Introduction:
The Back Rx Way to a Healthy, Pain-Free Back
If you’re reading this book, you’re probably all too familiar with the pain of a low back injury. A strained muscle in the low back can make you gasp with pain at the slightest movement. The herniation of a spinal disk, the most troublesome cause of severe low back pain, can virtually cripple you. Worst of all, in the aftermath of a low back injury, pain may take up permanent residence almost anywhere in the back or legs, including sites far removed from the point of injury.
If you’re hurting now, skip ahead to page xvii for some simple ways to ease the pain. Come back to read these pages when you’re feeling better. In order to make a full and lasting recovery from low back pain, you must first understand what causes it.
In North America, four out of five people will suffer a serious episode of low back pain at some point in their lives. Only the common cold causes more lost work days than low back pain for adults under forty-five years of age.
Low back injuries usually heal within weeks, a testament to the back’s inherent strength and resilience. But long-term healing is notoriously difficult to achieve. One episode of low back pain generally leads to another. Four out of five people will suffer a recurrence within one year, and then face a 70–80% risk of further recurrences. The right treatment can make all the difference between healing completely, building a more injury-resistant and resilient back in the process, and falling into a downward spiral of recurrent injury that defeats every measure of conventional and alternative care and leads to failed back syndrome, long-term dependency on pain medication, and even surgery. That downward spiral traps far too many low back pain sufferers.
I’ve had to heal my own low back pain. So I write this book both as a physician and as a fellow sufferer. The Back Rx program enabled me to beat my low back pain for good. And it has helped thousands of patients I see in my sports medicine practice and research at the Hospital for Special Surgery, an affiliate of Cornell University Medical Center in New York, where I also serve on the faculty as a professor. Back Rx achieves these results by blending carefully selected elements of rehabilitation, yoga, and Pilates with a central focus on breath control. It is one of the few exercise programs for the low back to be shown effective in controlled clinical trials.
In an ongoing study, my research colleagues and I are monitoring the progress of two groups of low back patients who receive the same medical care and take the same pain medication, except that one group does the Back Rx program for fifteen minutes three times a week. At the end of the first year, the group doing Back Rx had a 70% success/cure rate (as measured by a more than 50% reduction in low back pain), whereas the other group had only a 33% success/cure rate. The group doing Back Rx also needed much less pain medication and had significantly less recurrence of back pain than the other group.
Building on the work of many other low back pain researchers and clinicians at the Hospital for Special Surgery and elsewhere, my research and clinical practice have demonstrated that an exercise program like Back Rx can be the key to healing low back pain without surgery or long-term dependence on medication.
My patients come from every walk of life, including professional sports, which allows me to see the full range of low back problems. Professional athletes are especially interesting patients in this regard. Understanding why even highly conditioned individuals are susceptible to low back pain provides great insight into the common denominators of this baffling medical condition and how best to address them. I see professional athletes as private patients and in my role as a consulting physician for the ATP tennis tour and the PGA golf tour. My involvement with both tours began with research studies whose results provide powerful evidence for the effectiveness of the Back Rx program. I initiated this research in 1999–2000, when I spent a year on the road with the ATP tennis tour.
During my year on tour with the ATP, I had two main jobs to do. One was to find qualified low back care physicians in the tour’s many stops around the world, from Tashkent, Uzbekistan, to Moscow, Russia, to Rome, Italy, to Tokyo, Japan, to Shanghai, China. The other was to conduct a research study into why low back pain is so prevalent among professional tennis players.
The study I conducted found that the players most susceptible to low back pain had the least range of motion in the hips. In 2001 the PGA asked me to do a parallel study of professional golfers. This study produced the same results, showing a significant link between a restricted range of motion in the hips and the incidence of low back pain. This finding is important for the rest of us, whether we are fitter than average or committed couch potatoes, because of the sedentary nature of modern life and work. Sitting in chairs, which most of us do for long hours every day at work, school, and home, leads inexorably to a restricted range of motion in the hips.
