Authors: Mark Brown
Copyright © 2008 by Mark D. Brown
All reasonable effort has been made to assure the accuracy of the information in this book. However, this information is not meant to be all inclusive or to be a substitute for direct diagnosis and treatment by a qualified physician. Readers who have questions about a particular condition or possible treatments for that condition are advised to consult with a physician. The author and the publisher shall not be liable for any damages allegedly arising from the information in this book. The opinions expressed in this book are the author’s alone and not those of the publisher. Whenever a person can be identified in this book, either they or a surviving family member gave permission to the author for their story to be told in an effort to help you.
Library of Congress Cataloging-in-Publication Data
Brown, Mark D.
Conquer back and neck pain : walk it off! a spine doctor’s proven solutions for finding relief without pills or surgery / Mark D. Brown.
1. Backache—Popular works. 2. Neck pain—Popular works. I. Title.
39966 Grand Avenue
North Branch, MN 55056 USA
(651) 277-1400 or (800) 895-4585
How Our Genes Lead to Back Pain • How Spinal Discs Work • Why Disc Degeneration Causes Pain
Take This Questionnaire to Find Out What Type of Back Pain You Have
How to Know If You Need Immediate Help • Some Urgent Conditions That Require Emergency Care
Emergency Physicians • Primary Care Physicians • Physiatrists • Chiropractors • Spinal Surgeons • Neurosurgeons vs. Orthopaedic Surgeons • Other Specialists • Massage Therapists, Acupuncturists, and Personal Trainers
How You Know If It’s a Herniated Disc • Do You Really Need Surgery? • MRI Scans, CAT Scans, and Myelograms • Surviving an MRI Scan When You Have Claustrophobia • What Does It Mean to “Walk It Off?” • Epidurals • Types of Surgery and Risks
How Spinal Stenosis Causes Pain • When to Suspect Spinal Stenosis • Causes and Symptoms • When Surgery Is Necessary, and How It Is Performed
Spondylolisthesis: The Most Common Spinal Deformity • What Does ‘Unstable Spine’ Mean? • Scoliosis • Osteoporosis • What Is a Spinal Fusion and How Is It Done?
Determining the Cause • Arthritis • Degenerative Disc Disease • How Depression and Stress Affect Back Pain • How to Take Control of the Pain
Anti-Inflammatories, Narcotics, and Muscle Relaxants • Chiropractic • Traction • Types of Exercise • Stretching • Physical Therapist vs. Trainer • Pain Management • Minimally Invasive Treatments • Destroying Sensory Nerves to Treat Pain • Back Braces • ‘Touch’ Therapy
Don’t Have Back Surgery If You’re Unprepared • Spinal Stenosis and Spinal Instability As Causes • Missed Diagnosis or Multiple Sources of Pain • Adjacent Segment Failure • Unmet Expectations of Surgery
Everyday Things You Should Avoid • Exercise: The Best Preventive Medicine • Why Quitting Smoking Is So Important • How to Avoid Pain From Spinal Deformity and Osteoporosis • Managing ‘Whiplash’ Injuries • Sex and Back Pain
Risks of Artificial Disc Replacement • Disc Transplants – Potential for the Future? • Hope in Gene Therapy
Conquer Back and Neck Pain: Walk It Off!
Dr. Mark Brown brings more than 35 years of clinical and research experience to those of us who are interested in the challenges presented by these most common of musculoskeletal maladies. Dr. Brown has been an international leader in this most important area of healthcare, and we can all benefit from his compassionate approach to his patients.
Back and neck pain are without a doubt the nemesis of the musculoskeletal aliments and account for nearly 100 million episodes per year just in the U.S., with 62 million having back symptoms and 21 million reporting neck symptoms. The impact is realized not only in number of visits to a multitude of healthcare providers, but also in lost productivity as a nation. Back pain accounts for the greatest number of days lost from work, making up the largest part of some $800 million (direct medical and indirect, work- and home-related) spent annually on musculoskeletal conditions. Lost workdays are most commonly due to low back pain, averaging almost one day per month per injured worker.
