Oh, my aching back

No human being can escape the misery of low-back pain. It’s as sure as that the sun will rise in the east and set in the west. If you don’t suffer directly from backache, then you know or live with someone who does, and eventually his or her misery becomes your daily distress.

I know. I grew up with a father whose back pain kept him—and by extension the family—in a pretty dark mood through most of the 1950s and ‘60s. He’d growl over the most innocuous behavior by us kids, and Mom would say, “Oh, it’s his back, honey. He can’t help it.”

Then, sometime in the early 1970s, when Dad was well into his 50s, the family experienced a sort of divine intervention when an osteopath measured the old man’s legs and discovered one was shorter than the other. A lift in the heel of his shoe liberated us, and Dad became a pleasant man again, at least most of the time.

The American Academy of Orthopedic Surgeons estimates four out of five adults will experience significant low-back pain in their lives. Either through heredity or stacked odds, I have had to learn to live with chronic and constant back pain for the last 20 years.

The answer is simple. We can blame that first early humanoid who decided to stand up and look over the tall grass to see where he was going rather than employ the more standard loping, knuckle-dragging gait his family and friends used to get around.

This first walker may have been well ahead of his time by freeing up his hands for more useful work, but he was probably also the first guy to start grunting at his mate and offspring over the little things because his damn back hurt so much.

Twenty-five years ago, I figured it was my line of work—installing furnaces and air-conditioners in tight spaces like attics and closets—that caused my lower back to ignite in occasional spasms of burning pain. Since workers’ comp was paying, I got to sample three approaches to relieving back pain—sort of like sampling from a smorgasbord of Western medical theory.

The chiropractor tried to indoctrinate me by signing me up for a lifetime of treatment. I didn’t bite. The osteopath (actually it was his lovely assistant) manipulated the muscles of my lower back with some low-voltage tool and a warm lotion—temporary relief at best. The orthopedic surgeon said I had to change my line of work and that he would put me on disability. “Get into computers,” he said. But with the little I knew of computers at the time, I’d end up in a warehouse, lugging big boxes of computers around.

I did finally get out of that type of work, and now I spend most of my days sitting and staring into a computer screen. But four years ago, while roofing a house, I ruptured a disk in my lower back. The viscous material inside the disk that cushions my vertebrae had leaked out through the rupture and was pressing against a nerve that went down into my right leg.

I went under a neurosurgeon’s scalpel. He scraped the disk jelly away from the nerve. This relieved the pain and weakness in my leg, but I’ve had a constant dull ache in my lower back ever since. To understand the severity, let’s just say nothing less than a Kennedy half-dollar is worth the pain of bending over to retrieve when dropped or spotted on the floor.

I visited my doctor, an osteopath, last week. He had diagnosed the ruptured disk and sent me to the neurosurgeon who’d sliced and scraped me back into relative health. Explain my pain today, Doc, I said.

Dr. Dennis Wagner is a down-to-earth guy, a realist. He doesn’t beat around the bush when talking about your medical needs.

“You have to keep your weight in line and maintain good muscle tone—not just your abdomen, but all muscles around the trunk of your body,” he said. “We are not symmetrical in terms of strength of the muscles. It’s much easier for your body to flex because those muscles are much more available, larger and stronger than the muscles that extend you. In order to maintain a balance you have to truly balance the strengths.

“The basic problem with back pain is that humans insist on walking on their back legs. That is the problem. You are taking a structure that was meant to be a sling and you are putting it on end.

“When you lift something, you place you legs and feet in a way that they are stable and all the stress is focused on those three or four vertebrae right at the bottom of your spine.”

The actual pain I feel, he said, comes from the outer lining on the vertebrae.

“There are only three tissues in the body that sense pain—the skin, the lining of the chest and abdomen and the lining on the bone. Those vertebrae are moving against each other—and probably moving improperly—and they are going to get inflamed. Pain is part of the inflammatory response.”

So what is the cure?

“You’ve got to do it all,” the good doctor said. “You’ve got to have the right weight, the right muscle tone, the right activity and the right lack of activity. You must keep the right flexibility and avoid certain things because you know they are going to hurt you. You lift that engine block, you know you are going to have pain.

“Sometimes you’ll have to cool the whole thing off with rest, ice, anti-inflammatory [drugs], or all three.

Anti-inflammatories include over-the-counter ibuprofen or stronger prescription medicines.

“Now, if the source of pain is an extruded [ruptured] disk, where the disk material is compressing the nerve,” he said, “that is a lot more than inflammation, and Advil is not going to make it any better.”

Over time, he explained, the disk material, which has oozed from the rupture, will be absorbed or diminish, which is one reason why we get shorter as we get older.

“Flexibility,” he said, “is really a big deal. You have to get down and flex all those muscles and keep them at the right working length.

Swimming is one of the best exercises you can do because when you move through the water, instead of putting compression on your bones, particularly your spine, as most other exercise activities do, you are pulling the joints apart to some degree.

Osteopaths have gone through medical school studying the muscular/skeletal system and paying particular attention to manipulation—bone cracking, in layman’s terms. Osteopaths, Dr. Wagner said, taught chiropractors the practice.

“A guy by the name of Palmer took a class in manipulation sometime around 1896 and then developed the Palmer school of manipulation. He was the first chiropractor.”

The difference between chiropractors and osteopaths, he said, is that chiropractors view manipulation as the principal means to health. Osteopaths take the view that manipulation is only part of a bigger process.

“If you have an infection, then you need an incision and drainage or antibiotics,” Wagner said. “That is why osteopaths have always fought so hard for the full practice rights.”

As for manipulating the bones, he said, “Wisdom is knowing what not to do.”

One chiropractor I talked with, Dr. Robert Puckett, who was recommended highly by someone whose opinion I respect, surprised me when he said most of the back pain he treats comes from those doing office work.

“We were not meant to sit for long periods of time,” he said. “We should be out hunting and gathering.”

When we bend from a standing position, he said, we put 150 pounds of pressure per square inch on our disks; when we lean and twist from a sitting position, that pressure can jump to as much as 600 pounds of pressure per square inch.

“You have to accept the fact you have a bad back,” Puckett said. “Some are in denial. Some you have to light a fire under to get them to do anything about it. And some you have to slow down to keep them from doing more harm.”

And here I thought it was all those furnaces and air-conditioners I lifted as a younger man. In fact, I’ve probably done more damage sitting at a computer desk for the last 10 years. Say, is that a 50-cent piece that just rolled under my desk? I think I’ll just bend over from this sitting position and pick it up.