A PAIN IN THE BACK
BACK AILMENTS HAVE BECOME ONE OF THE MOST DISTRESSING HUMAN PROBLEMS
In his 21 seasons as a National Hockey League referee, Bruce Hood came to accept periodic back pain as part of a hazardous occupation that involves dodging pucks and breaking up fights. But Hood, who now owns a travel agency in Milton, Ont., near Toronto, said that he was not prepared for the excruciating pain that he experienced in July, seven years after he retired as a referee. The pain originated in his lower back and travelled down his left leg to the tips of his toes. Hood, 55, spent five days in hospital, and doctors scheduled him for surgery on Sept. 3 to repair a damaged disc, one of the fibrous cushions that separate the vertebrae and act as shock absorbers. Then, Hood said, he learned that a new, nonsurgical treatment might ease his condition. As a result, he cancelled the operation a mere 14 hours before it was scheduled. In the weeks since, Hood has received daily treatments on an innovative device called a decompression table, developed by Toronto physician Allan Dyer. Hood has joined the ranks of millions of people around the world suffering from often crippling back pain and searching for new ways of easing it.
The decompression table, manufactured by Toronto-based Vat-Tech Inc., was approved for sale in the United States earlier this year by the Food and Drug Administration and it is already being used by prominent clients including Toronto Blue Jays manager Cito Gaston and Pittsburgh Penguins superstar Mario Lemieux (page 56). But despite testimonials to its pain-relieving abilities, Dyer and his associates concede that they expect to encounter skepticism in the medical community. That is because back problems, as most experts acknowledge, are among the most common and most perplexing afflictions known. Medical and other professionals estimate that eight out of 10 Canadians suffer from back pain at some time in their lives. And some add that it is the second most common cause of absenteeism in the workplace, behind the common cold.
The decompression table is just one of several new high-tech machines developed in Canada for treating back pain. One of the most
recent and innovative devices was developed in Montreal by Serge Gracovetsky, a 47-year-old Concordia University professor of electrical engineering and president of Spinex Medical Technologies Ltd. Gracovetsky said that he spent almost 10 years on what he calls a spinoscope. It allows physicians to measure with unprecedented accuracy the movement of spinal muscle, ligament and fibre, which are known as “soft tissue,” as opposed to the so-called hard tissue of the spinal cord itself. Said Gracovetsky: “This is a totally new approach to the problem.”
The spinoscope consists of 24 lightemitting mechanisms that attach to the back in a straight line from the top of the spine to the bottom. As the patient performs stretch and rotation exercises prescribed by a physician, the mechanisms emit infrared light, not visible to the human eye, which allows a camera to photograph the movement of the soft tissue surrounding the spine. The images are fed into a computer and displayed on a screen. Gracovetsky said that the U.S. Food and Drug Administration approved the sale of the machines in 1987. Since May, 1988, his company has sold 45 spinoscopes to hospitals, clinics and universities in Canada and the United States, at $105,000 each. Gracovetsky said that so far, his machines have assessed 20,000 patients, and that Spinex will hold a users’ conference in Washington in November to discuss the machines’ performance.
Success: Spokesmen for companies that have purchased spinoscopes say that the equipment allows a doctor to determine accurately and objectively whether certain muscles or ligaments are functioning properly. Janet Shapter, president of the Atlantic Back Institute in St. John’s, Nfld., said that she and her husband, Edward, an orthopedist, bought a spinoscope a year ago and have tested about 240 patients. Most of them were referred to the Institute by the Workers’ Compensation Commission of Newfoundland. Shapter added that in almost every case, the spinoscope showed that certain groups of muscles and ligaments were not functioning properly. Said Shapter: “We can get images of individual vertebra motion and say, ‘This is moving’ or ‘No, it’s not.’ For the first time, we have something objective.”
Dr. Patricia Padula, director of biomechanics at the Nassau County Medical Center on Long Island, N.Y., said that the centre has been using a spinoscope for only a month and has been able to develop specific treatment programs for all 20 of the people tested. She claimed that with
the aid of the machine, doctors can determine more precisely what areas of the back need rehabilitation. Said Padula: “Now, we can say the patient has low-back pain but the upper back is really where the problem is, so we’re going to concentrate on developing the upper back.” Despite the availability of such computer-based high-tech equipment, some back specialists contend that the medical profession still has a poor understanding of the problem—and only moderate success in treating it. Dr. Hamilton Hall, a Toronto-based orthopedist and founder of the Canadian Back Institute, a nationwide chain of privately owned clinics, said that chiropractors are generally just as good as doctors at relieving back pain. He also noted that treatment for the same back problem can vary widely from community to community, or from one country to another. Added Judylaine Fine, executive director of the Toronto-based Back Association of Canada, an educational organization that keeps its 3,000 members informed on new treatments: “I have the distinct impression that what’s wrong with your back depends on the decade in which it was diagnosed, which is very depressing.”
