Initially, it appears a great and heart-warming article of surgical success – but read between the lines a bit and you’ll see a damming example of all that’s wrong with the current system of medical care for the low-back.

Look for these key points:
1. 10 years of pain!
2. Constant pain.
3. GP and painkillers – sure to work, them!
4. Didn’t, so back to the GP.
5. Referred to surgeon for a life-threatening three-hour operation (though I’d have thought the risk of paralysis that she mentions, the MRSA, anaesthetic induced death and, well, just death was not likely or serious enough to stop her having this operation as she had been in constant pain for 10 years!)
6. “The beauty of this operation is that it doesn’t constitute major spinal surgery”!
7. £10,000!

So, here it is:
“Around eight in ten Britons are affected by back pain at some time in their lives. Anne Baker, 65, a retired shopkeeper living in Sheffield, had a pioneering procedure to cure her debilitating back ache. She tells ANGELA EPSTEIN her story.

Pioneering surgery: Anne Baker can now enjoy life after having spinal fusion
THE PATIENT
My back has always been a problem, particularly after playing golf or lifting things. But over the past decade, it slowly worsened until I was in constant pain.

I went to my GP, who said it was wear and tear in my spine and gave me painkillers. Unfortunately, the benefit was only short term — I had a constant nagging pain in the centre of my back, which made me stoop, and I couldn’t hold my head up properly without being in immense pain. I was forced to give up golf and increasingly relied on my husband to do jobs around the house. He even had to fasten buttons on the back of my clothes.

It reached a point, five years ago, where even lying in bed was uncomfortable and the only way I could get a moment’s sleep was by half-sitting up on the sofa. As well as being in awful pain, I was exhausted all the time, which made me miserable.

I went back to my GP — after several appointments in previous months — in desperation, thinking there must be something that could be done. The painkillers were now having little effect so he referred me to a specialist, Lee Breakwell.

Although I was afraid of surgery — I’d heard stories of people coming out even worse after very invasive operations — there seemed to be no alternative. It was either an operation or a wheelchair and I was already practically housebound, so what was there to lose? A scan revealed one of the discs in my spine had degenerated so badly over the years that it had slipped out of place, causing the vertebra on top to tilt downwards by 30 degrees. Without the cushioning effect of the disc, two of my vertebrae were resting on each other, which was causing the dreadful pain.

So I was amazed when Mr Breakwell said that he could cure me using a new technique which was much less invasive than the conventional procedure. First I would need the disc removed — usually the vertebrae on either side would then be ‘fused’ together using screws: this stops the movement and the pain. But, instead, Mr Breakwell said he would use a bone graft, which helped the vertebrae to fuse better together, with fewer complications. I was a bit nervous about having a general anaesthetic and couldn’t help worrying that if something went wrong, that would mean being paralysed.

Although I was very sore from the stitches when I came round, incredibly, the constant nagging pain in my back was gone. The feeling was indescribable. The day after the operation, I could stand up straight without that terrible pain. The nurses helped me with exercises which I continued to do at home after being discharged, five days later.

Within three weeks, I could stand up straight without any pain. It was astonishing to see myself in the mirror after so long stooping — I seemed to have grown an inch-and-a-half.

Progress was slow, and I had to walk using crutches for seven weeks. But I could sit up properly and lie down flat without any discomfort after a couple of weeks — a milestone after sleeping on a sofa for two years. About six months later, I was able to play golf for the first time in four years. I’m constantly aware of my good fortune — even little things such as fastening the buttons on my dress.

Before the surgery, I felt like an old woman and thought my future was a wheelchair and pain for the rest of my life. Now, I can wear nice clothes and high heels and play golf. I even have a perfect swing, as the metal rod in my back helps keep my hips straight! It’s like being given a whole new lease of life.

