Borenstein - Back in control!: a conventional and complementary prescription for eliminating back pain

DAVID BORENSTEIN, M.D.

Copyright 2001 by David Borenstein, M.D.

All rights reserved. No portion of this book may be reproduced or transmitted in any form or by any means without the written permission of the publisher.

M. Evans and Company, Inc.

216 East 49th Street

New York, New York 10017

Library of Congress Cataloging-in-Publication Data

Borenstein, David G.

Back in control! : conventional and complementary prescription for relieving back pain / by David Borenstein

p. cm.

ISBN: 978-1-59077-015-3

1. Backache 2. BackacheAlternative treatment. I. Title

RD771.V217 B669 2001

617.5'64dc21

2001023344

Book design and typesetting by Evan H. Johnston

Printed in the United States of America

9 8 7 6 5 4 3 2 1

ATTENTION:

This book includes the most up-to-date information about conventional and complementary therapy for low back pain, based upon my twenty-two years of clinical experience with people with spine problems. The object of this book is to educate people about low back pain and offer relief of this disorder. Despite these good intentions, this book cannot offer any guarantee about the ultimate resolution of your back condition. Do not be tempted to use this book as a substitute for a medical evaluation. An examination by a health professional is always an appropriate approach to the evaluation of low back pain. Your physician has the unique advantage of listening to your description of your problem and completing a physical examination before forming an opinion about your back pain. The information in this book may differ from the advice offered by your health care provider. The recommendations in this book are not meant to replace medical treatment or diagnosis by your physician. When in doubt about the advice you have received, obtain a second opinion from another health care professional. Ultimately, you are solely responsible for your own medical decisions.

This book is dedicated to all my patients who have given me the honor of being their physician. This work is the result of their persistent requests to put my explanations of their back problems on paper.

I want to thank the individuals who have been willing to lend support, encouragement, and expertise in the development and review of this book:

Arthur Frank, M.D., medical director of the Weight Management program at the George Washington University Medical Center, for his thoughtful comments concerning the food and nutrition sections of this book.

John Starr, M.D., orthopaedic surgeon, for offering his expertise in reviewing the surgical components of this book.

Tom Welsh, R.P.T., physical therapist, for his generosity and friendship in allowing his exercise program to be included in this book.

Virginia McCullough, for organizing my first manuscript proposal, finding my book agent, and helping me with my first draft.

Marian Betancourt, for helping me with my final draft of this book.

Nancy Love, my literary agent, for having confidence in me and finding a company to publish my book.

Judy Guenther, illustrator, for taking my ideas and drawing illustrations that make understanding much easier.

PJ Dempsey, my editor at M. Evans, for guiding me through the beginning, middle, and end of a very long process that has resulted in the publication of this book.

My partners at Arthritis and Rheumatism AssociatesJohn Lawson, M.D.; Werner Barth, M.D.; Norman Koval, M.D.; Herbert Baraf, M.D.; Robert Rosenberg, M.D.; Evan Siegel, M.D.; Emma DiIorio, M.D.; and Sheila Kelly, M.D.for being supportive and understanding during the development and production of this book.

I knew better than to bend over to grab a pair of socks from the bottom drawerthat was my first mistake. I knew I should bend my knees and reach down, rather than bending in half. Twisting from the waist was my second mistake, although I had used that motion thousands of times and it had never affected me the way it did now. Just as I started to straighten up, I felt a sharp pain on the right side of my back as the muscles there went into spasm. The pain was like a knife cutit literally took my breath away, and I couldnt move.

Rational thinking and severe pain do not go hand in hand. In fact, when one is in pain, the most ridiculous thoughts seem perfectly reasonable. Bracing myself against the dresser that morning, I began to consider how I would put my clothes on without feeling the excruciating pain in my back. The socks in my hands seemed miles away from my feet, so how would I ever get them on? Limping as I put one foot in front of the other, bracing against the furniture for support, I began to gather up other clothes, being careful to test each small motion to see if it would bring on more pain. Putting on my shirt wasnt so bad, but I couldnt imagine how I would get my pants on. So, maybe I could just show up at the office without them. Perhaps the staff wouldnt even notice!

I felt like a prisoner in my body, stuck in one place, in one position. I tried to straighten up a couple of times before I was successful, but my back was stiff and it took great effort. As if I didnt have enough going on, a big sneeze exploded before I could prevent itand the spontaneous body movements that came with it. I had thought my pain was a 10 on a ten-point scale, but I was wrong. The sneeze shot me up to 14 or 15 for at least a few seconds. In addition to the increased intensity of the pain, it was now spreading up and down my back. After the second sneeze, I thought I was going to die.

Eventually, I managed to work up the courage to complete a series of bracing and bending movements, and carefully using the handrail on the stairway, I limped down to face breakfast, which I ate standing up. Then I took a couple of pain relievers, hoping that as the day continued my range of motion would improve. Bending over the sink to brush my teeth was out of the question, so I accomplished that task with a towel around my collar and a plastic cup of water.

Driving to my office wasnt so badonce I had eased myself into the car. As I drove along, I did my best to avoid potholes, which looked deeper than ever. So far, every small decision, every normally routine and insignificant task, required careful consideration. Pain and restricted motion led me to park the car in a place where no neighboring cars would limit how far I could swing my door open, because it would be a chore to get out of the car. With my back straight, I moved my legs around and held on while I stood up. Normally, I get some extra exercise by walking up the stairs to my office, but today, the elevator looked very inviting.

Pain turned my usually comfortable office into a minefield. I had to maneuver around chairs and file cabinets and desks. And the biggest mine in the field was, of all things, my soft cushion recliner. I knew a firmer chair with less give was a much better choice. Throughout the day I continued to make one small choice after another to accommodate the pain and discomfort. For example, I avoided twisting my body to see the computer screen, I carried only two files at a time, and I changed position often in order to avoid becoming stuck in one place. It goes without saying that I canceled my scheduled exercise session with my workout partner.