Dr. Allan Horowitz, published newspaper article, The Liberal, Copyright March 30, 1988
QUESTION: I have had a sore back and hip ever since I lifted the end of my boat trailer many years ago. The pain comes and goes, and is usually quite severe about once a year. This pain lasts about two weeks then it settles down to its normal state of “just being there.”
My question is this: Why is it that sometimes my pain is so bad, while at other times I hardly notice it? I have been told by an orthopedic specialist that I have a herniated disc. He did not recommend operating on me unless I felt I couldn’t handle the pain any longer.I do not want an operation.
ANSWER: If in fact you do have a herniated disc then you have to realize that you must take care of your back for the rest of your life. There should be no thought in your mind of getting a ‘cure’ and then forgetting your back. It just doesn’t happen that way.
Yours is a very common situation where the pain is bad enough to consider a surgical approach, but this severe pain is present only infrequently, and therefore not enough to seriously pursue surgery. It is easy to tell a surgeon to do whatever he wants as long as he helps your pain when you are in agony, but as soon as you begin to feel better, you start to question things much more carefully.
PROBLEM FOR LIFE
If you have a herniated disc which is causing back and hip pain, and no surgery is attempted, then it is very likely you will have your problem for life. That doesn’t have to be so bad. A herniated disc means that some of the disc material which acts as a cushion betwen the spinal bones has been squeezed out from between the bones. This disc material is now in a place were it shouldn’t be, and therefore sensitive structures are being irritated, and pain is felt.
In your case it sounds as though the disc material which has ‘leaked’ from where it should be is situated in a place where it doesn’t cause too much trouble. This disc obviously isn’t right and you know something doesn’t feel the way it should, but you don’t have any severe pain. Perhaps one or two incidents will be required to cause the disc material to be pushed into a more harmful location.
If the disc material is pushed directly onto a nerve, then severe back, hip and leg pain will be felt.
What are the incidents that could cause this to occur? Bending into a ‘funny’ position, not getting enough sleep, lifting something heavy, carrying something in an awkward position, being under a great deal of stress, coughing, sneezing, sleeping in an unusual position …
I know what you are thinking. ‘’I always am under stress, but my back only flares up once a year.” “I never get enough sleep.” “I cough a lot, but I don’t end up in pain because of it.”
Remember I said one or two incidents. Perhaps you have been under a lot of stress at work lately. You are also not getting enough sleep. Then you carrying something heavy in from the trunk of your car. As soon as you get in your house you bend to take off your shoes and suddenly you are in pain. It is rarely one thing which leads to an acute aggravation of a disc herination, but rather a few things piled on top of each other. You should always remember that you have a ‘bad back’ and you should live your life accordingly. Remember the things which have made your back bad in the past and take great care not to do them too often.
If your back only flares up once a year, you will probably never need surgery … if you are smart. Don’t take your back for granted. Don’t abuse your back, even when it feels good.
GET BETTER
Oh yes, and one other thing. Most chronic disc problems like yours will get better as you get older. By the time you are 60,65,70, the acure flare ups of your back pain will probably be a thing of the past. Good luck and I hope you can wait that long.
Allan Horowitz, D.C., is a chiropractor and writes this public service column.He will attempt to answer readers’ questions on a variety of topics including back pain, headaches, nutrition, sport injuries and preventive medicine.
Address your questions to Allan Horowitz, care of The Liberal, Box 390. Richmond Hill, L4C4Y6.