Los Angeles Times

On April 4th, the LA Times posted a decent article discussing one of medicine’s most confounding problems.

The Puzzle of Back Pain – Los Angeles Times Article 

I really appreciate the comment made by Dr. Alok Sharan, chief of spinal surgery at Montefiore Medical Center in the Bronx, N.Y., regarding spinal surgery as a last resort.

“You should exhaust all other options,” says Dr. Alok Sharan, noting any operation’s risk of complications. “Surgery should be your last option.”

The article also mentions that many patients who do opt for surgery are left disappointed.  “Surgery has proven to be successful in treating ruptured disks that are causing sciatica, but it’s most effective at treating the sciatica.”

“Ironically,” Sharan says, “back surgery is more effective at relieving leg pain than at relieving back pain.”

I feel that this is not really ironic at all and was surprised the article didn’t mention the following.  It is logically simple to remove ruptured or bulging disc matter that may be pressing directly on a nerve that is sending referred pain down the leg.  Once the bulging disc matter is removed, the nerve is no longer compressed and the result is the decrease or elimination of leg pain.  But (and this is a big but) the back pain is not going to dissipate, because the poor postural habits or imbalanced musculature resulting in improper joint biomechanics have not been addressed and cannot be “fixed ” with a surgical procedure!  Those faulty joint biomechanics are what cause compression in the spinal joints and result in a spinal disc rupture.  So, yes, surgery might remove the referred pain, but only neuromuscular re-education will address and correct the faulty movement patterns that have been causing the low back pain.

Unlike surgery, neuromuscular re-education (physiotherapy, bodywork, rehabilitative pilates and yoga therapy) is a process that, as many of you know, takes time, mind-body awareness, self-study and 100% commitment.  And without it, the back pain will persist, the sciatic pain may re-appear, and as I have seen a few times, the patient may end up back in the operating room  getting rid of more bulging disc matter.  And we only have so much disc matter!  The more we have removed, the less we have to cushion our vertebral bodies.  Once that disc matter is about gone, there is nothing between one vertebra and the next.  Some would consider this “bone on bone,” and that little phrase is never good.  The next step would be another surgery, possibly a lumbar spinal fusion, and so on and so on….

Surgery is a life-saving art form that becomes more innovative and impressive by the minute, but when it comes to back pain, surgery is just another tool (an invasive tool with no guarantees and possible complications) that should be considered as a last resort.  However, an absolutely necessary surgery can be appropriately viewed as a step in the healing process, alleviating some of the pain so that you may move closer to healing the root of the maladies within the body through neuromuscular re-education.