Still, those who suffer from back problems can usually describe, in graphic detail, where they hurt and how much. Former referee Hood said that he used to wake up, drenched in sweat, with a pain that felt similar to a toothache throbbing from his lower back to his toes. For his part, Robert Norman, a 50-year-old professor of biomechanics at the University of Waterloo in southwestern Ontario, conducts research on back injuries and suffers from back pain himself. Norman said that two or three times a year, he falls victim to an attack of muscle spasms in his
back and spends a couple of days in bed recovering. He explained that the pain feels like a severe muscle cramp and each spasm lasts about a minute. And Claire Botkin, a 48-year-old computer software salesman in Calgary, said that she developed severe pain in her lower back about three years ago simply from reaching down to pick up a shoe. The pain was so intense, she says, that she could barely bend her back or stand up for three weeks.
Stress: Indeed, while back problems have traditionally been associated with such blue-collar occupations as construction and factory work, experts point out that they can affect anyone (page 58). Professional athletes frequently suffer debilitating back pain caused by injuries suffered on the playing field. Los Angeles Kings superstar centre Wayne Gretzky missed 17 games during the 1989-1990 season because of muscle spasms in his lower back, and he injured it again when he was hit hard from behind during a Canada Cup game in Montreal on Sept. 14. As well, German tennis star Boris Becker, ranked No. 2 in the world, has been sidelined for several weeks this season with back problems.
But according to many experts, white-collar office workers are just as likely to suffer back problems because of long-term, low-level stress on the muscles and ligaments in the back. Said Shrawan Kumar, a professor of rehabilitation medicine at the University of Alberta in Edmonton: “The longer you stay in a sedentary position, the greater are your chances of suffering back pain.” Indeed, the single most important factor contributing to white-collar back problems is that people spend too much time sitting. The problem is exaggerated by poor sitting posture, and by
WHITE-COLLAR WORKERS ARE JUST AS LIKELY TO SUFFER BACK AILMENTS
the use of chairs with insufficient back support.
Steven Reinecke, the director of seating research at the Vermont Rehabilitation Engineering Center in Burlington, said that studies have shown that North Americans on average spend half of their waking hours seated and that 75 per cent of all workers sit while doing their jobs. That makes workers more vulnerable to back ailments, Reinecke explained, because prolonged sitting passes most of the job of supporting the body to certain isolated groups of muscles and ligaments.
The long-term result is fatigue, stress and— eventually—pain. Said Mary Young, a physiotherapist with the Glen Sather Sports Medicine Clinic at the University of Alberta: “It has become almost a fallacy to talk about the ditchdigger as the person most likely to develop back pain.” She added: “People come to us who may attribute their injury to sports, but it is more likely to be related to their day-to-day habits. They sit all day, then try to participate in some activity.”
Increasingly, governments and private companies alike are recognizing that working in an office can lead to back problems. Last December, San Francisco’s city council passed a bylaw to protect employees from injuries caused by prolonged and repetitive work performed on video display terminals. Richard Lee, senior industrial hygienist with the city’s public health department, said that the bylaw
stipulates that both public and private employers with more than 15 workers have to give employees 15 minutes of alternate work every two hours in order to avoid sore wrists, eye strain and back pain.
Some physiotherapists and chiropractors now offer seminars for corporate employees in order to reduce the incidence of back injuries. Frances Wilson, co-founder of the Back School of Calgary, an education organization that is part of a physiotherapy clinic, said that she and her partner, Patricia Holmes, stress preven-
tive back care. They point out that maintaining strong abdominal, leg and back muscles can go a long way towards preventing back injuries. They also stress the importance of weight control. Said Wilson: “Men with large stomachs are putting their backs under the same strain as pregnant women. As the abdominal muscles stretch, the muscles and tissues in the lower back tighten, and this results in imbalance.”
