One day not long ago, as I walked through New York's Pennsylvania Station toward my commuter train, I sneezed. My body whipped forward with the force of the sneeze, and I suddenly found myself on all fours crawling around the terrazzo, unable to stand. There was a tremendous pain in my lower back, and the noise I was making was a fair imitation of the bellow of a wounded moose.
Now a man on all fours in Penn Station is not an unusual sight. Even in my pain I could see several other folks on hands and knees variously barking, baaing and mooing—part of New York's herd of unremarkable loonies. So I went unnoticed by the majority of the thousands of homeward-bound commuters. One well-dressed executive pointed me out to his companion, however. "That's why I quit the three-martini lunch," he said righteously. An elderly woman dressed in one of Attila the Hun's fur coats and carrying several paper shopping bags stuffed with old rags stopped. "Ye shall know them by the mark of the beast," she proclaimed, and slugged me on the ear with an umbrella. Insulted and suffering incredible pain, I crawled aboard the train and rode home on all fours, like a steer through Kansas.
After almost two weeks in bed on a diet of Valium and codeine, I could once again blink, flex my toes and count to 10 without searing, crippling pain in my lower back. I was able to hobble about, one side of my body collapsed toward the pain, and generally make my way around the house. During this agonizing period, by reading a number of books and pestering specialists from Atlanta to Boston, I began to learn about "lower back syndrome."
A U.S. Public Health Service survey indicates that 70 million adults have experienced at least one episode of severe and prolonged back pain, and according to the National Center for Health Statistics another two million are being added to that number each year. Experts agree that backache is the second leading cause of pain in the U.S., after headache. And when one thinks about it, as does orthopedic surgeon Dr. Leon Root, a specialist at New York's Hospital for Special Surgery, the reasons are clear. Says Root, "The evolutionary change from quadruped to biped millions of years ago made man a special animal, able to free his hands for complex tasks. But anatomically, we pay an expensive price for that advance—the human back bears a great and unique load, and it is structurally weak." Think for a minute. Our brains and our backs, wherein our evolutionary superiority is most clearly marked, are the most susceptible to pain.
March 13, 1978
Doctors call what happened to me in Penn Station when I sneezed "acute lumbosacral strain." It involves the muscles of the lower back—overworked, under tension and stress—knotting up in a prolonged spasm. According to Root, up to 90% of all patients driven by pain to see their physicians for lower back problems suffer from muscular strain or tearing, and perhaps from accompanying ligament and tendon damage. The remaining 10% are suffering from congenital defects in the spine, infections, malformations, kidney problems, arthritis and that old bugaboo, the "slipped disk" (which is, properly, neither "slipped" nor a "disk").
Although I was disappointed to learn that my case was so ordinary, it serves to illustrate the problem of "everyback." About a week before my sneeze, I had played squash—violently and all-out. And it was there that my problems began. Root, a fellow sufferer whose own problems began as a consequence of a blind-side tackle in a college football practice, notes that "after the first few nice weekends of spring, orthopedists and neurologists can depend on waiting rooms full of patients with strained backs. When the weather gets good, middle-aged executives—deskbound, overweight, out of shape—suddenly decide that they're Frank Merriwell and I see a long parade of weekend golfers, tennis buffs and gardeners, bent over in pain. And it's all avoidable."
I had played squash at the end of a tension-filled day in which I'd pounded the typewriter to meet a deadline and been harassed by phone calls from a surly loan officer at my bank.
I looked upon the squash game as a physical way to deal with the aggression and stress I felt. I am 37 and, unfortunately, out of shape, overweight and strung tighter than a harpsichord. When I took the court against my skinny, 26-year-old opponent who played squash daily, I was the No. 1 candidate in America for lower-back muscle spasm.
After the match (which I lost convincingly), I felt a tightness and twinging in my back. Stupidly theorizing that if pain is felt while exercising, more exercising will alleviate it, I played again the next day, even harder.
The muscles of the lower back are called upon to do a great deal. A relatively thin band of muscles, where the lumbar region of the spine joins the sacral region, must lift and lower the upper torso. A Swedish physician interested in stress, Alf Nachemson (who designed the Volvo seat), has demonstrated that a man bending over to lift a 50-pound weight puts something like 660 pounds of pressure at the juncture of the lumbar and sacral spine. Consequently, the muscles of the lower back, if improperly exercised, will go on strike. Overworked, contracted unnaturally as a result of the tensions of modern life, a sudden twist to the side or a fast bend, as in a sneeze, may lock the muscles into a spasm that will throw a man to the floor in agony.
It is the job of muscles to contract on impulses from the brain. By contracting sets of muscles we walk and carry out our daily chores. Even while reading this, your eye muscles contract and release as they direct your eyes across the page and back again. But when an unnatural stress is placed on a muscle, the muscle locks up and simply won't listen to reason.
Experts generally agree that the majority of back sufferers need no longer be in pain or tiptoe around in fear that their backs will "go out" again after an initial attack, and that, indeed, most back pain is preventable. The answer lies in therapeutic exercise, both a stretching routine and a strengthening series.
Modern medicine has experimented with a wide variety of cures for low-back syndrome—traction, braces, diathermy, acupuncture, hot and cold packs, body casts and chiropractic manipulation. A new treatment, consisting of putting needles into bones and called osteopuncture, is now being touted. But to specialists like Root, neurosurgeon Bernard Finneson of Philadelphia (who has founded a back clinic) and Dr. Hans Kraus of New York (one of John Kennedy's back doctors and founder of much modern treatment), the answer lies in exercise if your problem stems from muscular tension and trauma. Exercise goes a long way to correcting poor posture; it will trim the waistline and ease tension.
