Guide | April 12, 2020
The cross with the cross
It's no secret that most people suffer from back pain.
In my day-to-day work as an orthopedic surgeon, I am confronted with this issue several times a day. The level of distress is usually high, as is the uncertainty.
Most patients visit the practice not because of persistent pain, but because of their anxiety. Fear and worry are usually worse than the physical pain.
First and foremost, it can be said that there are two pillars of back treatment:
- The Operation
- No surgery
Surgery is necessary only in ABSOLUTELY exceptional cases and should NEVER be the first option. X-rays, CT scans, and MRI images are not the determining factor for whether surgery is necessary; the patient is ALWAYS the determining factor.
There are some very alarming—or, in other words, disturbing—MRI images of the spine that, however, do not cause the patient any symptoms. The opposite scenario is much more common: severe lower back pain without corresponding findings on an MRI.
Please keep in mind: Only sudden paralysis, complete numbness in the legs, or wetting your pants without realizing it are indications that warrant immediate surgery.
Everything else: In other words, while these cases involve severe pain without the symptoms mentioned above, they can be resolved without surgery in nearly ALL patients.
Treatment: No surgery ( i.e., conservative treatment) means:
Time, warmth, and movement. And a good dose of patience, too...
To restore mobility to the spine, you can use pain medication, (special) injections, acupuncture, physical therapy, manual therapy, osteopathy, etc.
All of the therapies mentioned support mobility and thus help relax the back muscles. Why is this so important?
Because MOST BACK PAIN IS MUSCLE PAIN.
Herniated discs, spinal stenosis, facet joint osteoarthritis, osteochondrosis, stress, too little exercise, too much improper movement, etc., always lead to tension in the back extensor muscles. And relaxing those muscles is our common goal.
Back pain is generally medically harmless but bothersome. Please don’t get me wrong. EVERY pain and every patient should be taken seriously. Any ailment should always be evaluated and should never be downplayed. It is also important to determine the cause. It is important to understand and know that most back pain goes away on its own and, in very rare cases, becomes chronic or requires surgery.
It’s also good to be aware of all the alternatives and not let yourself be persuaded to undergo any therapies that don’t seem logical and/or sensible to you.
Conclusion
Nothing and no one should be judged across the board. Surgery may be necessary when the indication is properly established and may be the only remaining treatment option for the individual. However, when considered in relation to the vast majority of back problems, this represents only a tiny fraction.
Hardly anyone with back pain needs surgery. And if you can still walk to the doctor’s office, you certainly don’t. If necessary, get several second opinions, and don’t let anyone talk you into anything. “Time heals all wounds,” as the saying goes—and that’s how most pain goes away.