And which of modern medicine’s go-to treatments just don’t work
As far as I’m concerned, the science couldn’t be clearer—the right treatment for back pain is a settled question. And it has nothing to do with drugs or surgery!
In fact, I was even invited to write an editorial about it that was published in the esteemed Annals of Internal Medicine nearly 15 years ago.
And from 2002 through 2007, I was principal co-investigator on one of the biggest studies on back pain ever conducted. It was funded by the U.S. Health Resources and Services Administration (HRSA). We gathered data from over 700 studies from around the world. We organized a consortium of over a dozen accredited chiropractic colleges and medical schools, such as Harvard Medical School and Jefferson University Hospital, and had committees of dozens of clinical researchers to review the results. And we concluded the same thing that “hands-on” healers had concluded a century ago, and that modern research had even concluded a decade before:
Drugs and surgery should be your last resort!
There are much more effective strategies for relieving both acute and chronic back pain—no matter what the cause. So, please, before you reach for that bottle of pain pills…before you subject yourself to an endless cycle of x-rays and MRIs…and certainly before you sign that consent to surgery—please, consider the “alternatives” FIRST.
I’ll tell you more about them in just a moment. But first, it’s helpful to know why back pain is such a common problem. And believe it or not, it’s a problem that has evolved right along with mankind.
The great evolutionary trade-off
Last month I told you about the importance of your gait (or how well you walk) as a key to health and longevity, especially as you get older. But it’s not about how much you walk. It’s about how well you walk. And indeed, it’s the ability to walk upright that sets humans apart—but it’s also what sets us up for a lot of pain as well.
Walking has been a key factor in the ability of humans to survive. In fact, the ability to walk upright on two legs is a distinctly human trait. And throughout human history, this trait has freed the hands so that, together with larger brains, humans could express their creativity and productivity to build our modern, “man-made” world.
One important trade-off is that in order to walk (and run) more effectively, the legs needed to be placed more narrowly together than they are on other, four-footed mammals. This effect results in a narrower pelvis, especially at the hips.
However, humans have developed very large brains. So women need to have wider hips to allow infants to pass safely through the birth canal. (Interesting side note: Humans are the only animals who have such potentially difficult delivery, which is why we call it “labor.”)
But since you can’t walk effectively if the hips are too wide, human infants were born at earlier and earlier stages of development, while the brain is still immature. So human young are the most immature
creatures in the universe, and require a prolonged period of dependency— with implications for nuclear family, extended family, and human social organization as a whole.
Consider it a grand evolutionary biological compromise between upright posture, freeing the hands, and having bigger brains.
But there’s another tremendous impact that walking upright has had on humans. One that millions of people struggle with every day—back pain.
From discomfort to disability
The spine provides structure to the entire body and helps protect the vital organs. It also provides the protective conduit for the “wiring” that runs to all the parts of the body—the spinal cord and the spinal nerves.
In animals that walk on all fours, the natural design of the spine is like a simple suspension bridge. But over time (millions of years, probably), humans began to stand erect. And the shape of the spine converted from a suspension bridge to a shallow S-shaped (or sigmoid) curve…to provide balance, structural support, and some “suspension” as well as “shock absorption.”
But as you can imagine, pounding away against hard surfaces while walking not only affects the joints of the legs, but the shock waves work their way up through the pelvis to the spinal column and the individual vertebrae. The result is degenerative arthritis, or osteoarthritis in the spine.
And just like in other joints, osteoarthritis of the spinal vertebrae can lead to stiffness. As well as contribute to bony outgrowths that can impact and irritate the spinal nerves that branch out from the spinal cord. These kinds of irritations are common in the arms and the legs (“pinched nerves”). And on a chronic basis, they can cause the familiar condition of sciatica.
In the spine itself, the middle 12 vertebra are held relatively rigid by the ribs, but the seven cervical vertebrae in the neck, and the five lumbar vertebrae of the lower back have more degrees of freedom, and less support. Which is why lower back pain is such a universal source of discomfort in humans.
Of course, when there is a sudden rupture of a spinal disc (or cushion), or even a traumatic fracture of a portion of a vertebra, there can be sudden debilitating pain.
However, even without a sudden rupture or traumatic fracture, low back pain can be disabling. In fact, it’s the most common cause of disability in working Americans (those who still have work).
But regardless of the origin of your pain, the treatments are the same.
