Conquer Back and Neck Pain - Walk It Off! (25 page)

The most common treatment people have for back pain today is chiropractic. I have used this method to treat patients over the years and have observed many patients who claim to have benefited from it prior to seeing me. I have also seen a number of patients who complain that their herniated disc was caused by a chiropractic adjustment. The objective of chiropractic is to relieve back pain by realigning the spine using manipulation. The manipulations may be any combination of stretching, twisting, or bending your spine by the chiropractor in so-called “adjustments.”

I have helped a number of patients over the years with a manipulation in an acute episode of back pain. I learned this treatment in the early years of my practice from a qualified practitioner. I was also invited to be the keynote speaker by the American Chiropractic Association at one of its annual meetings. It was at Disney World in Orlando shortly after it opened. My four children were very young at the time and they still remember the four days we stayed at the Contemporary Hotel inside the park because of the monorail that runs through the hotel. I presented six hours of lectures on how to determine which patients should not be manipulated. The lectures were well attended and received. Since then I have maintained a good relationship with the chiropractic profession, which has been of benefit to all of our patients.

To illustrate how I have used the chiropractic method I will tell you of several instances in which it helped people. I received a call from one of my neighbors who, while lifting a large potted plant on his patio, experienced severe low-back pain. He was lying on the floor when I arrived. He is over six-feet seven-inches tall, a former professional basketball player, and is one of the happiest and most loquacious individuals I have ever met. He informed me straight off that his pain was no joke! After reassuring myself that he did not have a serious problem, I helped him to stand up and performed a standing traction type of manipulation, which helped to straighten him. He had immediate relief from back pain. For months after this episode he would vocally proclaim my skill in every crowded venue where we would meet. How embracing! Had I known he would do this I never would have manipulated his back…just kidding, neighbor!

Another episode that comes to mind to illustrate the usefulness of a manipulation occurred many years ago. A colleague called me to see one of his patients between my surgical cases. It turned out that the lady had come from her winter home in the Bahamas in her own private plane just to have a manipulation to ease her neck pain. I saw her in an examining room alongside the operating room between my surgical cases and determined that she was a good candidate for a manipulation and performed the procedure. She had immediate relief, was grateful, and I went back to surgery. I had totally forgotten the episode when, several months later, I ran into my colleague in the courtyard of our medical center. He said that he had been carrying around a thank-you note from the lady and handed it to me. I put it in my white coat pocket and went about my business. Some time later, when I was emptying my coat pocket, I came across the note and opened it. It was a very gracious thank-you note, and attached to the note was a generous contribution to my research fund! Needless to say, I was surprised.

My son kept telling me about his friend’s mother, who had been back and forth to the hospital for chest pain. At first the doctors thought that she was having a heart attack, but all her test results were normal. She must have suffered for six months before she came to see me with pain in one area of her thoracic spine. I examined her and reviewed all of her x-rays and concluded that the pain was coming from her spine and that it was not from something serious like cancer or an infection. As I was giving her a spinal manipulation we both heard a popping sound in her back, and her pain was cured. Although there is no way to prove it, I think the manipulation straightened a misaligned joint between one of her ribs and the adjacent vertebrae. Of course my son then spread this story around the neighborhood, and I was the local hero for having cured her pain after she had suffered for so many months.

The problem with chiropractic treatment is illustrated by the following episode. It is difficult to determine who is a good candidate for chiropractic, whom it would be dangerous to perform it on, and exactly what is taking place when it is performed that relieves the pain.

My late friend, medical partner, and neighbor, who ran several miles daily to keep in shape, would suffer from periodic episodes of benign low-back pain. During these attacks he would lean to one side like the Leaning Tower of Pisa. I treated him with spinal manipulation on more than one occasion, but I was not convinced it did much to shorten his course of pain or to relieve it to any degree. He was not sure either, so we stopped doing it after a few attempts. The point about this case is that if it does not work with a few tries, quit having it done.

The point of all of these stories is that a manipulation can help relieve acute neck, chest, and low-back pain in the right candidate, but
not
in older people, not sick people, and not people who have had an injury. There is no place for it in chronic back pain, in my opinion. In fact, repeated manipulations over an extended period of time may contribute to chronic pain (more about this in
Chapter 8
).

My father may have benefited from chiropractic manipulation for his acute attacks of back pain. On the other hand, my aunt could have been seriously harmed by a manipulation for her neck pain because she had a severe constriction of her spinal canal pressing on her spinal cord. A manipulation of her spine could have left her acutely paralyzed.

Your chiropractor is well aware of who is a candidate for adjustments and who should not have spinal adjustments. I only adjust patients after I am satisfied that they do not have a herniated disc, severe spinal stenosis, a vertebral fracture, osteoporosis, arthritis, an infection, or a tumor. Rarely will I perform a spinal manipulation on someone over 60 years of age, and I would not manipulate anyone under the age of 16. These are the age groups in which serious conditions are more likely to be causing the back pain.

There is some clinical research — evidence-based medicine — that shows that the natural course of acute low-back pain attacks can be shortened by manipulations. I have seen this in my patients and use this method when it is indicated.

Periodically I will see a patient who has gotten into the habit of repeatedly twisting their neck or low back for relief. I call this “auto-manipulation,” and I do not advocate this. I think that repeated passive twisting of the spine must contribute to further weakening of a degenerated disc. Although the manipulation feels good at the time, it may result in more back pain a few days later when a sprained disc becomes inflamed and painful.

