If you haven't had back trouble yet, the chances are very good that you will. Back pain is a serious problem in industrial societies, so serious that I have decided to devote this first chapter to discussing the scope of back pain in the United States. If you are like most people, you will find a little solace in realizing that your problem is not unique. If you do have back trouble, you are not weird, weak or even much different from everybody else. Rest assured, you are not alone.

As you will see in the next chapter, "A History of Back Pain," humans have had problems with their backs for a long time. One theory that you'll undoubtedly hear often is that back pain is a product of evolution that our back problems all started when we shed our tails and stood erect. I'm not sure I accept entirely that standing upright is our problem. Dogs and other animals stand on all fours. Some of them have degenerative back pain. I'm not even sure I want to stand adamantly on the theory of evolution as modern science now espouses it. But I won't bore you with my feelings on creation.

I will concede that part of the problem is that we stand erect. That doesn't mean that our backs aren't really designed for

Four Weeks To A Better Back

walking and standing on two feet. Instead, I'd say that it is the way we stand and walk on two feet that is probably the problem. My experience with back pain and back problems is that most back pain and back problems can be avoided. All that is needed is a little care and concern, and, of course a little knowledge. With just a little insight into how the back works and how to make it work correctly, your back can be, to steal a computer term, "user friendly."

That's the thrust of this bookthat you do have choices and control where your back is concerned. You don't have to be in pain. There are steps you can take right now to assure that your back will get stronger and hurt less. Contrary to what anybody tells you, you are not doomed to a life of back pain, simply because you and your ancestors are no longer monkeys.

Epidemic Back Pain —
A Technological Advancement

Healthcare professionals in all fields today agree that an inactive body will age faster than an active body. In our society, as opposed to ground-dwelling or agrarian cultures where people use their backs differently, the aging process of the back begins somewhere around age 35 for most people. The good

Modern technology and stress play havoc on our backs!

Facts and Fallacies

news is that relief of back pain is almost always possible, and seldom about three percent of the time does a bad back require surgery.

Even though back pain has always been with us, it has been only since the majority of us no longer tend the fields, hunt, take care of the livestock or perform some other physical labor that back pain has reached epidemic proportions. Technology may continue to make life easier, but, unfortunately, not for the human back. Your ancestors were hunters and gatherers, and that is the lifestyle for which your back was designed. The back was not created to lounge in front of TVs or spend hours hunched over computer screens. Your back doesn't know how to adjust to high heels or spend long hours riding in a car, or sitting. If your back hurts, chances are that it is responding to your lifestyle. Being overweight and obesity overloads your back also.

Regardless of all the recent fitness trends you see in all forms of media, obesity is still a major problem in the United States. We Americans love to eat. And the rest of industrialized world is following suit. Affluence and big appetites seem to go hand in hand, as we're seeing in some of the more recent emerging industrialized societies, such as Korea and China

Some Shocking Statistics: Back Pain in the U.S.¹

At some point in their lives, 80 percent of all Americans suffer from some kind of back problem mostly lower back pain, during their lifetime. Thirty percent have one or two occurrences per year. Each year, our bad backs cost the country lost work time and medical expenses combined about $100 billion. Of that $100 billion, $25 billion goes to medical bills. The rest goes to lost work time and productivity, and over the counter back care medications and products.

¹ Of course, the back pain epidemic is not limited to the United States. I have used the following statistics only to show the scope of the problem. The figures for all other industrial cultures are probably comparable.

Four Weeks To A Better Back

Back pain is big business in the U.S.

Usually, when we speak of back pain, the problem arises from the lower back the point in our spines that does most of the work supporting our bodies. This book focuses primarily on pain stemming from low-back, or lumbar, problems, but we'll also take a good look at pain caused by problems at the neck (cervical) and mid-back (thoracic) levels. So, when I say that we're spending 100 billion, I'm speaking about all levels of back pain not just the lower back.

You're probably thinking, Yeah, OK, that's a lot of money. But Americans probably spend at least that much on aspirin for minor

80 percent of all Americans
suffer from back pain

Facts and Fallacies

aches and pains. You're right, we do. But remember what I said earlier about only two to four percent of all back problems requiring surgery? Most healthcare professionals will try several other forms of treatment before suggesting that a patient have an operation. This means that all other, less-expensive treatments are tried first. Approximately a quarter of a million Americans had back surgery last year. One hundred billion dollars is a lot of money to spend on our backs.

Of course, these figures do not measure the amount of pain and suffering endured by the victims themselves, nor do they give an accurate picture of the hardships placed on the families and loved ones of back pain sufferers. There is no way to gauge just how much trauma a woman goes through while caring for her bed-ridden, out-of-work husband, or vice versa. Or how much the children suffer.

Just in case you still don't understand the enormity of the problem, maybe this set of numbers will help you get a more vivid picture: Back pain is responsible for more than 40 percent of all absences from worksomewhere around 93 million workdays per year (or more). This figure is far above the next highest absentee-causing illness. About four percent of America's workforce is permanently disabled from their back problems. And, because of the changing nature of our workplacesan increasing number of people sitting in front of computersthese numbers get worse each year.

