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Contents

 

 

 

How the Back Works

Your Neck (cervical spine)

Your Mid-Back (thoracic spine)

Your Lower Back (lumbar spine)

You Weigh More Than You Think

Your Back is Not Alone

Chapter 4

Causes of Back Pain

Which Back-Pain Problem is More Serious?

The Causes of Back Pain

Idiopathic Back Pain

Poor Posture and Obesity

Pregnancy

Overuse or Overexertion Injuries

Traumatic Back Pain

Sprained Ligaments and Strained Muscles

Ligament Damage

Muscle Damage

Ruptured or "Slipped" Discs or Herniated Discs

Herniated Cervical Discs

Herniated Thoracic Discs

Herniated Lumbar Discs

Degenerative Back Pain

Wear and Tear

Arthritis or Osteoarthritis

Degenerative Disc Disease

Tension and Emotional Problems

Causing Back Pain

Attitude

Other Causes of Back Pain

Congenital

Tumors

Infections

Circulatory

Osteoporosis

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Chapter 5

Prevention of Back Pain

Good Body Mechanics

Standing

Sitting

Sleeping

Walking

Good Body Mechanics in Everyday Tasks

Lifting

Sweeping, Mopping, Vacuuming, Shoveling, Hoeing and Other

Drudgery:

Sports and Exercise

Chapter 6

Four Weeks to a Better Back

Everything is "99 Percent" Attitude

A Word of Encouragement and Caution

Four Weeks and Simple Spine Exercises to a Better Back

Low Back Exercises:

Four Neck Exercises

Chapter 7

Conservative Treatment

Manipulation

Bed Rest

Hot/Cold Therapy

Drugs

Massage

Traction

Braces

Other Conservative Treatments

Acupuncture

Cortisone, Novocaine and Other Injections

Chemonucleolysis and Epidural Steroids

Trigger Point Injections

Psychological Treatments

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Chapter 8

Which Professional?

Chiropractors

Osteopathic Physicians

General Practitioners

Orthopedic Surgeon

Neurologists

Neurosurgeons

Spine Surgeons

Minimally Invasive Spine Surgeons

Rheumatologists

Physiatrists

Acupuncturists

Herbalists

Physical Therapists

Yoga Instructors

Massage Therapists

Other Professionals

Chapter 9

Evaluation and Diagnosis

The Case History

Where Does it Hurt?

The Examination

Blood Tests, X-rays, EMG, CT and MRI Scans

Chapter 10

Medical Treatment

Medication

Physiotherapy

Pelvic Traction

Exercise Program.

Chapter 11

Yout Diet and Back Pain

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Nutrition

The Five Food Groups

Calories

Protein

Minerals and Calcium

Chapter 12

Sex and Back Pain

Sexual Movements

Flexion

Extension

Bringing it All Together

Chapter 13

Spine Surgery and Back Pain

Surgery May Be Unavoidable

Spinal Discectomy

Five Important Reasons to Avoid Surgery

Spinal Laminectomy

Spinal Fusion

Micro Spinal Discectomy

Minimally Invasive Spinal Surgery

Chapter 14

Percutaneous Microdecompressive Endoscopic

Spinal Discectomy with Laser Thermodiskoplasty:

Out-Patient, Same-Day Surgery

(Bandaid Surgery)

What is Percutaneous Microdecompressive Endoscopic

Spinal Discectomy with Laser Thermodiskoplasty?

Who should consider this procedure?

This procedure is not designed for patients with/contraindications:

Herniated Lumbar Discs

Herniated Thoracic Discs

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The Thoracic Procedure

Herniated Cervical Discs

The Cervical Procedure

Postoperative Care

Is This Procedure for You?

Benefits of Percutaneous Discectomy

Aging Spine and Multilevel Herniated Discs

Chapter 15

Working Together: You are the Team Leader

You are the Team Leader

 Afterward

 Bibliography

 Glossary

 Index

 

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Library of Congress Cataloging-in-Publication Data

Chiu, John C., M.D.