The Back Rx program accordingly features exercises specifically designed to counteract this tendency and increase the range of motion in the hips.
The treatment room at a professional golf or tennis match is a microcosm of the low back pain world. On one table a top-10 player may be receiving treatment from an acupuncturist, while different competitors work with chiropractors, massage therapists, and osteopaths, as well as specialists in conventional physical therapy and rehabilitative medicine. I have observed that although no single one of these therapies works for everyone, each of them works for large numbers of people. Back Rx incorporates insights and healing knowledge from all of them, and in the course of the book I will offer guidelines for choosing which treatments are best suited to your own individual needs.
One thing that everyone who studies and treats low back pain agrees on is that it is fundamentally a mind-body problem. As we’ll see in more detail in Chapter 2, emotional factors and psychological stress play a major role in the onset and persistence of low back pain.
A number of books have emphasized the mind’s role in low back pain in a conceptual way, without offering reliable, concrete methods for putting the concept to practical use. The way one recent book puts it is typical: to heal low back pain, it tells readers vaguely, “learn to work with your negative feelings.” Negative feelings from stressful experiences can indeed hinder full recovery and heighten recurrences. But healing low back pain begins not with psychotherapy, but with mind-body physiotherapy. You have to engage the mind at the fundamental level of body awareness, posture, and balance first. These three fundamentals form the essential foundation for healing the whole person.
Back Rx meets this challenge and teaches you how to engage the mind in healing through its focus on breath control, a key feature of both yoga and Pilates.
In my sports medicine and back care practice, my research on low back pain, and my own efforts to lead a healthy lifestyle, I’ve gained an increasing appreciation for the benefits of yoga and Pilates. Yoga, which I first learned to do at my grandfather’s side as a young child in India, engages the entire body in healthy breathing, while freeing the mind to focus without distraction or anxiety on anything it needs to do. This age-old practice has a mind-body potential that the latest neuroscience is only beginning to understand. For its part Pilates, whose founder, Joseph Pilates, was greatly influenced by his study of yoga, is the best strengthening practice yet developed for the core body muscles—of the torso, back, abdomen, pelvis, and thighs—that are crucial to good back health.
The paradox is that although yoga and Pilates are ultimately the best possible way to maximize back health, in the short run the vigorous twists, turns, and bends of advanced yoga and Pilates can actually cause back injuries. It’s quite a catch-22: the very thing that can help you the most can very easily hurt you.
Back Rx solves this problem with a carefully sequenced introduction of yoga- and Pilates-based movements and poses that will strengthen the back without traumatizing it. From the first step on, this sequence of medical yoga and medical Pilates addresses the body and mind together by showing you how to find and follow your natural breathing rhythm. The slow, sustained, deep, gentle breathing of Back Rx helps you in two ways. It automatically clears and refocuses the mind, and thus begins to melt away emotional and mental stress without any direct mental effort or concentration. And it tunes the body, so that each deepening breath progressively relaxes and conditions injured or atrophied muscles.
There are three series of Back Rx exercises to heal and strengthen your back. Each series takes fifteen minutes to complete and should be done three times a week for eight weeks on average. Series A alone will get you moving pain-free again after an acute low back injury. Many patients maintain good long-term back health by continuing to do Series A regularly, without moving on to Series B or C.
For those who want to raise their back fitness for sports and recreational enjoyment or as a stress-, injury-, and age-fighter, however, Series B offers a vigorous back toning routine and Series C provides a strenuous core body workout.
The vast majority of low back pain sufferers, more than 80%, can heal with Back Rx alone. For the small percentage who need to take other measures as well, Back Rx can be the spine that holds an effective treatment program together. There are exciting developments that can minimize the invasiveness and maximize the benefits of back treatments and surgeries. I look forward to telling you about them later in the book, including some minimally invasive, nonsurgical procedures that I have been fortunate enou...
