COVER

AN EPIDEMIC OF BACK PAIN

KEVIN SCANLON April 7 1986
COVER

AN EPIDEMIC OF BACK PAIN

KEVIN SCANLON April 7 1986

AN EPIDEMIC OF BACK PAIN

COVER

The spinal column. It is the body’s main communications channel, a marvel of natural engineering— and one of the major sources of human pain and discomfort. A complex network of fat, muscle, nerve and bone, it stretches from the skull to the pelvis. And it will cause back problems for eight out of every 10 Canadians at some time in their lives. A century ago lower backache was rare, but now it has reached epidemic proportions in North America—largely because more people are living increasingly sedentary lives. Said Toronto back specialist Dr. Hamilton Hall: “Now, we have a lot of overstuffed chairs and a lot of overstuffed people.”

Misery: For the millions of people who share the misery, back pain can be an incapacitating experience which slows ordinary movements and makes routine tasks like tying a shoelace a tortuous event. Some sufferers describe it as the ache of an impacted wisdom tooth that never goes away. Others say that the agony resembles the shooting pain of a leg cramp. And there are as many treatments as there are variations of back pain: from craniosacral therapy (the hands-on manipulation of skull bones and muscles) through chiropractic manipulation to surgery. That bewildering array of disciplines and therapies often confuses patients searching for relief. As a result, when orthopedic surgeon Hall (page 44) spoke in Toronto last January, more

than 1,300 people showed up looking for answers at a lecture that was expected to draw a crowd of 120.

Hall, who also suffers from a bad back, had a blunt message: he told his

listeners that one way to prevent common back pain was exercise. Indeed, that is one method of combating osteoporosis, the leading cause of back problems among elderly women (page 42). That metabolic disease, which causes bones to become weak and brit-

tie, affects the skeletal structure of about 250,000 Canadian women and 25,000 men.

Back pain also inflicts a staggering social cost in terms of time lost from work and disruption of family life. In 1984 back problems accounted for about one-quarter of all compensation claims in Canada. And in 1984 Ontario’s Workers’ Compensation Board awarded $399 million for work-related back injuries and the province’s workers lost about 3.1 million days away from their jobs because of back injuries. For many workers—and the boards that must decide if the injuries are legitimate—the compensation process can be a long, frustrating experience.

Sad: In Calgary, Dennis Lewis has been fighting with the Alberta board ever since he first hurt his back in 1975 while working in a supermarket warehouse stacking 75-lb. cases of canned fruit. Lewis has not worked full time since he reinjured his back in 1981, and he even staged a monthlong hunger strike last July in an unsuccessful attempt to increase his $150 monthly disability payment.

Although Hall recommends an early return to work for people who hurt their backs, he says he sympathizes with workers who become compensation board clients because of back injuries. But he added that it saddened him to see some workers who are otherwise in good health come to depend on their benefits and regard

their back pain almost as a new career. Said Hall: “You can’t live with a bad back for a year and remain the same person. It is the dominant feature in your life. How do you get rid of that stigma? As soon as a company hears you have a bad back, you might as well tell them you have leprosy.”

Stress: Relieving back pain is a lucrative source of income for doctors and therapists. It is also profitable for such commercial ventures as Toronto’s Back Store, a retail outlet featuring such items as $1,625 chairs designed to alleviate stress on the spine. Said Judylaine Fine, author of the 1985 book Your Guide To Coping With Back Pain and the founder of the Toronto-based Back Association of Canada:

“Back pain is big business. Consumers have to have a working knowledge of the treatments if they are going to be able to decide objectively.”

Although such serious problems as spinal or brain tumors, osteoporosis and rheumatoid arthritis can cause backaches, about 90 per cent of lower back problems can be traced to more common causes. Those include sore muscles, a ruptured disc— which many people mistakenly call a “slipped disc”—and osteoarthritis, or wear on the joints. It occurs when one of the oval discs cushioning the vertebrae loses some moisture and shrinks. That aging process then causes some of the facets—the bony projections which connect the vertebrae—to jam more tightly together. And the additional stress on the joints often causes muscle spasms when small back muscles contract into a hard mass and send pain travelling up and down the spine. In a similar way, injury or the aging process can cause a disc to rupture, pushing its jellylike interior through the surrounding shell and putting pressure on spinal nerves.

Intense: In some cases, only slight exertion is needed to trigger back problems—as CBC radio personality Peter Gzowski discovered. On Feb.

18, the 51-year-old host of Morningside bent over a desk to sign a note and immediately felt an intense pain in his lower back. Said Gzowski: “It knocked me off the air for two days.” He traces his back problems to a traumatic inju-

ry he received when he was 10 and fell off a bridge in Galt, Ont. The six-foot, two-inch radio host has been susceptible to back problems since then, but he manages to avoid lengthy absences from work by performing a 10-minute

regimen of pelvic-tilt exercises which strengthen the muscles supporting the spine.