Another scenario I sometimes see is the person who had dramatic relief of an acute back pain by a chiropractic treatment. They are then convinced to have “maintenance treatments” to prevent further attacks of pain. The manipulations are performed not only at the originally painful area of the spine, e.g., low back, but along the entire spine. The person then begins to develop aching along the whole spine but does not attribute these new symptoms to the repeated manipulations. When I see a patient with this history I suggest that they stop all treatments, and their generalized spine pain goes away. I have seen similar symptoms that have been caused by repeated deep massage or the use of a vibrating device. I suspect that the small joints in the spine — the paired facet joints at each disc level of the entire spine — are irritated by repeated manipulation or vibration and become symptomatic from these maneuvers. For this reason I do not recommend repeated manipulations, massage, or vibration for treatment of spine pain.

There are possible risks from manipulation of the spine, just as there are with any treatment. The most serious reported complications of spinal manipulation are stroke, paralysis, massive disc herniation with cauda equina syndrome (see page 30), and vertebral fracture. Degenerative disc disease in the neck usually results in the build-up of bone spurs (osteophytes) around the border of the disc. There is a pair of arteries (vertebral arteries) carrying blood to your brain in a tight bony canal on either side of the discs in your neck. These arteries can be constricted by bone spurs from adjacent degenerative discs. There have been cases in which a manipulation of the neck caused the bone spurs to block the arteries, causing a stroke, blindness, and even death. The same bone spurs can contribute to spinal stenosis in your neck. There have been case reports of paralysis coming from manipulation of an arthritic neck when the bone spurs were made to press harder into the spinal cord. I do not recommend that older individuals who are prone to degenerative arthritis have manipulation for pain because of these risks.

Literally, just as I was about to write this section my wife handed me an advertisement from the
Miami Herald
. “How Space Age Technology Is Solving Back Pain Without Drugs Or Surgery,” complete with a toll-free number. I called, and the presumable inventor’s recorded voice suggested I leave my name and address and he would send me the information on this dramatic space-age cure. The ad listed a web page that provided the name of the device, which I immediately Googled. It turned out to be yet another iteration of a traction device to reduce herniated discs. The web page was cleverly designed with links to medical journals touting the efficacy of the device. One of the articles featured a pre-and post-treatment MRI scan that showed reduction of a lumbar disc herniation. The treatment requires that you spend 45 minutes a day for a minimum of two weeks on the traction machine to guarantee 86 percent good results! I have had patients tell me that this course of treatment cost them more than $3,000. In my experience, if they had walked the pain off for two weeks instead of undergoing this treatment, they would have had better than a 90 percent chance of “good results” without the expense. This is the type of cleverly presented information that often appears in advertisements and on websites, which you must try to interpret in an attempt to find a cure for back pain.

The rationale for traction treatments is that the normal disc height is restored and/or disc herniations are reduced, thus taking the pressure off of the nerves to relieve the pain. What seemed to be a well-designed medical study from Scandinavia showed that traction was more effective than waiting it out in cases of painful lumbar disc herniation. I had already seen many patients who had undergone hanging traction treatment for disc herniations and back pain in a center devoted to this treatment in Miami. The center did not last long. I was not impressed with their results and was not impressed with the results of the Scandinavian study either. I have seen several patients who were injured by hanging traction devices over the years. I think this is a potentially dangerous method of treatment, particularly for older individuals who are susceptible to stroke. I do not recommend this type of treatment for my patients.

From an anatomical standpoint, most symptomatic disc herniations occur when the central spongy part of the disc (nucleus pulposus) “button holes” through a hole in the outer rim of the disc (annulus fibrosus). When traction is placed on this type of disc herniation, the button hole tightens up and traps the displaced disc in the spinal canal. The traction has the effect of further stretching the nerve root over the disc herniation, which can result in more pain and nerve damage. I have talked to a number of patients who said that their leg pain was worse as the result of traction, and I suspect this is what happened to them.

I have seen patients who were suffering only from back pain who later also developed leg pain as the result of traction treatment. I suspect that a degenerated disc was actually herniated by the traction in these cases.

Neck traction can relieve acute severe arm pain from a herniated disc. There are neck-traction devices that you can use in your home that have been around for as long as I can remember. I have not prescribed them in recent years because they are cumbersome and it is difficult to teach patients how to use them. Also, the arm pain is relieved while you are hanging in the device, but it returns as soon as the traction is released. You cannot sit around all day long with your neck in traction. I find that patients get more relief from walking it off than they do sitting in traction.

Exercise is very important for the treatment and prevention of acute and chronic back pain. In fact, I think it is one of the most effective things that you can do. There are several studies and observations that I have made to convince me that exercise is important. One study compared one group of people who were treated with two days of bed rest for acute low-back pain with another group who were treated with one week of bed rest. The people who were mobilized after two days had 46 percent fewer sick days, suffered less, and recovered more quickly. Another study looked at three groups of people who suffered from chronic low-back pain. One group was treated with vigorous exercise, a second group with mild exercise, and the third group with massage and other modalities. The vigorous exercise group had the best pain relief and return of function compared to the other two groups. The final study was performed on firefighters. Again, three groups were compared. The first group exercised vigorously every day. The second group exercised intermittently, and the third group did not exercise at all. Over a three-year period, the firefighters who exercised vigorously every day had significantly fewer and less severe attacks of back pain and lost less time from work than the other two groups. The best way to treat acute back pain is to walk it off (first study), and exercise is also the best way to treat chronic back pain (second study). In addition, exercise is the best way to prevent back pain (third study). I have found this to be true for my patients, and it’s also what works for me!