THE SURGEON
…[To begin the three-hour operation, I made a 10cm vertical incision in the small of the back along the spine, and peeled back the spinal muscles to reveal the base and bones of the spine. I then drilled into the vertebrae on either side of the damaged disc and stabilised them with small screws in order to remove the disc (a disc is around 10mm high and four cm in diameter). I packed a teaspoon of bone graft — grated bone, which is better absorbed by the body than solid bone, taken from Anne’s pelvis during the operation — into a banana-shaped piece of plastic (a ‘spacer’) about 10mm high with a hole through it. The plastic is then placed into the space where the disc used to be, so that the bone from the graft can grow and fuse with the joints on either side. The bone graft doesn’t need any treatment to prompt it to grow. However, the adjacent joints need still to be in order, to keep the space open for the new bone to grow in. I do this by locking little screws into the joints. The bone graft takes between six and 12 weeks before it gets taken up by the body and turned into proper bone.

While the bone graft doesn’t act as a new disc, it makes that part of the spine solid and puts an end to the pain previously being caused by a jarring damaged disc.

We need discs in our back to provide shock absorbency for the spine. However, missing one disc shouldn’t matter too much, as we have other discs to compensate. The beauty of this operation is that it doesn’t constitute major spinal surgery [!]. The procedure is quite localised, yet it can cure a disabling disc problem. It relieves pain and enables the patient to function normally again.
Anne’s return to the golf course is a wonderful example of this. And it should solve her problem for life.

The operation is available on the NHS. It costs £10,000 privately.”

Good grief, why didn’t they spend a little time and money (I’d estimate about 1/33th of what they paid for the operation alone) on some early care in the first few years and maybe, just maybe, none of this madness would have had to happen.

Now, I am really glad that Anne is functioning well and that the surgery was a success but I am appalled at the loss of a decade of her life due to medical mismanagement.

“Back pain relief in just five minutes a day

If you suffer from back pain and have received professional help, the chances are that you have been told that you need to strengthen your ‘core’. Studies into the causes of back pain have identified weak musculature of the low back and ‘core’ as a common factor in many cases of chronic back pain. So, what is this term ‘core stability’ which is being bandied about and where is this elusive core?

The core muscles are located around the abdominal region, back, pelvic floor and hips. These muscles are responsible for balance, posture, trunk stability and are the foundation for movement. If they are weak, other muscles have to compensate, which is where poor posture and back pain come in.

Core stability isn’t about having a six-pack. Your six-pack muscle (the Rectus Abdominis) is a superficial muscle and, although it does form part of the core, we are more concerned with strengthening the smaller, deeper muscles for maximum stability.

So, now you know where the muscles are, we can work on identifying them in your own body in order to effectively strengthen them.
Below are four core strengthening exercises. During each exercise, you need to employ these muscles and maintain the contraction throughout. If you’ve done Pilates before, you may have heard this referred to as ‘zipping and hollowing’ or ‘pulling in’. Once you’ve mastered this technique, apply it to everyday life. Contract your core when lifting, running, even getting out of bed to keep your spine protected.

Here’s how to do it…
Lie face up on the floor with your legs bent and feet flat on the floor. Locate the top of your pelvis [on each side directly above where your pockets are] and walk your fingers diagonally down to[wards the top of your zip at] the front [each hand] by about 5cm.
Keep your fingers there, now cough. As you cough you’ll feel a contraction in the muscles under your finger. This is your core ‘firing up’.
This is the contraction you want to establish and maintain throughout the exercises so practice doing this by coughing again and trying to hold the contraction for at least 30 seconds.
If you find you’re holding your breath, try counting out loud.
It does take a bit of practice to get the hang of this but once you’ve got it you’ll have no problem holding the contraction while exercising and breathing at the same time!

So, to the exercises…

Roll down
This will mobilise your spine and provide a good stretch down your back. Stand with your feet hip width apart and your knees slightly bent. With your core contracted, put your chin on your chest and slowly roll down through your spine. Keep your knees slightly bent.
Think about articulating one vertebrae at a time, feeling the stretch down your back until you’re bent over with your neck relaxed and your arms hanging down, like a rag doll. Then roll back up, stacking one vertebrae on top of the other. Bring your head up at the very end to finish the exercise.

Leg raises part one
Lie face up with knees bent and feet flat on the floor hip distance apart. Contract your core and raise one leg off the floor until the knee is above your hip-joint, keeping your knee bent.
Be careful not to lose the natural curve of your spine. If your back starts to ache, chances are your back is arching and your pelvis is tilting away from you.
Avoid this by holding the contraction thigh and tilting your pelvis towards you by pushing your spine toward the floor.
Note I said pushing ‘towards’ the floor, not ‘into’ the floor. You don’t want to lose the natural curve by pushing the spine into the floor.