But like many other victims of back pain, Gzowski often fails to find time

in a hectic schedule for that insurance. He added: “I should do the exercises. If I keep doing them, I’m okay.” And when the pain returns, he has the cold comfort of knowing that back problems are a bond of pain linking

rich and poor, celebrities and unknowns. Author Ernest Hemingway often wrote standing up, and President John F. Kennedy used to sit in a White House rocking chair to ease the pain of a back injury from the Second World War.

Gzowski has learned to endure his backaches, which occur every few years, but many back specialists say that their hardest task is convincing patients that the pain does not have to rule their lives. And according to Fine of the Back Association, a nonprofit charitable foundation with about 3,700 members across Canada, curing back pain becomes almost an obsession for many victims. Said Fine: “Many people fail because they have the erroneous notion that they can get their spine back to the way it was when they were 16 and could dance until dawn. It is important not to I feel that the treatment is a failure if you can only get to be pain-free 80 to 85 per cent of the time.” Added Hall: “That is where the problem is.

It is not that we have not got good methods. It’s that we cannot seem to get the message across to the general public that back pain, although very painful, is not very dangerous.”

Agony: At the same time, many doctors find it difficult to diagnose the exact source of the problem. And their knowledge that the pain is usually not perilous sometimes makes them appear indifferent to victims who are experiencing intense agony. That attitude often leads patients to visit several doctors—or to begin seeking such alternative treatments as chiropractic manipulation of the spine. Said Hall: “The reason chiropractors do so well is they are never vague.

It is always: ‘Here’s the diagnosis: something is out of line. Here is the treatment: my manipulations.’ Put that up against the average doctor who says, T don’t know what it is.’ So, where would you go?”

Patricia Murray, a 34-yearold mother of three who lives in Lantz, N.S., gave up on doctors after she injured her neck in an automobile accident four years ago. She tried heated baths, traction, heat packs, electrical stimulation, medication and acupuncture—but nothing worked until she went to a chiroprac-

tor. After two months of treatment she removed the neck brace she had : worn for almost a year. Said Murray: “The pain still completely disrupts my life, but at least I can say I have some good days now.”

Toronto chiropractor David Drum says that his manipulations soothe chronic backaches, but he acknowledged that the effects of the techniques are “fairly short-range.” He added that without a lifestyle change and the introduction of exercise, they provide relief for only as long as a week. Said Drum, who has treated such superstars as ballerina Karen Kain and actress Shirley MacLaine: “I am a tremendous believer in exercise. Without it, I don’t think there is much justification or rationalization for my own profession.”

There is clearly tension between chiropractors and doctors. Most physicians describe chiropractors as unqualified manipulators, and some chiropractors say that many doctors are knife-happy surgeons who perform unnecessary operations. Still, one influential Saskatoon physician says he is convinced that chiropractic treatment relieves back pain. To that end, Dr. William Kirkaldy-Willis, director of the Low Back Pain Clinic at the University of Saskatchewan and editor of the 1983 book Managing Law Back Pain, often uses chiropractic manipulation to treat his patients. He also uses injections of Marcaine, a local anesthetic, to “break the cycle of pain,” and he prescribes light elastic support garments for the back.

Abnormal: Kirkaldy-Willis says that only five to 10 per cent of his patients are helped by surgery. In fact, doctors are more likely than they were a decade ago to prescribe exercise before considering surgery. But some patients must undergo an operation to remove a piece of ruptured disc or to fuse two vertebrae to stop abnormal movement at the joints. That was the case with Bobby Rous: seau after severe back pain ended his 14-year career in the National Hockey League in 1975. At 35, after playing with

the Montreal Canadiens, the Minnesota North Stars and the New York Rangers, he retired in 1975 after a spinal fusion operation in December, 1974, strengthening his back at the cost of a slight loss of flexibility. Said Rousseau: “I had been playing with a

back problem since the age of 18, but stretching exercises allowed me to continue. I had learned to live with pain.”

But Rousseau has experienced no pain

since the operation, and he is now the golf pro at the Louiseville, Que., Golf Club near Trois Rivières.

James LaFrance, a 56-year-old Toronto auditor, says that he endured 15 years of back pain after “something went ‘pow’” while he was lifting a lawnmower into the trunk of his car. Every six months he had major back pain. Finally, too sore to walk upright and suffering severe leg pain, he took his doctor’s advice and had an operation to remove a piece of ruptured disc from his spine. That was two weeks ago. In two more weeks he plans to return to work. Said LaFrance: “The leg is fine. I can walk around straight up, which I couldn’t before.”

Banned: Meanwhile, at St. Michael’s Hospital in Toronto, the controversial drug chymopapain is used in some cases instead of surgery. Banned by the U.S. government in 1975 after a study questioned its safety, but reinstated seven years later, the enzyme from the papaya plant is injected into the nucleus of a herniated disc, which it then dissolves. Significant advances have been made on diagnostic fronts at the hospital, which has improved a spinal monitoring technique that warns the surgeon of possible damage to the spinal cord during an operation. Said Dr. Ensor Transfeldt: “That was always a big concern.”