As a true clinician scientist, Dr. Brown provides real-life experiences to enlighten us all. He is the consummate patient advocate who presents us with a practical, no-nonsense approach to the diagnosis and treatment of back and neck pain.
Dr. Brown’s seven types of neck and back pain remind me of Stephen Covey’s seven habits of highly effective people. Covey allows each of us to take more control of our hectic lives and allows us to spend more time in quadrants that are effective and meaningful. Dr. Brown allows us to classify our symptoms in a way that makes understanding our condition and what to do about it simple and yet doesn’t underestimate the symptoms’ impact on our lives or those of our families, who need to understand what is wrong, what isn’t wrong, and what to do to get better. He helps us to understand how we can take responsibility in a partnership with our doctor and to know “when to walk it off” and “when to call for help.”
The role of your family doctor has never been more important, and in most cases he or she is the best front-line diagnostician and your advocate. As an advocate for shared decision-making, or what we at the Dartmouth Institute call “informed choice,” Dr. Brown empowers patients with evidence-based knowledge while understanding their values and preferences, serving as a true exemplar of a patient advocate. Dr. Brown’s book should be on the bookshelves in each primary care physician’s office and serve as a partner to those on the front lines.
What’s your activity level? Are you a couch potato, a weekend warrior, an avid runner, or – like me – somewhere in between? Dr. Brown’s activity groupings allow us to understand where we are and what we can expect or need to do to change our expectations. Finally, Dr. Brown allows us to be who we are but to challenge ourselves to be better for ourselves, our partners, our families, our friends, and colleagues in the workplace. He teaches us how to be the ruler of our own back and neck symptoms and how not to be ruled by them. He advocates for surgery in special circumstances, and those need to be clear and better understood by all of us. By reading this book we can benefit from Dr. Brown’s years of experience and thousands of patient visits summarized so succinctly in this book.
The patient testimonials say it all. Thank you, Dr. Brown, I can
Conquer Back and Neck Pain: Walk It Off!
Dr. James N.Weinstein
Director, The Dartmouth Institute for Health Policy and Clinical Practice
Chairman, The Department of Orthopaedics,
Dartmouth Medical School, Dartmouth Hitchock Medical Center
(the most frequently cited and read spine journal in the world)
Mark D. Brown is Professor and Chairman Emeritus of the Department of Orthopaedics and Rehabilitation, University of Miami Miller School of Medicine. He has been a practicing spine surgeon for 35+ years, with his Ph.D. thesis and all of his research being devoted to the cause, prevention, and cure of painful spinal disorders. He is a founding member of the International Society for the Study of Lumbar Spine, and his other memberships include the American Academy of Orthopaedic Surgery, American Orthopaedic Association, Association of Bone and Joint Surgeons, the Cervical Spine Research Society, and the North American Spine Society. He serves as a Consultant Reviewer for the Journal of Bone and Joint Surgery, on the Board of Associate Editors of Clinical Orthopaedics and Related Research, the Associate Editorial Board of Spine, and the Editorial Board of Journal of Spinal Disorders & Techniques.
It is because of my patients that I have written this book. I thank them for the honor of treating them and inspiring me to write about their problems in order to help you.
This book is dedicated to my fellow back pain sufferers…may they find lasting relief.
I thank all of the patients and families who have allowed me to share their stories in this book, also in order to help you.
From its inception, Tom Sand, of Health Communications, Inc., has believed in the important message of this book. He gave me valuable advice from the perspective of a patient as well as a seasoned publisher. He introduced me to a number of people in the book business, one of whom is Roanne Weismann, a health care writer, who introduced me to Sunrise River Press, and Karin Hill, my editor. Karin’s work ethic and editing skills are apparent in the quality of this book. Although we have never met in person, but know each other over the phone and on-line, she has become a friend for life. It has been a lot of fun editing this book with her.