Four Weeks to a Better Back / John C. Chiu, M.D.

Includes Index

ISBN 1-55622-274-2

1. Health Care. 2. Back Pain. 3. Medical Treatment. 4. Surgical Treatment

(Medicine file) 1. Title

ZZ86.D47H345 1994

688-2'2544536-dc20 92--22256

CIP

Copyright © Better Mind & Body Press Online

P.O. Box 1816

Thousand Oaks, California 91359-0876

(800) 354-8554

Email: chiu@spinecenter.com

All rights reserved. Reproduction of part or all of this book is prohibited without written permission from the author.

Printed in the United States of America

1st Edition 1993

2nd Edition 1998

All inquiries for volume purchases of this book should be addressed to Better Mind & Body Press at the above address. For telephone inquiries Please call:

(800) 354-8554

 


Just ask these people about Dr. Chiu's approach for relieving back pain . . .

As martial arts is a way of life and a method for remaining both mentally and physically healthy, so too are the precepts laid down in Four Weeks to a Better Back. Many people want to turn themselves and their problems over to a professional, taking little or no responsibility for their situations. Dr. Chiu puts the problem of back pain and health in general back into perspective.

W. J.

Martial Artist, Jujitsu America, 10th Degree Black Belt

As a registered nurse, I have dealt extensively with people suffering from back pain. Still, I had no real idea how bad it could get until it happened to me. Dr. Chiu's back book has been both inspirational and instrumental in getting me back to work and back to a normal life.

R. J. L.

Registered Nurse

They say that doctors make the worst patients. Dr. Chiu's book and professionalism made dealing with my back problem remarkably easy. I knew going in all the pitfalls, but Dr. Chiu instills his patients with confidence, including the difficult ones.

G. Y. L. Jr.

Neurosurgeon

In all my years of treating back pain, I've seen many, many remedieseverything from the reasonable to the absurd. Few remedies make more sense than the advice in Dr. Chiu's new book, Four Weeks to a Better Back. Well done.

T. P., D.C.

Chiropractor


Dr. Chiu's book, Four Weeks to a Better Back is a no-nonsense approach to back care and back treatment. All the myths are dispelled and the truth rings through.

T. G.

Acupuncturist

Four Weeks to a Better Back emphasizes the positive. In addition to being lively and entertaining, it is a great instructive book for back pain. We would all live better lives by adopting Dr. Chiu's pragmatic attitudes.

G. E.

Neurologist

People come to me for physical therapy with a host of bizarre notions about their back and back pain. Dr. Chiu's book should be required reading for everybody with back pain.

G. M.

Physical Therapist

I had back pain for several years. No matter what I did, it persisted. I was getting desperate, thinking that I'd be in pain for the rest of my life! Then I tried the exercises pertinent to my particular problem laid out in Dr. Chiu's book. I've kicked the back pain habit and have gotten on with my life.

W. R.

Housewife

The highly physical nature of my trade renders me unable to work a couple of times a year, due to back pain. Dr. Chiu's healing methods have reduced the occurrences and shortened the convalescent periods the few times that my back pain has returned.

M. H.

Construction Worker and Contractor


I sit all day in front of a computer. My back gets tired and sore. After reading Four Weeks to a Better Back and applying the principles in it, I no longer suffer from nagging back pain.

B. N.

Secretary

I agree whole heartedly with Dr. Chiu's contention that life, like back pain treatment, is 99 percent attitude. His approach to treating this epidemic condition is right on target.

R. S., Ph.D.

Psychologist

After years of back pain, I tried the methods and procedures laid out in Dr. Chiu's book, and finally opted for the minimally invasive spine procedure he describes. My recovery has been nothing short of miraculous.

J. K. N.

State of Alaska Saftey Official


Dedication

This book is dedicated to all back pain sufferers.