Tension: Toronto chiropractor Richard Collis, whose corporate clients include Marlin Travel, Royal Lepage Real Estate Services Ltd. and the Canadian Imperial Bank of Commerce, said that he teaches office workers to do a series of stretching exercises while sitting at their desks or computers. One is meant to relieve tension and soreness in the shoulders and neck area. Collis recommends a series of three shrugs, in which the shoulders are raised
towards the ears and held there for up to five seconds.
A second exercise involves raising the arms, interlacing the fingers and raising the palms upward. The position should be held for 10 to 20 seconds and repeated three times. Collis said that he has recommended 16 simple exercises that should reduce an individual’s chances of developing back pain if they are performed consistently over a period of time.
An exercise program, experts say, must be tailored to suit an individual’s needs. Still, for many, walking is the ideal exercise. Walking improves general cardiovascular fitness while it tones leg muscles, without jarring or straining bones and muscles. Other exercises, including cycling and swimming, accomplish the same goals. But despite the obvious benefits of exercise, Wilson says that many sufferers are looking for more immediate or dramatic relief from chronic pain. They find it difficult to accept that they have to exercise up to five times weekly for the rest of their lives, she adds. “You can’t brush your teeth just once and expect to have no cavities,” said Wilson. “It’s the same thing with your back. You can’t exercise just once and expect to have a healthy back.”
Figures compiled by the Workers’ Compensation Board of Ontario show that back problems resulted in more claims for lost wages than any other type of injury last year. The board handled 56,615 back-injury claims in 1990, down slightly from the previous year. Back injuries •£ accounted for 31 per cent of o the total lost-time claims that £ the board processed.
0 For his part, Hall said that
1 Canadian Back Institute clinu ics treat 25,000 patients annually—but that only two per cent of them require surgery.
He said that operations may be necessary when a disc becomes herniated—when it develops a bulge and begins pressing against a nerve. Surgeons also operate when a disc has deteriorated severely. In those cases, Hall explained, two vertebrae are fusèd together for stability and relief of pain. But he added that a large majority of patients at his clinics are treated through exercise programs.
Therapists first assure patients that back pain, while real, is actually harmless because it is not a symptom of a disease for most people. Hall said that they then develop a three-phase treatment plan tailored to a patient’s problem. The objective of the first step is to control the pain, which usually involves teaching the patient how to improve his posture. Then, the clinic prescribes a set of exercises aimed at fully restoring mobility. Pushups in which the individual only lifts the upper half of the body
are usually prescribed. A second set of exercises, including sit-ups, is designed to strengthen stomach, back and side muscles to prevent a recurrence of the back pain.
Said Hall: “Teaching people to control their back pain is a tremendous asset because they stop worrying about it.”
Exercise: Still, other specialists say that they are focusing on the discs and vertebrae as the primary source of back problems. Dr. Stanley Gertzbein, who left Toronto’s Sunnybrook Hospital in July to become director of research and education at the Texas Back Institute in Houston, said that the spinoscope is not as accurate as other measuring techniques.
Gertzbein claimed that his research has shown that spinal instability, or movement of the vertebrae, is more likely to cause serious back pain than stressed muscles and ligaments. He added that he has developed a “revolutionary concept” for measuring spinal instability that involves the combined use of X-rays and computers. He said that his method of measurement
allows for early detection of -
spinal instability, and that the problem may be corrected through proper exercises. Said Gertzbein: “We use exercise to strengthen the muscles and stabilize the vertebrae. We train the muscles to do the same job as a brace.” Besides the array of approaches and treatments from the medical profession, healthproduct manufacturers are continually introducing new items aimed at reducing back pain. Michael Sherwood, manager of the Back Store Inc. in Toronto, said that consumers can
choose from dozens of different cushions, hot and cold gels, massage devices and chairs. By far the most popular device is a portable backrest manufactured in Toronto by a company called Obus Forme Inc. The $70 backrest, which has a plastic core that is wrapped in foam, is about an inch thick. It features a removable protruding cushion that provides extra support for the small of the back or any other area of preference. Sherwood added that 70 per cent of his clients had the store recom-
mended to them by a chiropractor or doctor.
For most chronic back-pain sufferers, it is one more stop in the search for relief. And relief may be the best that most victims of back pain will be able to find. As most of the experts acknowledge, despite the encouraging and imaginative innovations, there is still no such thing as a complete cure.
D’ARCY JENISH with
STOPS IN THE SEARCH FOR RELIEF