"Poor posture, uncorrected throughout youth and adulthood, will almost always lead to a back problem," says Root. "The spine is S-shaped, and a simple law of mechanics is that stress, applied to a curved structure, causes the greatest load on the inside of the curve. The way to relieve an uneven load on the back is to flatten out the curve."
Here is a simple posture test: lift your head as far away from your toes as possible, but keep your chin tucked in. This flattens the top of the S-curve. As you do this, tilt your pelvis forward by contracting the powerful muscles of the buttocks. This contracts the bottom of the S, the lumbar spine, the weak spot. Now, slump back to your normal stance and see how poor your posture is compared with what it should be.
"In the lifelong contest between you and your back, posture is practically the whole ball game," says Root. "Most trauma pain is caused by poor posture. Most stress, tension and fatigue pain is caused by it. The same for disk pain, pregnancy pain and all other kinds of lower back pain."
One answer, then, is to do the above exercise as often as possible until the position begins to feel natural. Another way to better posture is to pretend that a wire is attached to your chest, pulling it straight up into the air.
Hans Kraus is most concerned with the effects of tension and emotional stress on backs. We live in a world far removed from the one shown in John Wayne movies. If the boss yells at us, we can't deliver a looping left to his jaw; we grin and bear it. We can't even run away from it. And so our biological fight-or-flight mechanism is short-circuited. Adrenaline pours into the system with nothing to do there: we become tight, tense, strung out.
Because so much of our movement capability is located in a small area of the lower back, its muscles, tendons and ligaments are the ones most deeply affected by tension, the muscular equivalent of a stomach ulcer.
Those convinced that violent exercise will relieve tension that vodka poultices applied to the inside of the body will not, are walking time bombs, ticking off the minutes until hit by crippling back pain. They suffer through rush-hour traffic to get to a driving range to thrash furiously at buckets of balls or they go out at dusk tingling with daily frustrations to practice their serves without proper warm-up exercises. They may be doing great harm in the process. This does not mean that one has to stop taking part in sports, or even do them at half-strength. What it means is that one's exercise must be calculated.
If the muscles of the lower back are tight from tension, or weak, then it is necessary to build up other muscles to help bear the load—the lower abdominals, the hip flexors, the hamstrings and the buttocks are especially in need of strengthening.
There are many combinations of stretching and strengthening exercises, about as many as there are knowledgeable physicians in the back-pain field. Three currently available paperbound books on the subject provide sensible, systematic exercise tips and explain in great detail the pathology of lower back syndrome.
Oh, My Aching Back (Signet, $1.95) by Root (with Thomas Kiernan) is a concise and intelligent treatment of the subject, and his eight general exercises are the most compact and useful for those who believe that they may be prone to a bad back.
Backache, Stress and Tension (Pocket Books, $1.50) by Kraus, ranges wider in its interest, exploring the effects of stress and tension in modern life. Kraus also includes six self-administered fitness tests that he developed with another physician many years ago. They are designed, among other things, to tell you if you are a potential back case. In addition, the book contains an exhaustive catalog of exercises—but not an exhausting one, for overexertion is not in the ball game for back cases.
A slightly different point of view is presented by Finneson in The New Approach To Low Back Pain (Berkley Publishing Co., $2.95). Being a neurosurgeon rather than an orthopedic man, Finneson's presentation of details on the mechanics of pain is enlightening, at least to us sufferers.
As each of these books warns the reader, the man who treats himself has a fool for a patient. Before doing exercises, read the books thoroughly and get your personal physician's O.K., for the exercises aren't for everyone.
If you merely suspect that you may be a candidate for crawling around on your hands and knees, Root's book should suffice. If you are a bona fide sufferer and, like me, love to know every one of the hideous and intimate details of your ailment, then all three are recommended reading.
After recovering from my initial bout of back pain, and doing my exercises religiously for six weeks, I am once again able to play squash and tennis. Further, by doing the tension-releasing exercises, I find myself a much calmer—though still harried—hysteric.
The experts suggest avoiding some sports, advise which to engage in immediately and which to undertake with caution. They all recommend returning to sports activities slowly, what got you into trouble in the first place was too much activity without first getting rid of your tension. Perform a medically sound round of warm-up stretches before any physical activity, and ease into things.
Swimming is great for back sufferers because the water bears most of the weight of the body. Stay away from the butterfly, however, for it forces you to arch backward.
Golf is O.K., but not great, at least according to Kraus, who says, "The great golfers have such a smooth swing, but a duffer is so jerky he can cause his muscles undue strain." So caution is the word in golf.
Tennis is fine, but modify your serve so that you do not arch backward at the top.
Both football (even touch) and baseball are too stop-and-go to get high marks. And a back patient who remembers his pain is unlikely to play football anyway.
Running is highest on the recommended list after swimming. Cross-country skiing ranks third, for in it the knees are bent and the back properly flexed to stretch the muscles. Downhill skiing gets lower marks because of the possibility of injury in a spill.
Not recommended are water skiing (the back is arched too dangerously) and bowling (the presence of extra weight on one side of the body is asking for it). And anyone who's been through the indescribable pain of muscle spasm in the lower back, whether on the floor of Penn Station or not, is definitely not asking for it.