Healing Through Exercise: Scientifically Proven Ways to Prevent and Overcome Illness and Lengthen Your Life by Jörg Blech
Authors: Jörg Blech
Ads: Link
emerged, and their fear of hurting their backs was lowered. After going through this program, 63 percent of the patients were able to resume their jobs and daily lives. 18
Surgeons would be happy if they achieved such a success rate. There is no doubt that in many instances an injured back needs an operation, for instance, when patients lose control over sphincter and bladder. This usually signals that a massive prolapse has compressed the nerves in the pelvic region. When these muscles fail to work, when a foot cannot be moved, or when other body parts become inoperative, most doctors agree it is high time for surgery. In other cases, when back pain and fever occur at the same time, there might be an inflammation rampaging near the spine. Finally, there even might be a tumor growing and compressing nerves in the back.
Although these and other conditions require surgical treatment, most surgical procedures are advised to alleviate pain and prevent further progression of the problem. But what is the outcome of the surgical removal, in part or whole, of an intervertebral disk? The experts James Weinstein, Richard Deyo, and colleagues compared the outcomes of surgical and nonsurgical treatment in a randomized study that included more than 500 women and men in 13 spine clinics in 11 U.S. states. 19 One-half of the patients underwent discectomy; the other half received nonsurgical treatments like physical therapy, education with some home exercise instructions, and anti-inflammatory drugs.
After two years, the outcome revealed that patients with herniated disks improved whether they had surgery or not. Though surgery appeared to alleviate pain faster, on average all patients had gotten better, and there was no substantial difference between the two groups.
This is significant because in many cases physicians pressure patients by telling them that, without surgery, their conditions will worsen. Now, the first study about this question reveals this is not the case at all. Eugene Carragee of Stanford University Medical Center in California states: “The fear of many patients and surgeons that not removing a large disk herniation will likely have catastrophic neurological consequences is simply not borne out.” 20
A similarly cautious approach appears appropriate when doctors press for another sort of back surgery, spinal-fusion surgery. During this procedure, which is rapidly increasing in the United States, physicians use metal screws and rods to fuse two or more vertebrae. Though this complex and risky intervention has been performed for 90 years, it was only a few years ago that researchers set out to analyze its success.
The trial, led by Jeremy Fairbank at the Nuffield Orthopaedic Centre in Oxford, involved 349 chronic back pain patients. Of these, 176 were assigned to spinal-fusion surgery and 173 to a three-week intensive program of rehabilitation, involving daily exercises and cognitive behavioral therapy. The rehabilitation aimed not only to address physical ailments but also to help patients overcome fear of pain or exercise, to learn to cope with the psychological effects of pain, and to learn to relax.
There appeared to be a slight advantage to surgical treatment, but the difference was barely significant in clinical terms. Thus, Fairbank states: “There was no clear evidence from our trial that primary spinal fusion surgery was more beneficial than intensive rehabilitation. Our results suggest that patients eligible for surgery should be offered a rehabilitation program first. We believe it is safer and cheaper than using surgery as the first line of treatment.” 21
If a patient, as is so often the case, still feels pain and discomfort after surgery for a herniated disk, these complaints do not necessarily result in self-doubt and restraint among surgeons. Frequently they will recommend a second operation, especially if they are not responsible for the first. In these cases doctors like to say their
Surgeons would be happy if they achieved such a success rate. There is no doubt that in many instances an injured back needs an operation, for instance, when patients lose control over sphincter and bladder. This usually signals that a massive prolapse has compressed the nerves in the pelvic region. When these muscles fail to work, when a foot cannot be moved, or when other body parts become inoperative, most doctors agree it is high time for surgery. In other cases, when back pain and fever occur at the same time, there might be an inflammation rampaging near the spine. Finally, there even might be a tumor growing and compressing nerves in the back.
Although these and other conditions require surgical treatment, most surgical procedures are advised to alleviate pain and prevent further progression of the problem. But what is the outcome of the surgical removal, in part or whole, of an intervertebral disk? The experts James Weinstein, Richard Deyo, and colleagues compared the outcomes of surgical and nonsurgical treatment in a randomized study that included more than 500 women and men in 13 spine clinics in 11 U.S. states. 19 One-half of the patients underwent discectomy; the other half received nonsurgical treatments like physical therapy, education with some home exercise instructions, and anti-inflammatory drugs.
After two years, the outcome revealed that patients with herniated disks improved whether they had surgery or not. Though surgery appeared to alleviate pain faster, on average all patients had gotten better, and there was no substantial difference between the two groups.
This is significant because in many cases physicians pressure patients by telling them that, without surgery, their conditions will worsen. Now, the first study about this question reveals this is not the case at all. Eugene Carragee of Stanford University Medical Center in California states: “The fear of many patients and surgeons that not removing a large disk herniation will likely have catastrophic neurological consequences is simply not borne out.” 20
A similarly cautious approach appears appropriate when doctors press for another sort of back surgery, spinal-fusion surgery. During this procedure, which is rapidly increasing in the United States, physicians use metal screws and rods to fuse two or more vertebrae. Though this complex and risky intervention has been performed for 90 years, it was only a few years ago that researchers set out to analyze its success.
The trial, led by Jeremy Fairbank at the Nuffield Orthopaedic Centre in Oxford, involved 349 chronic back pain patients. Of these, 176 were assigned to spinal-fusion surgery and 173 to a three-week intensive program of rehabilitation, involving daily exercises and cognitive behavioral therapy. The rehabilitation aimed not only to address physical ailments but also to help patients overcome fear of pain or exercise, to learn to cope with the psychological effects of pain, and to learn to relax.
There appeared to be a slight advantage to surgical treatment, but the difference was barely significant in clinical terms. Thus, Fairbank states: “There was no clear evidence from our trial that primary spinal fusion surgery was more beneficial than intensive rehabilitation. Our results suggest that patients eligible for surgery should be offered a rehabilitation program first. We believe it is safer and cheaper than using surgery as the first line of treatment.” 21
If a patient, as is so often the case, still feels pain and discomfort after surgery for a herniated disk, these complaints do not necessarily result in self-doubt and restraint among surgeons. Frequently they will recommend a second operation, especially if they are not responsible for the first. In these cases doctors like to say their
Similar Books
