Overcoming back pain
COLUMBUS, Ohio — It's the midway point of the city's annual marathon, 13 miles to go, when I detect a slight tightening in my back.
I quickly add the sensation to the list of twinges to monitor: possible blister on left middle toe, ache in left hamstring.
I liken this mid-run analysis to absentmindedly absorbing those quirky sounds the car makes and ranking them in order of concern. Click. Ping. Clank.
As almost every adult American experiences at some time or other, back pain is the clank. It's the pain you fear may never go away, the one that plagues you sleeping or awake, the problem that can stop you in your personal and professional tracks.
For me, the clank came four years ago, out of the blue and debilitating beyond belief. What I went through during the long and painful months that followed is on my mind now as I run past the appreciative crowds watching the marathon in downtown Columbus.
The day before Christmas 2002, I could barely take two steps.
Studies show that eight of every 10 people in the United States will suffer from lower back pain at one point in their lives.
Back pain is the leading cause of disability in people under the age of 45 and the third-leading cause in people older than that, after cancer and heart problems. It's the second most common reason after the sniffles to see a doctor.
Back injuries are the most frequent source of workers' compensation claims nationally, accounting for one of every five claims, according to the National Council on Compensation Insurance. The average cost of each claim is about $13,300.
Surgery for back pain is also on the rise, leading some doctors to question whether they're seeing an epidemic of back pain or an increase of back pain complaints and treatments.
"We've come to expect with advances in science and medical technology and what we see on TV that there is a cure for whatever ails us," said Dr. Anna Stowell, a psychologist and pain researcher at the University of Texas' Southwestern Medical Center in Dallas.
Whether the spike in treatments is a result of an increased number of sufferers or more complaints, researchers agree that a more sedentary lifestyle combined with the country's obesity problem isn't helping people's backs.
Americans are also staying active longer, which puts new strains on old backs.
"A lot of people think about herniated disks and some sort of serious trauma," said Richard Deyo, a professor of medicine at the University of Washington. "The truth is, it's just the result of aging and wear and tear on the disks, and bad luck."
My problems began on a ski trip to upstate New York in February 2002. At the end of the day my back was sore.
A month later, a stabbing back pain hit during a run and soon it was difficult to stand up straight.
My doctor prescribed pain pills and back-strengthening exercises and suggested an over-the-counter anti-inflammatory such as ibuprofen.
The pain slowly diminished. I did the exercises — most of the time — and started running again, though I rarely took any pills.
About to turn 41, I didn't do my back any favors.
I started mimicking the front flips I saw kids doing at the pool. I would swim into the shallow end to toss my 7-year-old twins in the air a few times — "Air Daddy," we called it. I did my best to ignore the almost imperceptible twinge in my back each time I lifted them up.
As I learned too late, this type of repetitive activity is one of the leading causes of back injuries. Among male workers, carpenters have the highest incidence of lower back pain; among the major occupations of women, it's the nurse's aides — people lifting patients all day.
"It's sort of like taking a paper clip and bending it over and over," said Dr. William Marras, executive director of Ohio State University's Institute for Ergonomics.
I stopped doing back exercises and my right leg started to hurt.
By October, I had stopped running and was having a hard time walking more than 100 yards without stopping and resting my aching leg. It was especially disheartening for someone who'd been running for more than 30 years.
My doctor, Columbus osteopath Tom Peponis, diagnosed the new problem quickly: a herniation in which the soft material inside the disk bulges out and puts pressure on nerves running down the leg.
In technical terms, referring to the position of the spinal segments, I had an L5-S1 herniation. In other words, this was the vanilla ice cream of back injuries.
The engineering of that joint "makes it most susceptible to herniated disks," Peponis said. "It's the fulcrum that transports the weight of the upper body to the lower body."
Dr. Scott Otis, a Columbus-area specialist in back pain, laid out my options: rest and possibly some physical therapy; a round of injections with steroids; surgery.
It turns out that surgery for back injuries like mine is a hot topic. What's called a diskectomy — or trimming the offending bulge to ease pressure on the nerves — is the most common surgery in the United States for people with back and leg pain.
Yet two big government-funded studies published in the Journal of the American Medical Association last fall found that patients with herniated disks saw substantial improvement over two years whether or not they had surgery.
I opted for a conservative but aggressive approach: no surgery but two cortisone shots about two weeks apart. Steroids are injected directly into the area of herniation to reduce the swelling and ease pressure on the nerves.
On a particularly bad day, I tried walking up the street with my wife and the help of a cane. I made it just past our house before I had to turn around.
The pain didn't go away.
Off work for several weeks, I stayed in bed, watched TV, read, and generally felt sorry for myself.
"The teaching in the 1970s was bed rest for two weeks," said Dr. Anthony Delitto, chairman of the physical therapy department at the University of Pittsburgh.
"We've come so far away from that — you really want a minimal amount of rest and you want to activate a person as soon as possible."
The turning point for me came that December in a large pool of warm water as I moved my legs slowly while periodically stretching my hamstrings. The combination of warm water and loosening exercises gave me flexibility in my leg I hadn't felt for months.
"It's problem-solving, basically," said my physical therapist, Brenda Shoup. "It's identifying, 'What are this person's limitations, what are their goals, what do they want to get out of therapy?' and then how can I help them get there the fastest?"
As the pain eased, I methodically plotted a recovery. For months, I walked around the park, resisting the urge to run.
Eventually, a hundred yards at a time, I jogged, a bare shuffle, then returned to walking. Always, at the end, I did five to 10 minutes of stretching and back exercises.
I changed the way I did even the smallest physical task. No more bending over without a hand on a chair or table top. Kneeling replaced leaning. I perfected the golf bend, the movement that imitates a golfer picking up a ball by stretching a leg out to relieve pressure on the back.
For me, recovery meant accepting limits — no more "Air Daddy," for example. For others, it might mean a change in diet or exercise habits or trying to walk more and drive less.
By the spring of 2004, I was well enough to start running a few mornings a week with my teenage daughter.
Later I joined a Saturday morning running club. As summer rolled around and talk of their Columbus marathon training picked up, I thought, "Why not?"
It's October 2006 and I'm past the 18-mile mark. The tightness in my back has loosened. I'm feeling pretty good.
Still nervous about the uncharted territory of the race, I wait until 21 miles to pick up the pace and see what I've got left.
Ever so slowly, I pass one runner, then another.
I manage a sprint to the finish where I'm amazed to find that my time of 3:17 beat my goal by 13 minutes.
The next day I have trouble walking but the day after that I manage a two-mile jog-walk-shuffle.
Back home, I head straight to the basement and hit the floor for my exercises.
It's tempting to take a shower instead, but I remind myself of everything I've accomplished with my ongoing recovery.
Running 26 miles in a row. Not bad.
Walking with my wife again — now that's great.
On the Net:
North American Spine Society: www.spine.org