Acknowledgments

I wish to acknowledge my indebtedness and gratitude to the thousands upon thousands of patients who have trusted me with their back problems. They are restrained and imprisoned by their chronic back pain. They have borne their burdens with greater insight, courage, and experience that I believe I would or could not be capable.

These patients have been my principal teachers. When Robert said, "I'm in agony and can't sleep. I can't walk. And I can't enjoy life because of my back pain," he gave me a new insight on the severity of how back pain affects a person. When Judy mentioned that low back exercises helped her back problem, this prompted me to appreciate the importance of low back exercises.

When Charles mentioned that physiotherapy and anti-inflammatory medication gave him relief from back pain, he taught me something about the importance of physiotherapy and medication. When Commissioner John Diaz and others obtained relief from percutaneous lumbar discectomy as outpatients, this proved to me that the procedure was effective. Many other patients have taught me over the years the efficacy of various procedures, including non-invasive spinal neurosurgery and micro spinal surgery.

In addition, I wish to thank the California Legislature and the City of Los Angeles for their recent recognition of my "Outstanding Contributions and Expertise in the Field of Minimally Invasive Spinal/Neurosurgery."


I am happy and proud to acknowledge as well how much I have learned from my teachers, other neurosurgeons, orthopedic surgeons, chiropractors, podiatrists, young residents, trainers, fellows, nurses, students, visiting professors and surgeons, never fearful of questioning me and willing to share their ideas and to relinquish ideas they previously held. (Many were constructive, contributing co-workers in my clinical work and clinical studies. Their contributions are known and acknowledged.)

I thank Elizabeth L. Gould, Ronald Soderquist, Ph.D., my son, Stanley, for his computerized model demonstrating laser thermodiskoplasty shrinking a lumbar disc, and my staff, including Nancy Carmichael, Jenise Bell, Bonnie Northcutt, Helen Guerro, Thrisa Pollock, Sunny Chaing, Eleanor Yuan, Ben Liu, and others for their support and research on this project. In addition, I'd like to thank Thomas Pollack, D.C., Thomas Clifford, M.D., Garth Embree, M.D., William Stryker, M.D., Timothy Ross, M.D., and William Davis, M.D. of Memphis, Tennessee for their help and knowledge, and Judy Susuki for preparing the illustrations, and Nancy Carmichael for demonstrating the back exercises.

It is impossible to list individually each of the dear friends whom I care for and whose caring for me has supported me during my years of training, practice, and writing this book. I do so non-verbally with joyful confidence that this expression of my good fortune and thankfulness will nevertheless be heard.

Above all, I wish to thank my father, Dr. Stanley Chiu, my mother, Irene, my wife, Susan, my children, Stanley, Elizabeth, Christina and John Jr. for their patience and critique, especially Elizabeth for her reading and comments.

Finally, I thank the editor and publisher, Bill Harrel, for his continued efforts, concern, encouragement, and advice.


Preface to First Edition

If ever there was a person qualified to give advice on back care, it's Dr. John C. Chiu, a renowned neurospine surgeon. His experience treating back pain and back conditions is unprecedented. Dr. Chiu lectures and teaches about back pain around the world, and he remains on the cutting edge of technology, ushering in new surgical procedures, such as percutaneous lumbar discectomy and laser percutaneous lumbar discectomy, that require no tissue dissection and less trauma.

Dr. Chiu's list of credentials reads like Who's Who in Medicine. He obtained his medical degree at Baylor University College of Medicine. His neurosurgical training, residency, and neurosurgery fellowship were completed at the renowned Mayo Clinic, University of Lund, Sweden,University of Zurich, Switzerland, UCLA Medical Center, and other outstanding medical institutions.

