By: Jean Johnson for Back1Not only is it more costly than intensive rehabilitation, concluded a recent British study, surgery is no more effective in relieving the symptoms of low back pain.
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Four out of five adults will experience low back pain, according to the American Association of Orthopedic Surgeons that offer the following tips on maintaining good spinal health:
Use the correct lifting and moving techniques.
Exercise regularly to keep the muscles that support your back strong and flexible.
Don't slouch; poor posture puts a strain on your lower back.
Maintain your proper body weight to avoid straining your back muscles.
Keep a positive attitude about your job and home life; studies show that persons who are unhappy at work or home tend to have more back problems and take longer to recover than persons who have a positive attitude.
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Millions of people see physicians each year for whatever is termed in the business as mechanical or chronic low back pain – a condition defined as pain lasting for more than 12 months. The ailment knows no international boundaries, although it is most prevalent in countries with higher per capita income. There sedentary lifestyles and adequate funds to treat problems stemming from sedentary lifestyles exist. If it sounds like a cyclical thing – bingo! In the U.S. 60 to 80 percent of the population will experience lower back pain some time during their lives, while internationally the figure runs around 80 percent. The problem tends to have an onset during lower middle age – 30s and 40s – although, in addition to during pregnancy, women over 60 also report more low back symptoms. Mechanical low back pain is one of the most common causes of work-related disability in people under 45. In the U.S. alone, workers compensation costs run into the billions, and in the European Union the problem accounts for nearly half of all sick days.
“My brother essentially died of lower back pain,” said Teresa Stevens of Boise, Idaho. “He was a big man and had always been too heavy. Then when he started as a cable company repair man, he fell 50 feet from a telephone pole. After a surgery on his leg, he had so much pain he couldn’t walk like he used to and his back pain was excruciating. It was two years while he was bounced from doctor to doctor by Workman’s Comp. All the while he just got bigger and bigger until finally his heart gave out. It was so horrible to see him neglected like that. I always thought that if they’d worked harder on physical therapy with him he might be here with us today.”
Not all have stories as tragic as Stevens’. Fifty-plus Gary Rogers of Tubac, Arizona, a retired science teacher, has had low back pain for years. He tried everything but it was surgery that finally gave him relief. “It was great. It worked,” Rogers said. “Until this past few months and now the problem’s back. I’ve got an appointment to see the surgeon, and it looks like they’ll have to go in again.”
Rogers, who is height and weight proportionate and a relatively active man, says he tried all the physical therapy – and massage, too – but nothing helped. “But my situation is not that straight-forward. I broke my leg in a skiing accident when I was in my 30s, and they tell me that has figured into my back situation.”
The British study looked at 349 patients suffering from low back pain. In findings reported in the British Medical Journal, 176 patients had surgical spinal fusion, while 173 underwent intensive programs of daily physiotherapy that included mechanical exercises and cognitive behavioral therapy. “In the short term, compared with intensive rehabilitation, surgical stabilization of the spine as first line treatment for chronic low back pain patients who already failed standard non-operative care seems not to be cost effective,” wrote member of the research team, Helen Campbell of the University of Oxford. Put another way, going under the knife didn’t pay.
Physician and director of Providence Portland Medical Center’s rehabilitation unit Oregon, Molly Hoeflich M.D., commented on the latest word from Britain. “The literature on low back pain keeps flipping back and forth on what’s beneficial,” she said. “But, generally the standard of care, unless there is obvious nerve damage, is that patients should try one to three months of physical therapy to see if it won’t treat the problem.”
Hoeflich also added that “If you can encourage people to do regular exercise and try to strengthen back muscles it does seem to help.”
Irene Eder Ph.D. of Pullman, Washington says her experience is in line with Hoeflich’s understanding. “When I was a graduate student sitting for hours in a desk chair I got on the cheap to write my dissertation in, my back started acting up. Of course it hadn’t helped that I’d put on a few pounds either. So I started doing yoga aimed directly at my low back, sit-ups since my yoga teacher said the core abdominal muscles are critical in helping support the whole works, and got a food plan that helped me drop some of the weight. It was tough, but it worked even though I ended up having to see a counselor to deal with the emotional side and see why I was abusing my body in the first place.” Eder adds that twenty years down the pike and pushing 60, she’s still doing her spine and abs work and operating free of pain.
Clearly not all will be able to sew up the low back pain issue as tidily as Eder. Then again most will not succumb to death as did Stevens. Rather, it’s those in the middle like Rogers that will have to make the decisions. Surgery or rehab? According to the Brits, it’s six to one, half a dozen to the other.
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