Conquer Back and Neck Pain - Walk It Off! (2 page)

Those members of my family who are more sophisticated in writing than I am helped me get my message across. I am particularly grateful to my wife, Josie, my brother, Thom, and Chris and Tony, my sons, for agonizing over many iterations of the manuscript. Rebecca, my niece and a book author, introduced me to Mike Marland, the great cartoonist who illustrated this book.

Special thanks are due to teachers and professional colleagues, two of whom, during their lives, were particularly influential to my understanding of the problem of back pain. My professor of orthopaedics, Dr. Anthony De Palma, encouraged me to become an orthopedic surgeon as well as to write a Ph.D. thesis on disc degeneration. He instilled in me a desire to study the problem of back pain throughout my career. Dr. Alf Nachemson, a fellow founding member of the International Society for the Study of the Lumbar Spine, taught me to only prescribe treatments for back pain that have been proven in well-designed clinical research trials.

I have named only a few of the people who have influenced me to present this important information to you. Although many others who helped me on this book remain anonymous, their contributions were important, and I am grateful to them. They know who they are.

Since you’re reading this, you’re probably getting tired of struggling with back pain. You may have tried many types of treatments already, but so far nothing has helped. You may be starting to wonder if surgery is the only option that will finally let you reclaim a pain-free life.

If you search the Internet for information on “back pain,” you will quickly find out that you are not the only one whose back hurts. In fact, back pain is so common that it seems everyone has had it at one time or another. But there are many different types of back pain, and hundreds of ways to treat it, so how are you to know what’s causing your back pain, and what you should do about it?

In my more than 35 years of studying back pain and treating patients suffering with it, I have developed an approach to treatment and prevention that I recommend to everyone I treat. My approach is safe, effective, as painless as it can be, and less expensive than most other approaches!

Not a day goes by without a patient saying, “Thank you, doctor, for explaining what I have, what to expect, and what my options are for relief. I feel better already!” This book contains the same advice I give my patients: down-to-earth explanations of what is wrong, what to expect, how to get relief, and how to prevent the pain from recurring. It has been proven in medical studies that an understanding of the problem is half the cure. The object of this book is to give you: 1) an understanding of the seven types of back pain; 2) a way to determine which type is affecting you; and 3) information on what really works to prevent and cure your pain.

There are many astonishing “treatments” described on the Internet that I don’t recommend, either because they are not proven to work, they do not provide lasting relief, or because they are dangerous compared to safer and less expensive alternatives. And, although surgery is certainly necessary in some cases of back pain, I have found that the vast majority of problems are cured without surgery. People often get frustrated after trying numerous treatments and painkillers that don’t solve their problem, and they conclude that surgery is their only option for relief. What they don’t realize is that it’s often the very treatments they think should be helping them that actually
hinder
their own body’s efforts to heal! In this book, I will tell you what treatments to avoid and why they may be making you worse.

I’ll also give you stories of real-life back-pain sufferers. These people have agreed to tell you their stories in the hope that their experiences will help you. You may very well recognize your own problem in one of these stories and realize that you are not alone. You will read how other people with a problem similar to yours found out what was wrong, how they found relief, and how they avoid recurrent attacks of pain.

There are many myths surrounding back pain, such as: we have it because we walk upright; it is all in your mind; specific back exercises will relieve it; and good posture will prevent it from happening. However, the facts are a bit different: most back pain is genetic; it’s really your back and not your mind; back-specific exercises may aggravate it; and good posture does not entirely prevent you from having an attack of back pain. I will explain why these myths, and others, are not helpful in understanding why you suffer from back pain, and how believing in some of them may be keeping you from getting better.

Rarely should back pain keep you from doing the things you enjoy, like golf and sex. We do not have to suffer from it as much as we do. I will explain when to worry and when not to worry about your pain, when to “walk if off,” when to run (hobble) for medical help, and what treatments to avoid that may actually make your pain worse!

Every year I am asked to give a lecture on back pain to the senior class of the University of Miami’s nationally recognized Physical Therapy School. I start out the lecture by asking the students, the majority of whom are under the age of 30, “Raise your hand if you have suffered from back pain severe enough to have warranted seeing a doctor?” Much to my amazement, each time I ask these young people, more than 50 percent of them raise their hand. This is true year in and year out. Back pain is an epidemic in modern societies, affecting more than 80 percent of people at one time or another during their life. Back pain is allegedly second only to the common cold as a reason for time lost from work. Everyone knows someone who has suffered from back pain. But what causes back pain? Why is it so common? Before answering these questions, let’s look at one other interesting aspect of back pain. Even though it is so common, it is rarely serious.

My father suffered intermittent severe bouts of back pain that would render him helpless — an unusual state for him — for a day or two at a time. I recall that he would take aspirin, rest for a few hours to allow the acute spasms to subside, then — slowly, gingerly, painfully, and crookedly — get out of bed and walk it off!

As he got older his attacks occurred less frequently and were less severe. It wasn’t until years later that I would understand why he had these attacks and why they became less frequent as he aged. I would also learn how he could have prevented the frequency and severity of the attacks that he suffered from, through exercise and a healthier lifestyle.

