Me and My Aching Back
One man’s tale of spinal torment and eventual salvation
The day I decided to have back surgery, I was in Seattle on a business trip. Just as I stepped into my hotel room’s shower, I sneezed, sending a bolt of pain down my leg that literally knocked me down. There I lay, hoping desperately the seizure would go away so I wouldn’t have to scream for help; I didn’t want the bellman to come into my room and find me writhing naked on the tile floor.
That episode was the culmination of years of back problems, debilitating muscle spasms from my neck to my butt, days when one of my arms was paralyzed, nights when I couldn’t turn over in bed, and mornings when I couldn’t get out of it. When I collapsed to the bathroom floor in Seattle 10 years ago, I had undergone months of treatment for a garden-variety herniated disc—muscle relaxants, pain medication, physical therapy, bed rest, ice, heat—you name it, I’d tried it. The pain, primarily sciatica (a severe stabbing pain that shot from my lower back down my leg to my foot), came and went—but mostly it came—until the day it decided to stay.
Every case is different, of course, but according to the Annals of Internal Medicine, lower back pain like mine is the second most frequent reason for physician visits, vying with sniffles and other cold and flu symptoms for the top spot. Rumor (and educated opinion) has it that so many of us suffer from back problems because our bodies evolved to run on all fours across the savannah rather than walk around upright lugging golf clubs or shopping bags. There was also no notch on the evolutionary ladder that rewards sitting behind a desk pecking at a keyboard all day.
My herniated disc was L5-S1, a common problem area between the lowest lumbar vertebrate and the sacrum, or tailbone. The doctors I saw explained that a disc acts as a shock absorber sitting between the bones in your back. It looks kind of like a jelly donut. If you damage your back, either through a cumulative, repetitive injury over time or in an acute, one-time incident, some of the jelly stuff in the middle squirts out. When it pinches a nerve, you fall down naked on the floor.
Not wanting that to happen anymore, I underwent a discectomy, in which a surgeon cuts away a little bit of bone and ligament in the affected area, moves the nerve—gently, please—out of the way, then scrapes away the offending herniated disc so it no longer bothers the nerve. Instant relief.
Except…there was some numbness in my right foot and a little tingling in that leg from time to time. It wasn’t much, though, and the surgeon said it would probably go away with time. I gratefully learned to live with it—it wasn’t pain.
Fast-forward 10 years. I start having severe cramps in my legs and greater numbness in my foot. The spasms bother me first at night, then during the day if I sit for long periods, and, finally, even while I am walking around. I go to my family physician, Dr. Michael Fusco, who eliminates as many possible causes as he can and sends me to a back specialist.
What happened? Orthopedic surgeon Krishn Sharma, MD, of NYCONN Orthopoedic & Rehabilitation Specialists in West Harrison explains: “Anytime you do surgery, scar tissue forms. If we take away some ligament and bone in your back, your body will fill in with a fibrous, scar-like material. That can trap the nerve root and cause you to have some new symptoms, especially if you re-aggravate it.” My pain moved from my back, which doesn’t hurt at all most of the time, to my legs.
Ten years ago, my diagnosis was based on an X-ray. Now, I also have an MRI and an EMG, or electromyogram, in which technicians shoot electrical currents through needles into my legs at various places and record what happens in the nerve roots. It’s not fun, but it could be worse.
Dr. Sharma tells me I have three treatment options: non-operative (medication and physical therapy), interventional (a steroid injection in the spine), or surgical. When I immediately opt for door number three, he suggests I rethink my choice. In my case, he says, “The likelihood is that the scar tissue will come back, so surgical probably won’t have a long-term effect.” Plus, as Dr. Sharma so graphically puts it, “Nerves in general don’t take a joke well, so the more you manipulate one, the more likely it is to have a more persistent dysfunction. If you had a big honking disc fragment causing the pain, we could go in again, but your imaging studies don’t indicate anything other than some scar tissue and a slight herniation.”