Dr. Chiu is highly trained in a number of back care procedures, such as microneurosurgery, spine stabilization (fusion), microdiscectomy, percutaneous lumbar discectomy, and several others. He continuously augments his skills with various fellowships/courses involving the latest procedures and theory, and he has helped pioneer several new procedures, including three back procedures, percutaneous microdecompressive endoscopic lumbar discectomy, percutaneous endoscopic laser lumbar discectomy, and percutaneous endoscopic cervical discectomy, that reduce surgical trauma and loss of work. He has also lectured worldwide on the back, spine, back pain and high-tech endoscopic spinal surgical procedures.

Dr. Chiu has been instrumental in the development of the instruments used in the so-called "back pain without stitches," the discectome used in percutaneous lumbar discectomy and percutaneous cervical discectomy, and the laser probe used in


laser percutaneous laser lumbar discectomy. Through the efforts of Dr. Chiu and his colleagues, thousands of back pain sufferers are finding relief without having to undergo lengthy, traumatic back surgery, requiring dissection, transfusions and long recovery periods.

Dr. Chiu has been recognized by the California Legislative Assembly and the City of Los Angeles for his "Outstanding Contributions and Expertise in the Field of Minimally Invasive Spinal/Neurosurgery" and his work in establishing the Sino-American Medical Scientific Educational Exchange. He belongs to numerous professional associations and organizations. And he has been recognized by several of them for his medical pioneering excellence.

And now Dr. Chiu shares his eminent wisdom with you in this informative new book. Four Weeks to a Better Back can show you how to relieve back pain and take care to prevent further occurrences.

William Harrel

Computer Journalist


Preface for 2nd Edition

As we move headlong into the Twenty-First Century and rapidly into cyberspace, some things remain constant. Back problems are still painful, but as neurospine surgeon Dr. John Chiu points out throughout the first edition of his popular book Four Weeks to a Better Back, most back conditions are still effectively treated with conservative treatment, such as a good diet and exercise.

However, a lot has happened in the field of medicine since this book was published back in 1993. Back then, Dr. Chiu and a few other pioneers were just embarking on a whole new way to treat persistent back pain that would not respond to conservative treatment, percutaneous spinal discectomy.

Today we know this type of treatment as minimally invasive spine surgery, a form of surgery that requires no dissection of the body, no removal of bone, ligaments or muscle, no stitches, and little or no general anesthesia. Thanks to advancements in endoscopy and video imaging, new procedures are being developed, procedures that allow back pain sufferers to benefit from same-day, out-patient treatment with a speedy return to daily activites.

I've known Dr. Chiu for many years. He has made essential contributions in the development of these new procedures. His perserverence and creativity has helped not only to bring this new technology to the forefront, but he has also played a crucial roll in the development of the tools and equipment used in minimally invasive spine surgery, and extended its use to the neck and midback.

When Dr. Chiu wrote this book several years ago, minimally invasive spine surgery was in its infancy, and was primarily performed at the lumbar level of the spine. Little was understood about the effectiveness and usefulness of the procedure for treating other areas of the back, as well as treating patients with more than one herniated disc. Since then, Dr. Chiu has expanded the technology to include


the application of minimally invasive (microdecompressive endoscopic laser) spine surgery to all levels of the spine, and he has even used it to help patients who suffer from back problems at more than one problem area of the spine.

The second edition of Four Weeks to a Better Back is offered as an update to the first edition, serving primarily to bring back pain sufferers up to date on the marvelous new innovations in minimally invasive spine surgery. The application of this procedure have far exceeded the expectations of the medical community at large and save hundreds of patients from the more traumatic and dangerous surgeries of the past.

As a neurospine surgeon myself, I don't know of a more complete user's manual for the back than Dr. Chiu's Four Weeks to a Better Back. The new material on minimally invasive spine surgery and laser thermodiskoplasty are essential information that everybody who has ever suffered from back pain should have at hand.

Thomas Joseph Clifford, M.D.

Neurospine Surgeon

Diplomate of the American Board of Neurological Surgery

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