As a practitioner in the field of back pain and a member of ‘Backcare’ the UK’s national back pain association I receive regular updates on current research and recommendations. The most recent publication contained several interesting articles which I will summarise and share with you.
Orthopaedic surgeons speak out about what they see as the alarming trend in dangerous and unjustified back surgeries.
To quote George Ampat a consultant orthopaedic surgeon based at Royal Liverpool University Hospital ‘Unfortunately, there is a false belief that surgery or new technology can fix back pain. This is far from the truth.’ He says that out of 100 patients who see a health professional for back pain 97/98% will get better without surgery through exercise and over the counter medication.
There are many products on the market for the condition known as sciatica, most of which you will see advertised for a while before they disappear – usually because they don’t work. Sciatica is usually caused by a collapse of the spinal discs pushing the intervertebral cushion out, a bit like squeezing jam out of a doughnut. Fortunately, with time and stability work this will usually ease within a few weeks. One research study in the US looked at the results of surgery and showed a benefit for up to 8 years after surgery. In the same study, those who did not have surgery also continued to improve over the same period. Another study looked at the return to work ratio of those having surgery v those not having surgery. The result? 26% of those having surgery returned to work v 67% of those who didn’t. In addition, there was a 40% increase in the use of painkillers in those who had surgery.
Exercise myth busted - Don't delay, be active:
Nick Sinfield, a chartered physiotherapist says that a common effect of pain is that you become fearful of movement or believe that a certain movement will damage something. In fact you should be moving and doing physical activities that move the spine normally. Moving with a rigidly protected back will prevent your recovery not help it. By not bending and moving correctly strain is placed on already sensitive soft tissues.
In my opinion if your back is sensitive, painful or stiff you should choose your exercises carefully. Pick those which will reduce stiffness with gentle controlled movement and minimum spinal load on the spinal structure. This type of exercise will improve the function of the spine, enabling it to cope better with everyday life. The ligaments and muscles which support your back require strengthening and rest will only weaken these leading to more back pain.
Remember the proven benefits of exercise:
Increases blood flow to all muscles which helps the healing process
Reduced muscle spasm, especially with biomechanic based anti-spasm techniques
Increase in your confidence in your body’s ability to move
Reduction in anxiety which helps with soft tissue relaxation.
Improved body awareness enabling you to listen to your body better in the future therefore reducing the likelihood of a recurrence.
Surgeons Speak out - Surgery can't fix all:
David Hanscom an orthopaedic surgeon specialising in complex spinal surgery says that although there is no connection between disc degeneration and pain there are hundreds of thousands of spinal fusion operations being performed for back pain every year based on MRI scans showing disc degeneration.
He says that in the over 60's, disc degeneration is present in 100% of people - most of whom do not suffer from chronic back pain. This is normal. Disc degeneration is not a disease, it is a normal part of aging, like grey hair. Add to this the research that looks at back surgery patients after 2yrs with only a third showing improvement and you can see that it is easy to end up in what he calls the 'failed back surgery syndrome' with crippling pain for ever.
So, why do so many people see surgery as the best solution?
Well, there seems to be a number of factors having an effect. Firstly, the health industry is increasingly commercialized with huge sums of money to be made from drug development and spinal devices. So it’s no wonder that these are promoted.
Add to this the fact that exercise in the UK is still almost entirely unregulated so usually excluded from being prescribed on the NHS.
Also, the training required to be effective as a back specialist forms something of a barrier to many exercise professionals. As a result only a small number of us are fully aware of all the techniques and therefore the best way to help people with back pain.
Finally, people will always tend to select the solution that requires them to do the least work. Often the choice will look like a life time of exercise against an operation and a period of recovery followed by a pain free existence. Unfortunately this view is being called into question more and more.
My opinion?
This situation is a great shame because exercise is a cost effective, less invasive and therefore risky, solution. However the fix for all this is not easy and probably would involve some form of regulation for those exercise professionals who would like to provide the service for the NHS. Also doctors and surgeons need to be aware of the success rates of the exercise alternative, and also be directing patients down this course.
You can see from this why I feel so strongly that exercise options should be thoroughly tried before progressing to surgery.
If you have any questions on this just give me a call
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