Leg raises part two
In the same starting position as the previous exercise, contract your core and raise one leg then straighten it out in front of you, keeping a bend in the knee. Raise as high as you can without losing the natural curve in your spine, then, making sure you’re still holding in your core, press your low back into the floor and tilt your pelvis in towards you. This time you want to lose the curve. Hold, then return to your starting position and repeat the other side.

Front support hold
Often referred to as ‘the plank’ this is a great one for your core. On your front, with your core contracted, prop yourself up on your elbows and raise onto your toes so your entire body is off the floor (apart from your elbows and toes, obviously – if you learn how to do it otherwise, please let me know).
You’re aiming for a ‘dish’ position, so rather than having your back dead straight, you want to tilt your pelvis forwards to achieve a slight upward curve, like a bridge. This takes pressure off your back and works the core harder.
See for illustrations and further guidance. If you can spare five minutes each day to do these four exercises, you’ll be giving yourself a good start to achieving core stability and reducing back pain. ”

Not at all bad advice and if you look at our web site:
www.c1healthcentre.co.uk
you’ll see these shown on our page to boot.

http://www.telegraph.co.uk/health/expathealth/7718976/Back-pain-relief-in-just-five-minutes-a-day.html

For years, employees who suffer from chronic low back pain have been treated with a transcutaneous electric nerve stimulation (TENS), a portable device that applies a mild electrical current to the nerves through electrodes. The theory behind the treatment was that nerves can only carry one signal at a time. Physicians believed that transcutaneous electric nerve stimulation confused the brain and blocked the real pain signal. However, according to a guideline issued by the American Academy of Neurology, this method is not recommended.

Research on TENS transcutaneous electric nerve stimulation for chronic low back pain has produced conflicting results. For the guideline, the authors reviewed studies for low back pain lasting three months or longer. Acute low back pain was not studied. The report concluded that transcutaneous electric nerve stimulation does not help chronic low back pain.

Researchers noted that all but one of the studies excluded people with known causes of low back pain, such as a pinched nerve, severe scoliosis (curving of the spine), severe spondylolisthesis (displacement of a backbone or vertebra), or obesity. In the study that looked at low back pain associated with known conditions, transcutaneous electric nerve stimulation was not shown to be effective.

“The strongest evidence showed that there is no benefit for people using transcutaneous electric nerve stimulation for chronic low back pain,” said Richard M. Dubinsky, lead author of the guideline and a fellow of the AAN.

“Doctors should use clinical judgment regarding transcutaneous electric nerve stimulation use for chronic low back pain. People who are currently using transcutaneous electric nerve stimulation for their low back pain should discuss these findings with their doctors.”

The guideline determined that transcutaneous electric nerve stimulation can be effective in treating diabetic nerve pain, also called diabetic neuropathy. However, researchers said more and better research is needed to compare transcutaneous electric nerve stimulation to other treatments for this type of pain.

“So-called slipped discs are a common result of overzealous DIY or gardening but a spinal operation is not always the best answer”
Dr Mark Porter

Dodgy ladders, reluctant lawn mowers, sledgehammers, strimmers and heavy patio slabs all exact a toll on the lumbar regions of the nation’s Bank Holiday DIY-ers and gardeners, and most surgeries will have at least one person in the waiting room this morning with a bad back. The lucky majority will have a simple sprain or strain, but an unlucky few will end up with a slipped disc.
Two years ago I was one of the unlucky ones. I would like to be able to report that I damaged my back kite-surfing off Cornwall but the truth is, I did it lifting a half-empty bucket at home.

One person in 20 develops at least one episode of back and referred leg pain (sciatica) from a slipped disc at some stage of his or her life, with most cases occurring in men aged 30 to 50. The discs are found between every vertebra in the spine, where they act as shock-absorbing spacers that allow the spine to twist and flex. They are subject to considerable mechanical forces, particularly in the lower spine, and it is these lumbar discs that typically cause trouble.