Orthopedic surgeons still use myelograms—complicated and painful radiological procedures that require the injection of dye into the spinal canal. But the main promise of the future seems to be the multimilliondollar magnetic resonance imaging machine, which displays three-dimensional images of soft tissue such as the spinal cord. That is a significant advantage over the CT Scanner, the machine that revolutionized the X-ray field with its threedimensional views of the spine. Another technique, the bone scan, is in use in most hospitals; it reveals bone defects after a radioactive substance is injected into the blood.

Even with all the sensitive equipment at his disposal, Transfeldt, 36, who has been at

St. Michael’s for 18 months, relies heavily on patient education. Said Transfeldt: “That is vitally important. People have terrible pain, but doctors are bad communicators by telling them there is nothing wrong. What he means is there is nothing seriously wrong. If you understand, it is easier to put up with the pain.”

Relief: Currently, five patients with chronic back pain are in the 10-week in-patient program at the Pain Relief Unit at Montreal’s Royal Victoria Hospital. There, they learn to cope with their pain through various therapies. Said Dr. Alec Ramsay, a psychiatrist and research director of the eight-year-old unit: “We don’t make any promises. When they go out, their pain has not changed so much as the way in which they do things. For example, they may do things 80 per cent of the time instead of 20 per cent as before.” Added clinic physiotherapist Henry Tsang: “As a rule, people from countries such as Africa or India suffer very little from back pain because they don’t sit as much. When you sit, you have two or three times more pressure on your back than when standing.”

That fact of modern life helps explain the popularity of The Back Store in Toronto: about 10,000 customers go to the store each year while another 8,000 order products by mail. Peter Lebensold, who suffers from sciatic pain, is president of the specialty store, which opened in September, 1984. The store now stocks such items as the Obus Forme, a locally made orthopedic support. It is a concave cushion which straps onto chairs or car seats.

The most expensive model costs $90. For computer operators with sore backs, Lebensold has a backless Balans chair, a Norwegian invention which aligns the user’s spine in a sitting position which lessens back pressure. The chairs sell for up to $430.

Resort: The newest treatment in Canada for chronic back pain is craniosacral therapy, a 50-yearold American technique involving the hands-on manipulation of muscles and bones. A pioneer teacher is Dr. John Upledger, a West Palm Beach, Fla., osteopath who was on the staff of the Michigan State University College of Osteopathic Medicine. Upledger says

therapists can gently assist bone and muscle into the correct position and alleviate pain. Said Toronto practitioner Efim Svirsky: “We are sort of a last resort.”

Toronto acupuncturist Dr. Linda

Rapson, who says that her treatment has a 75-per-cent success rate, offers a personal endorsement of craniosacral therapy. She recalled that last year she was treated by Toronto therapist

Judy Bradley, who gently supported the bones at the base of her skull on her fingertips. Rapson says she felt a sudden, sharp pain and then it faded away. She says that her jaws, and even her teeth, which had always been slightly misaligned, moved closer to the correct position. Said Rapson: “One of my patients described it as al-

most spooky. It doesn’t feel like they are doing much at all, and yet you get such relief.”

In his 1980 book The Back Doctor, Hall made general suggestions for living with a bad back. Among them:

• Sleep on your back with your head on a feather pillow. Try not to sleep on your stomach.

• When sitting, use a footstool to keep the knees above the hips, which takes pressure off the lower back. Sitting at work, place a telephone book under your feet or use a bottom drawer. If you are the boss, put your feet on the desk.

• Never stand with both feet flat on the floor. Always put one foot on a low stool or on a brass rail if standing at a bar.

• Avoid arching your back when reaching for something on a top shelf or opening a window.

• Squat as frequently as possible. This is an ideal way of resting your spine while tending the garden or playing with small children.

• When lifting an object, keep it close to your body and keep your back erect while lifting with the muscles in your legs.

• During sexual intercourse (after headaches, pleading a backache is the most convenient excuse for avoiding sex) avoid arching the back and assume a comfortable position.

• In sports, cycling is excellent for back pain sufferers, and skiing is safe if the legs are used to turn.

Learning to cope with back pain, and living a full life in spite of it, is something that Hall stresses in his book and also at lectures to both fellow doctors and fellow back patients. With 80 per cent of the population affected, back pain should be understood, 5 not feared. Said Hall: “It’s “ normal to have back probÿ lems. The abnormal people Ü are the ones who don’t have back pain.” And as technological advances give North Americans even more time to sit down, the number of people who are free of back pain will fall even lower.

KEVIN SCANLON

LINDA CAHILL

FRANCIS MORAN

ALYCIA AMBROZIAK

KERRY DIOTTE

BRENDA RABKIN