So we start with anti-inflammatory medication and some aggressive physical therapy under the guidance of Debbie Bisaccia of Reforming Rehab in Harrison. Bisaccia gives me a vigorous core-strengthening regimen to follow that includes several different kinds of crunches, routines with the Swiss exercise ball, resistance bands, and Pilates reformer. The goal is to strengthen the complex net of muscles that surround the spine, reinforcing it and making it less susceptible to pain-inducing movement.
I get stronger, but the problems don’t go away so I go for an epidural steroid injection, which is a cortisone shot like you might get for tendonitis. In this case, it goes into the spine while you lie wide awake and very, very still. I’m not worried, because the shot is administered by Dr. Maria Cabodevilla-Conn, the same angel with the needle who had given me the EMG, so I know she has a steady hand. Believe it or not, the treatment hurts like hell for just a moment as the painkiller takes effect, then is no more painful than a normal injection.
The epidural makes a big, big difference. It looks like I’m not going to need surgery after all, but then my leg and foot still act up more often than I like, so I start considering non-traditional options while I keep up my therapy routine at the gym (my generous insurance company refuses to pay for further physical therapy, apparently because I no longer have one foot in the operating room).
My wife arranges a session for me with Toni Goodrich of the Yoga Center of Greenwich. She helps me into some Bikram Yoga poses and talks me through some stretches to open up “the channels” the nerves follow from the back, through the butt, and down the legs to the feet. When I tell Dr. Sharma about my yoga practice, he says, “ Those stretches are one form of exercise that can keep the muscles in your buttocks and your legs from compressing and irritating your sciatic nerve.” Whatever. The yoga stretches help. I add them to my time at the gym and good things begin to happen.
There are other treatments I may try next time. One is chiropractic. Dr. Philip Striano of Hudson Rivertowns Chiropractic in Dobbs Ferry suggests a course of stretching on the DRX9000, the latest high-tech device for relieving pressure on the disc. In my case, he says, “The machine is able to slowly stretch the scar tissue to make it more linear, actually remodeling it to allow the nerve more room.”
Dr. Sharma agrees, with a caveat. “That traction can be helpful because it temporarily opens up that space where the nerve roots are,” he says. Adding: “But it’s not permanent.” That’s okay by me. Apparently, neither was my surgery.
In a demonstration session, I start with a heat pack to loosen the muscles, then I lie on my back strapped to the machine with my knees supported. “It pulls in an algorithm of pull-and-relax, pull-and-relax,” Striano says, “so the muscles don’t go into a protective reflex spasm.” In English, he means that a steady pull will cause the muscles to pull back—hard. During the session, I feel my torso lengthening slowly as it is stretched, then relaxing as the pull is decreased. I easily could fall asleep. At the end of the session, I feel like an accordion relaxing back to a normal posture under the influence of gravity.
The other alternative isn’t new; it’s an ancient treatment first described in 475 BC in Chinese literature. I’m talking about acupuncture, of course, or the insertion of fine needles into the body at specific points. Dr. Sharma says it helps about two-thirds of back-pain sufferers, although, more frequently, simply by relieving chronic pain for an indeterminate period of time. When I describe my symptoms to Dr. Gabriel P. Lu, a Scarsdale MD who practices the ancient art in a highly scientific and quite modern way, he says, “The acupuncture itself doesn’t decompress the disc, but it will relieve the muscle spasms, decrease cramping, improve circulation, and release endorphins, which is your body’s natural pain killer. It isn’t a cure, but it will make your life better by relieving the symptoms.” A typical session lasts 15 to 20 minutes and costs $75 if administered by an MD like Dr. Lu. Most practitioners recommend a course of three treatments to evaluate the effectiveness in a given patient.
The docs tell me that I’ll be facing this the rest of my life and probably will have some arthritis problems in the back at some point too, so acupuncture sounds fine to me. In fact, just about any of the many treatments available—body-numbing drugs, endless rounds of abdominal crunches, injections in the spine, sweaty contortions in the hot yoga studio, machines that pull me like taffy, or needles that re-channel my chi—are better than flopping around helplessly on the tile floor like a fresh-caught mackerel.
Between back workouts, Dave Donelson lives and writes in West Harrison. He’s the author of Heart of Diamonds, a romantic thriller about diamond smuggling in the Congo.