His sister, my aunt, was not as lucky as he was. She suffered from neck pain for many years, and while I was in medical school she began to develop terrible symptoms of loss of balance and aching throughout her body. She went from doctor to doctor, but none could determine what was wrong, and a few of them labeled her neurotic.

One day while I was visiting her she described her symptoms and frustration with the medical advice she had received. I coincidentally had just rotated on the world-famous neurology service at Thomas Jefferson Medical School, where I had learned how to diagnose myelopathy, a disease of the spinal cord that causes loss of balance, stumbling, aches and pains in the arms and legs, and propensity to fall. I recognized her symptoms and arranged for her to see my neurology professor. He performed a myelogram, a test in which x-ray contrast dye is injected into the spinal canal, and confirmed that my aunt had pressure on her spinal cord from spinal stenosis (constriction of the spinal canal). She underwent surgery to relieve the pressure on her spinal cord, but her condition was too advanced and she subsequently died from complications of progressive paralysis. I was devastated by how this could have happened to her and vowed to determine how it did and what could have been done to prevent it!

As I was to discover later, my father’s back pain and my aunt’s spinal cord disease had been related to the same phenomenon: disc degeneration. Disc degeneration is a condition in which the normal cushioning function of the spinal disc is lost through the aging process, and it leads to spinal pain in a variety of ways. What I learned about disc degeneration, the most common cause of back pain, will help you understand what may be happening to you to cause your neck, back, arm, or leg pain.

One of the things that I have learned is that it is not our fault that we have back pain; it is because we are human! The first myth concerning back pain is that we have it because we walk upright on two feet. Wrong! Man’s best friend, our loveable pooch, who walks on all four legs, is as likely to have back pain as we are. On the other hand, our feline friends, cats, are not! It seems that back pain, slipped discs, spinal stenosis, and arthritis of the spine are the bane of people and dogs, but not cats. And the reason for this is in our genetic code and how it programs our discs to age before the rest of our body. We are just beginning to learn that conditions that cause back pain are more common in some species than in others. Unfortunately, we are one of those species that are susceptible to back pain.

One of my professors told me of a humorous conversation he had with one of his patients. The patient complained about the surgical fee my professor charged him to perform a disc excision. He wasn’t upset that the fee was too high; rather, he thought it was too low! It seems that the patient had paid a higher fee to a veterinarian to perform a disc excision on his dachshund than the professor had charged the gentleman for his own disc surgery. I tell you this story only to illustrate that we share our susceptibility to disc herniation with our canine pals. Misery loves company!

The bad news is that most of us do have the genetic makeup for disc degeneration, which leads to painful back disorders. The good news is that, unlike our canine pals, we can do something to keep these disorders from hurting and harming us.

Back pain is not our fault; we are programmed to get it because we belong to the human species. But, unlike other species, we can do something about it! First let us look at why we are genetically predisposed to painful spinal conditions so that we can understand how to prevent back pain and how it will be treated in the future.

The discs in our spine are genetically programmed to prematurely age, degenerate, or deteriorate, however you want to describe the phenomenon. This can occur as early as in our 20s! It is not unusual for me to see a teenager suffering from back pain that is caused by a prematurely aged disc. I wondered why this should be, so I asked one of my students to analyze the family histories of an unusual group of 63 young people who, by the age of 21, had undergone surgery for a herniated “slipped” disc. We then compared them to the family histories of another group of 63 people of the same age and sex who never had a history of back pain or disc problems. A significant number of relatives of the symptomatic youth had a history of back pain or herniated disc compared to the families of the group of young people who never had symptoms. Genetic experts interpreted these findings as strong evidence for an inherited susceptibility to back pain and disc herniation. We published these findings in the medical literature.

Subsequent clinical studies of adults have provided further evidence of a genetic basis for spinal disc degeneration in humans, as well as the relationship between disc-degeneration back pain and disc herniation. In the final chapter of this book we will explore the current research into how to replace the defective genes that cause discs to age before the rest of our body in order to prevent back pain.

Why does our genetic makeup cause the discs in our body to age before the rest of us? How does aging of the disc cause pain? In order to answer these questions, we must first look at how a normal disc is made and how it functions.

The 23 discs in our body are positioned between the vertebrae (the bone blocks that support your spine) and are firmly attached to them. They cushion our spine and yet allow our spine to move in all directions. The center of each disc is composed of a gelatinous tissue that functions like a sponge (nucleus pulposus) that soaks up water so strongly that it is hard to squeeze it out. The firmly held water in the center of the disc distributes the weight of your body evenly against your vertebrae much the same way that air in an automobile tire distributes the weight of your car on the road.

Your spinal discs are living structures that contain cells that produce and maintain the nucleus pulposus. Since there are no blood vessels in the disc, the cells depend on diffusion to move nutrients into the disc and waste out of the disc through the nucleus pulposus, which the cells themselves produce and maintain. If something impairs the flow of nutrients into the disc, the cells will get sick and begin to die off. The nucleus will break down and no longer hold water as tightly in the disc, and the disc will deflate. The concept of the disc as a living structure with cells that produce a gel-like center that holds water will be important to understand in
Chapter 11
, where we explore how to keep your discs in good shape and prevent back pain from occurring.