If You Have Back Pain, You Keep Prodigious Company

The idea that back pain is the plight of laborers, people who work with their backs and hands, no longer has much credence. Doctors today understand that

Four Weeks To A Better Back

back problems are more often caused by aging and sedentary lifestyles, rather than trauma and work-induced injuries. Active people, people who use their backs regularly, are less likely to have back problems. Everybodyfrom writers to movie stars to presidentsis subject to back pain. Here are a few examples.

You've probably heard about Elizabeth Taylor's struggle with drugs and alcohol. What many people don't know is that her ordeal, the one that ended with her checking into the Betty Ford Center for treatment of drug dependency, began as the result of severe back pain. She fell and aggravated an old injury. The pain was so acute that Liz suffered from depression, weight gain and finally, in an effort to get some relief, became dependent on painkilling drugs and analgesics.

Like many prominent people, Taylor has a long history of back problems. Liz's trouble began at age 12, when she fell from a horse during the filming of National Velvet. Since her adolescence, this super star has had several back surgeries. She was confined to a wheelchair, has worn back braces, and has been in traction.

Another example of a famous person who suffered from excruciating back pain is former President John F. Kennedy. Kennedy, who had more than one back fusion and wore braces a lot of the time, had to cancel several appearances because of his "sore back." Reportedly, his doctors treated the condition with the steroid cortisone. It has been speculated that the cortisone was the reason the former president maintained a smooth, young-looking complexion. Some historians also claim that the cortisone influenced the former president's fondness for extramarital sex.

Barbara Streisand is another well-known public figure whose career has been plagued by back problems. She too has

Facts and Fallacies

had to cancel many engagements because of back pain. It has been speculated that her long absence in performing was because the suffering brought on by her back condition.

Among people who make their living at desksa high-risk back pain categoryare writers. One of this century's most famous writers is Ernest Hemingway. Students in writing classesusually aspiring writers themselvesare often taught that Hemingway was so dedicated, so disciplined that he frequently worked standing up, because he believed his creative juices flowed more freely in that position. Hemingway even had a specially designed chest-high desk. Perhaps the master did do his best thinking on his feet. But today we know that the primary reason he wrote standing up was that his back hurt too much for him to be comfortable while sitting down.

Dispelling Some Common Myths

During my years as a neurosurgeon I have time and time again been amazed at the incredible amount of misinformation about the human back circulating like bad rumors throughout our society. For some reason, truth and common sense about the causes and treatment of back pain are shrouded in misconceptions, silly folklore and unwarranted fear. Many of the people otherwise intelligent, astute individuals who suffer from back problems seem to disregard everything they ever learned about health and physiology. They come to me with peculiar ideas and rules about the back that fringe on Dark Ages-intellect or voodoo.

Before we get much further into this book about how to take care of your back, let's dispense with some of these misconceptions:

• 1. The back is the most fragile part of the human body. Unless you've had a serious accident that has injured your back, it is not fragile. The amount of shock and pressure the back can and does endure is quite impressive. Backs can become frail and un

Four Weeks To A Better Back

• healthy through improper use and a lack of maintenance, but most people's backs don't start out weak or fragile.

2. Gardening, tennis, sex and other normal activities should be avoided so that you don't injure your back. I discuss physical activity and back pain in a later chapter, but for now lets just say that there is a difference between pain and injury. Injury may cause pain, but activity usually causes muscle soreness or strain, which is not really an injury. Most back pain comes from a lack of movement not from too much activity.

• 3. If you have back pain at 35, you're really going to have problems before you're 60. Please, relax. The back does have the ability to mend itself. Just because you are having pain now is no indication that you will hurt forever. If you are like most people, you have the choice to do something about the condition of your back.
• But what about some causes of back pain, like bone spurs and bone diseases or osteoporosis that can make the vertebrae vulnerable to fractures? Relax. You are living in a very exciting time. We have come a long way in correcting and reversing chronic back conditions. And new breakthroughs are forever on the horizon. If you are middle-aged now, the chances are very good that you won't develop a back problem that modern medicine can't handle.
• 4. The more your back hurts, the more serious the condition. This seems to make sense, doesn't it? I mean, big cuts hurt more than little cuts, right? Bigger tooth cavities hurt more than smaller cavities? Well. . .no. Pain is relative to which nerves it affects, and how

Facts and Fallacies

• it affects them. Mild conditions, like, say, a bunion or ingrown toenail can be excruciating, while some cancers don't hurt at all. The same is true of back pain. Some conditions, like muscle spasms that often correct themselves, can hurt much worse than some large, bulging discs.
• 5. If your back pain is caused by a serious condition, it will require surgery. As a neurosurgeon, a significant source of my income comes from performing surgery. However, I will be the first to tell you that seldom is surgery the answer for back pain. As I maintain throughout this book, back problems are usually the result of normal wear and tear on the body. Most of the time, the proper knowledge and the care of your back will be all you'll need to solve your back problem.

Four Weeks To A Better Back