Back pain may be better treated with exercise instead of surgery

Most back surgeries are unnecessary.

Despite that, they’re being performed with increasing frequency. A recent Associated Press report details the issue, and illustrates why this is a growing concern.

Almost $90 billion is spent on back pain annually, when, in reality, time is often the most effective treatment. In fact, studies show that 90 percent of back pain heal without further intervention.

Both doctors and patients have to bear some responsibility. Physicians, incentivized by a fee for service payment system, sometimes are financially biased towards a procedural cure. Patients, as well, have to adjust their expectations to have “something done.”

In many cases, surgery is not the definitive cure. The relief is only temporary, with the potential of further operations down the line.

Aggressive exercise programs — often not as aggressively publicized by doctors — can be a better fit for some patients. Consider this story cited in the piece:

After a volleyball injury, scans showed [the patient] had degeneration in seven disks but one bulged in a way that doctors thought explained the pain radiating down both legs. They cut away part of that spot; it didn’t help. Neither did multiple pain-blocking options.

This so-called “tailored rehab” is intensive, and requires a commitment on the patient’s part.

If we can better educate the public on the effectiveness of conservative measures, perhaps we can make a dent in the number of unnecessary procedures that many back pain patients are fruitlessly undergoing.

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  • Anonymous

    Well, this is great news, but what about the person actually IN this great pain?

    When the person’s doctors all are pointing towards some combination of “live with it”, “take powerful drugs”, and “more surgery”, how does one escape that and find an exercise “clinic” that will help? Do you have any resources? I know someone who could benefit greatly, I think.

  • stargirl65

    This problem is partly the patient’s fault. Many patients do not want to commit to PT since it is expensive for them. There is a copay for each visit vs one copay for surgery. Also we seem to want things done now and done easy. Americans want it all but do not want to do anything that is work to accomplish this. They do not want to exercise or lose weight, both of which helps back pain.

    We need to educate the public as well. But we need to incentivize the doctors to NOT operate.

    • http://paynehertz.blogspot.com Payne Hertz

      Some doctors seem to feel patients are responsible for everything doctors do wrong, whether its malpractice, using drugs as placebos, excessive testing or unnecessary surgery, but I fail to see how any of this is the patient’s fault. You get hurt, you go to a doctor, you do what the doctor says. That’s how it works for most people. If he tells you to take NSAIDS, go to PT, or get a surgery consult, you do it. If you don’t, you are “noncompliant.” If you are on any kind of pain medication, you were likely forced to sign a “contract” that requires you do what the doctor tells you, or you lose your meds.

      I know “Americans want it all but do not want to do anything that is work to accomplish this” is a standard right-wing trope, but one struggles to understand how the PT folks remain in business if this is true, let alone how such lazy, feckless people as Americans managed to build such a powerful modern economy—albeit one torpedoed by our hard-working elite. Could it be that some people don’t stick with PT because it doesn’t work for them? Naaah, must be some personality defect.

      Why is it a sin to want immediate relief for pain? When you have kids to feed and a job that isn’t going to wait for months for you to get better, is it so irrational to want something that can get you back on your feet right away?

      The idea that we now have to incentive doctors to not engage in quackery is truly bizarre. Perhaps we should pay them extra for not performing useless and dangerous surgery? If I refrain from shooting someone today, can I haz cash plze?

      • Runner

        @This problem is partly the patient’s fault.

        When i injured my back, my doctor didn’t mention physical therapy. I found that on the internet. Of course, I had mechanical issues with my running which the PT “fixed.” He gave me exercises for prevention. I had some permanent damage because of delay in getting to the PT.

  • family practitioner

    We also need to “walk the walk” and discourage early imaging with MRI. I tell patients that, in the absence of “red flags”, imaging should only be done for persistent symptoms. Some of them are ok with that, but others, they got to have that MRI. Maybe their friend told them they needed it, or their chiropractor, or “I pay a lot for this insurance and I want my MRI, dammit!” I do not feel like fighting with the patient. If an MRI is demanded, I refer the patient; then they’ll get all the unnecessary tests they want, and possibly an unnecessary surgery.

  • http://www.healthleap.com Jesse

    My neuroscience professor, Dr. Marian Diamond, needed rotator cuff surgery for her shoulder which she hurt playing tennis. In the 3 months between the diagnosis and the surgery, she created an intensive rehab routine which included swimming 5x/week, light weights and push ups. When she showed up for her pre-op, she demonstrated how her shoulder was repaired, and didn’t need the surgery

  • http://paynehertz.blogspot.com Payne Hertz

    The fact that back surgery is largely useless has been known for decades. I remember reading similar articles back in the early 90s which had references to the 70s. The head doctor at a major interdisciplinary pain clinic I went to told me that 50 percent of his patients had “Failed Back (surgery) Syndrome” –which is apparently caused by the failure of people’s backs–and told me my decision not to have surgery was the best decision I ever made in my life. He called such people “train wrecks” due to the degree of damage they suffered and to be sure, the “failed back” people seemed to be in the worst pain of anyone at the clinic.

    Like most back pain patients, I was advised to get a surgery consult and ended up with multiple diagnoses from multiple specialists, all of whom wanted to do surgery except for one, who was the only one who was honest about the poor prognosis for success and said he limited back surgery to those who were suicidal from the pain, incontinent or unable to walk.

  • DRJEBJ

    As a Family and Occupational physician I have recommended for years that patients with back strains and herniated discs remain as active as possible, do simple range of motion stretches once every 30 minutes and avoid painful activities. This has proven very effective.
    I have not been a fan of physical therapy because they often begin early strengthening exercises which stress damaged tissues and usually ask patients to exercise 3 times a day which is not nearly often enough.

  • DO Student Doc

    It seems that there is an obvious treatment modality being left on the table, so to speak (pardon the pun). I’m curious how many MDs here ever refer your back pain patients to DOs whom you know to be proficient at osteopathic manipulative treatment?

  • G. K. Pandey

    Best advice possible. Very sensibile.
    I have always found exercise and heating pad is all it takes to keep my back pain in check. Even when I had a tolerable low back pain I kept my exercise regimen and it goes away.

    All this hype about the bed softness and commercial products notwithstanding we can keep low back pain at bay by continuing to exercise.