If you suffer from back pain, it likely dominates your life. Naturally, you want to triumph over it. Victory, however, is elusive without struggle. Too often, as I am explaining treatment options to my patients with back pain, I am interrupted by the question, “Is there a pill that I can take?” Media, society and, yes, even physicians, have misled people to believe in, and rely on, the quick fix. Many treatments, including minimally invasive surgery, are promoted as solutions to back pain. Yet these quick fixes often do not withstand the test of time. None of these quick fixes are proven effective in a scientific study.
The promotion of laser surgery epitomizes the quick fix illusion. Painlessly beaming away your pain is extremely enticing, and as a health care provider, an extremely misleading promise of a quick fix. Despite any proven efficacy in its use, patients and physicians embrace this option. Ironically, many patients will also dismiss a suggestion for a steroid injection with the response, “I don’t want a Band-Aid fix.” Obviously patients recognize that the quick fix or Band-Aid approach is not only quick and easy, but also a temporary or incomplete measure. What they don’t seem to recognize is that laser surgery is a masterfully camouflaged Band-Aid.
Here is another problem with back pain: The treatment you receive is often determined by who you decide to see for treatment, and not by what’s actually wrong with your back. If you see a chiropractor, you will likely receive chiropractic treatment. If your first stop is physical therapy, then you will get physical therapy. And most problematic of all, if you start with a surgeon, you are likely to receive surgery.
Embrace the Slow Fix: Education and Exercise
My book, The End of Back Pain, is based on my 20 years of experience as a neurosurgeon treating back pain. And there’s one thing I know for sure: Educating a patient about their disability is the single most effective way to treat that disability. The more educated patient is the healthier patient. No matter what your health issue is, you will be empowered by learning more about it. It may be easier to let your physician tell you what to do, but you will have more success and better health when you learn about what is wrong in your case and participate in the decision processes.
I am an advocate of an approach of education and progressive exercise. Back pain requires a deliberate, intentional, and plodding fix. This slower fix looks to build back health rather than eliminate pain and this leads to a reduction in back pain. My approach looks to diminish the frequency, duration, and intensity of the invariable episodes of back pain. Building back health requires both a commitment to education and a sustained program of exercise.
Exercise provides a method of fundamentally changing your back. It harnesses your body’s innate capacity to adapt positively to stress.
A combination of aerobic conditioning and core strengthening works best. And not just crunches or planking core work. There is a pervasive idea that doing abdominal work will help back pain. This is partially correct, but abdominal work alone is not sufficient. Our core is comprised of much more than our abdominal muscles. The core is a circumferential group of connected muscles that includes the abdominal muscles, but also includes back muscles called the multifidus muscles. These muscles are essential to core strengthening. In the End of Back Pain, I focus on this part of the core that is usually overlooked. I refer to it as the hidden core. Your hidden core is the most important aspect and least utilized aspect of core strengthening. I have found that prioritizing the back muscles is most effective in promoting back health.
Cardiac disease provides the best analogy to this approach. Consider the following two options as a response to a patient having had a minor heart attack. The first response starts with accepting that you have been dealt a bad heart and then looking for medications or surgery to mitigate your bad fortune. The alternative response is not to accept your fate and to set out to fundamentally change the caliber and function of your coronary arteries through intense and sustained exercise and dietary intervention. Obviously, the second response is a slow fix. As with the heart, the exercises for back health represent the most important part of the slow fix.
The parable of the tortoise and the hare parallels to my slow fix solution. We have to look beyond obvious concepts that we too easily accept. It is obvious that the faster animal should win the race. In fact, if the hare were to take the race seriously, he would undoubtedly win. With this in mind, we should aspire to be the hare. But this is wrong. We fail to see the real strength of the tortoise, which is not only its dogged perseverance and focus, but its ability to resist being saddled by convictions and assumptions. Slow can win the race.
I tell my patients with back pain that they need to start their exercises while still in some pain. I tell them that letting “pain be your guide” is a potentially limiting, and thus, potentially harmful rule of thumb. I tell them to move even if moving is painful. I realize this advice is unsettling and counterintuitive, but I offer this advice as a physician and back pain sufferer myself. I know it can lead to breakthroughs in pain relief. It is the tortoise, and not the hare that is willing to take that advice and it is the tortoise, and not the hare, that prevails.
Nietzsche once said, “Convictions are more dangerous foes of the truth than lies.” Nowhere is this more evident than in the treatment of back pain. It is dangerous to be saddled by convictions or assumptions. If you are willing to think outside of the box, try something new and focus on what you could be, rather than your current state, then you will have a better chance of triumphing over your back pain.
As a surgeon, of course, I also have an interest in using surgery as a tool to help with back pain. However, surgery rarely fixes back pain. Carefully selected patients can, and often do, benefit from surgery. Surgery has increasingly been subjected to scrutiny, and often appropriately maligned, but this is a result of its misuse and overuse rather than an inherent deficiency. It is essential that, as a surgeon, I overcome the bias of the surgeon to look at all patients as surgical candidates. I want to give patients the longer solution and that’s the slow fix. I must prepare patients for the critical process of exercising for back health.
As we are often our own worse enemies is life, the same is true in confronting our back pain. Accepting conventional wisdom can often lead you down a longer path of suffering with unsatisfactory results. Challenging our assumptions, getting educated and taking charge of our back health is the safest and surest path to a more pain free existence.