by Al Lewis
Far ahead of diabetes or heart disease, musculoskeletal conditions are the #1 spending category for most employers and employees, for hospitalizations not involving babies. Not to mention the many, many outpatient expenditures that also go with orthopedic issues.
And tops on the list of musculoskeletal conditions? Back surgeries. Not just back surgeries, but all sorts of expensive and controversial interventions involving backs, like CT scans, MRIs, and cortisone injections.
At the same time, some conventional therapies may do more harm than good as well. While recommendations come and go in all categories, back treatment is probably in more of a state of flux than anything else.
Hence our latest Six Things Employees Should Know installment covers back pain. (Note that “you,” “us,” and “employees” are used interchangeably because some of our contacts forward these Six Things columns directly to employees.)
(1) 80% of us will find that their back pain goes away on its own…
Who amongst us has never suffered from back pain? It appears that about 80% of adults get it at some point. (That would be 100% of all adults over 50 at Quizzify.)
(2) …But 80% of us are convinced we are in the other 20%
And therein lies the rub for back pain. We are often quite sure that we are the ones whose back pain won’t go away. That leaves us vulnerable to all sorts of proposed tests -- and surgeries. One reason the US leads the world in scans and back surgeries is that they are expensive. That means someone is making a lot of money on them. And in healthcare, wherever there is money to be made, there is inappropriate care to be had.
(3) The current standard of care for most (not all) low-back pain is to maintain your daily activities.
Don’t “baby” your back. No or minimal bedrest. Too much resting may actually make things worse. Instead, stick as closely as possible to your daily routine. Note this advice applies to most back pain, not all back pain. Obviously, consult a physician if your pain gets quite a bit worse, if it includes a fever, numbness in the legs or groin, or loss of bladder control.
The 1990s called. They want their exercise back.
For decades, the standard “strengthen your core” advice was to do sit-ups. Then it was decided sit-ups put too much pressure on your lower back, so the go-to advice became: crunches. Turns out neither of those exercises are such a good idea. It’s planks we should all be doing.
(5) Fancy scans will almost invariably reveal that something is wrong with your back…
Most likely you have a bulging disc, or degenerative disc disease. So do most people. Is it the cause of your pain? Possibly, but maybe not. As an experiment, a woman went to 10 different imaging centers for MRIs. She received – get ready – 49 different findings. None of the 49 were found by all 10 centers, and only one was found in 9 of the 10.
(6) …which might lead you to get cortisone shots or even surgeries that you may not need or won’t benefit from.
If your scan yields a diagnosis (or, as shown above, multiple diagnoses), chances are you’ll want to “do something” about it. Otherwise, if you don’t intend to do anything, why get the scan in the first place? Cortisone shots (“corticosteroid injections”) may give temporary relief but that seems like a lot of risk, expense and effort to possibly feel better for a few weeks or months.
A more permanent solution would be a spinal fusion. Before considering that surgery, keep in mind that the #1 indication for spinal fusion is “failed spinal fusion,” meaning many people need a second operation. If you’re a smoker, this is an odds-on outcome, unless you quit for some number of months beforehand and at least a month afterwards.
Some fusion patients enjoy long-term relief, but judging from the statistics, no more than with conservative therapy. (Note: surgery results are much better when there is an actual specific problem to be addressed, such as a deformity like scoliosis.)
So what should you do instead? You have many alternatives, but no single choice is right for everyone. Acupuncture works for some people, for example – but only some people. If acupuncture, or any of the others on this list, were close to a sure bet, the “list” would have one item on it, not 11.
Likewise, “integrative medicine, a series of supervised exercises specifically designed for back pain, may provide relief." The good news about either of those options is that if they fail, you are no worse off than you are now. The same can’t be said for the more invasive options.
However, while it seems like this article contains more unknowns (acupuncture) than knowns (planks), the one take-away is, regardless of how much your back hurts today, the chances are 90% that you are in the 90%.
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