments are removed to give the nerve branching off the central spinal cord more space to move, without getting trapped by the spine, and discectomy, removing all or part of a bulging or slipped disc – the cushion separating each vertebra from another – which presses on the spinal nerve causing back pain.
Then there is disc replacement, where the disc is replaced by an artificial implant made of metal or plastic. Finally, fusion, where a degenerated disc is removed and the vertebrae above and below it are joined together, leaving that segment of the spine locked in position.
Recent reviews of all the evidence for the various kinds of surgery for back pain show that, like their predecessors, they offer minimal advantages over doing nothing or undergoing rehabilitation. So what can we do instead? As with most health issues in our lives, we initially have to look at the lifestyle we lead and what changes can be made.
• If you work at a desk, get a standing one. I tried this for five months when my office was moved. There is something to be said for it, as you have to keep moving, even in small movements. Also try sitting on a Swiss ball, or using a kneeling chair up to your desk. One of the major causes of back pain has nothing to do with the spine, but an imbalance between muscles in the back and legs.
This is often caused by hours of sitting at a desk. The Swiss ball has a reduced base for support, it moves beneath you and so requires you to activate your balance and postural muscles to stay upright.
• Keep moving – when researchers at the Nuffield Orthopaedic Centre in Oxford, UK, compared fusion surgery and gentle exercise – such as stretching, muscle strengthening and aerobic exercises, such as treadmill walking, step-ups, cycling and rowing, plus hydrotherapy treatment every day – patients fared just as well as those who had surgery. Other reviews have confirmed the effectiveness of exercise, particularly a programme individually designed and monitored by a professional.
• Consider working with a fully trained, qualified and experienced chiropractor, osteopath or physiotherapist. Finding the right practitioner is vital, so ask for referrals. Spinal manipulation can provide better long-term functional improvement and more pain relief than either back school or individual physiotherapy (Clin. Rehab., 2010).
One of the Magna Reports’ conclusions is that “spinal manipulation applied by chiropractors is shown to be more effective than alternative treatments for low back pain” (The Magna Report, 1993). I work with a chiropractor on a monthly basis and this has had a beneficial effect on any back issues that may arise from my lifestyle.
• Keep hydrated. When you sit for hours each day, the spine doesn’t move enough to recycle the fluid that keeps the discs lubricated. Drink water throughout the day.
• Acupuncture has proved so successful in relieving lower back pain that it is now listed in the guidelines of the UK’s National Institute for Health and Clinical Excellence.
• Massage, combined with exercise can offer lasting benefits for back pain.
• Yoga and/or pilates classes twice a week can help improve function and lower back pain and decrease the need for medication.
Other ideas to look into are prolotherapy and rehabilitative systems such as Egoscue therapy.
kathryn@maltanet.net