The term “slipped disc” is a misnomer. The circular discs never actually move, but a weakness in their tough outer wall allows the softer, gelatinous centre to bulge out or burst through (prolapse), compressing the surrounding nerves and causing pain and sometimes numbness and weakness, too.
Most damaged discs heal with time and there is little that medicine can do to accelerate that process, other than try to keep the person as comfortable as possible. Manipulative therapies such as physio can’t settle a damaged disc but they can help to alleviate accompanying muscle spasms and postural problems.

If symptoms do not improve in six weeks, I advocate referral to the nearest back pain clinic for further assessment, which often includes an MRI scan to look at the discs. If the symptoms are severe and show no signs of resolving, then surgery to remove a bit of the disc and relieve pressure on the nerve (a microdiscectomy) may be indicated. The results are excellent but it should be a last resort — most people who don’t have surgery eventually make a full recovery too, although this can sometimes take 12 months or more.

I have always advised patients of mine to grin and bear the pain in the hope that Mother Nature will eventually heal the wound and do a better job than a surgeon, but my experience has changed that stance and I am now far more pro-surgery than I used to be. My pain never settled despite throwing the British National Formulary at it — and when I started to lose feeling and power in my left leg, a neurosurgeon suggested a microdiscectomy and I agreed.

When I came round in recovery after the 90-minute operation, it was clear that it had been a success. The omnipresent sciatica in my left leg had vanished and, besides a bit of tenderness around the 3cm scar in the small of my back, I was pain-free.

Not every microdiscectomy goes so well and there were several factors in my favour. My problem was at the right level (damaged discs between the fourth and fifth lumbar vertebrae tend to do best); I am the right age (for once, being over 40 is associated with a better outcome); I had it done at the right time (surgery within 2-3 months of the injury is most successful); and I had an excellent surgeon.
Surgery is not needed for most people and is no better (and may be worse) than leaving things to heal naturally. But it provides almost instant relief when it goes well, and can prevent permanent nerve damage.

My sciatica may have gone but the strength in my left leg never returned completely and I nurse my back much more than I used to: lots of core stability exercises, no more marathons and no DIY or heavy gardening. Well, that’s my excuse, anyway.

Sciatica advice
Take it easy
As a general rule, 70-90 per cent of prolapsed discs will settle, or start to settle, within six weeks. Taking it easy will help the pain in the short term but bed rest should be avoided if possible.

Which drugs?
Paracetamol and ibuprofen are rarely strong enough alone for people with sciatica. Longer-acting, more powerful anti-inflammatories such as diclofenac work better, and you may need even stronger painkillers or muscle relaxants (low-dose diazepam).

Tingles and worse
Pins and needles, some loss of sensation and weakness in some muscles (particularly those working the big toe) are common in bigger prolapses and full recovery is usual, but such symptoms always warrant assessment by a doctor. If the symptoms affect both legs or you are having difficulty controlling your bowels or bladder, this suggests more worrying nerve compression and requires urgent assessment.”

So, he seems to have made a full recovery form the surgery except for the weakness in the leg, which stikes me as significant and not as trivial as he is perhaps making out. I also got the feeling that the surgery option is the one of last resort even thought it had a good outcome and I wondered why this was. Perhaps reading between the lines this is not as simple as it sounds and it may had some horrible risk factors that may mean it is onluy used if noting else works.

I liked the mention of the physio but the lack of decent spinal care not provided by those who know what they are really doing was a shame and it was telling that the pathway was: wait, drungs then surgery. I fail to see how the drugs could do anything for the underlying condiditon and no wonder it failed to resolve.

The best care must include Mackenzie exercises, precise manipulation and subsequent rehabilitation.

Researchers say that people with low back pain are at increased risk for chronic problems if they are in poor general health or have psychiatric illnesses. Additional predictors of future chronic pain include impairment in performing activities of daily living and difficulty coping with pain.

Poor pain coping behaviors include avoidance of work, movement, or other activities out of fear the activities will damage or worsen the back. The researchers also say that some patients tend to have “excessively negative thoughts and statements about the future,” which allows them to rationalize reasons to avoid physical activity or ignore the recommendations of their doctors.