The best ways to beat lower back pain, naturally
While it may seem counter- intuitive…one of the most important and simplest things to do when your back is sore is to actually keep moving! Gentle exercising, such as walking and swimming, are good for your lower back, provided you have not developed a disabling condition. In fact, not moving enough contributes to developing the discomfort in the first place.
And a new study conducted at the University of Tel-Aviv in Israel shows that walking is as effective as clinic- run rehabilitation programs for back pain.1
And it only takes as little as 20 minutes twice a week.
In addition to walking, acupuncture (as featured in last month’s issue of Insiders’ Cures) is another extremely successful treatment for relieving low back pain. Sir William Osler, who was a leading physician at the University of Pennsylvania, Johns Hopkins, and then Oxford, during the late 19th and turn of the 20th century recommended acupuncture for the treatment of lumbago (lower back pain) through the 3rd edition of his classic textbook of medicine in 1910. (Unfortunately, all mention of acupuncture disappeared in subsequent editions of his textbook issued after his death.)
But the No. 1, proven treatment for relieving back pain and restoring function, based on decades of indisputable science and data is…
Spinal manual therapy—or an “adjustment” carried out by a chiropractor or a physical therapist.
The original “bone setters” helped pave the way for “drugless healing”
The problem of low back pain was primarily responsible for the success of two entirely new medical systems that arose in the American mid-west during the late 19th century. First osteopathic medicine and then chiropractic medicine sprang up in regions where there were fewer doctors practicing.
There had been a tradition in both European and Asian societies (whose members emigrated to the American west) of folk healers and “bone setters” that offered “adjustments.” So osteopaths’ and chiropractors’ ability to “lay on hands” and physically manipulate the back and the body back into shape— and health—was a big attraction to suffering patients.
Another big attraction of these hands-on healers was that they promoted “drugless healing.” Which allowed people to avoid taking the drugs of the time. Some of which contained toxic compounds like arsenic, lead, and mercury. So, seeing a chiropractor or osteopath wasn’t just about getting effective physical treatments. Opting for osteopathic or chiropractic therapy saved people from dangerous, unpleasant, and less effective (or completely ineffective and even toxic) regular medical treatments. A good plan for our present day as well.
Unfortunately, despite the evidence, the benefits of chiropractic therapy got overshadowed by the supposed “breakthrough” of back surgery. Meantime, back surgeons got into a crisis of their own…
Don’t wait until it’s too late
About 10 years ago, the problem of “failed back” surgery had become so common that in some states, insurers were refusing to provide malpractice insurance to doctors who perform back surgery.
I attended Congressional field hearings in Pennsylvania to determine whether or not patients should be able to obtain back surgery in the state at all. Gov. Ed Rendell testified in these hearings. We had met before, when I opened the C. Everett Koop Community Health Education Center in Philadelphia in 1996, and we spoke afterward. He was quite open to the idea that most patients with back pain do not require surgery, and should not get back surgery. If only the medical community was as open-minded.
Of course, it wasn’t a secret. In fact, it was known for a long time in the U.S. that acupuncturists, massage therapists, spinal manual therapists (chiropractors), and even herbalists were helping people with back pain.
Granted, it was usually after a patient had received an ineffective medical therapy. At which point it was often too late to be able to heal naturally.
And since the interpretation of all research tends to be that we still need more research, the problem of low back pain has continued to be studied. Long after the average doctor and patient should have had the results they needed to guide sensible and safe treatment.
Even today, large hospitals are still doing studies proving that patients with low back pain can be sent directly for physical therapy the same day for successful relief—without even waiting to do an x-ray or MRI. (See the news brief “Back Pain? Skip the MRI!” that appeared in the December 2012 issue of Insiders’ Cures for more details.)
Having to wait for more studies just prolongs the agony.
So if you suffer from low back pain, skip the expensive medical tests and surgery. And stay as far away from steroid injections as you can! (For more on this topic, refer back to the Daily Dispatch from May 10th, titled “A shot in the dark.”
You can get rapid relief from a licensed chiropractor, physical therapist, acupuncturist, or qualified massage therapist. And if you can, keep moving.
Sidebar: Three herbal pain soothers worth a try
While they’re not a substitute for effective spinal manual therapies, there are several herbs that can help relieve pain. They include:
- Boswellia serratta extract (gum)—400 -500 mg/day
- Curcuma longa (root) (Tumeric)—200 mg/day
- Withania somnifera (root extract) (Ashwaganda)—500 mg/day
1. “An aerobic walking programme versus muscle strengthening programme for chronic low back pain: a randomized controlled trial,” Clinical Rehabilitation 2013; 27(3): 207-214