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Blame it on the back

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There’s a medical problem out there that threatens to outstrip the cost of treatments for all types of cancers combined, and that’s back pain.

According to a study published in the Journal of the American Medical Association in February 2008, Americans spent a staggering $86 billion on treatments for the spine in 2005 – an increase of 65 per cent in less than a decade. This is about the same as is spent on cancer treatment, and the numbers have only continued to spiral upward.

While the total costs increased by 65 per cent from 1997 to 2005, the money spent on drugs – a cool $20 billion in 2005 alone – increased by 171 per cent in the same period, with a 425 per cent increase in narcotic pain relief.

The statistics are similar in the UK, with the only difference being that our National Health Service (and hence all of us) are largely footing the bill.

This giant expenditure might even be worth it, if we were getting somewhere.

But as the bleak statistics starkly reveal, the number of people with lower back and neck pain serious enough to cause impairment has more than doubled, according to the American National Health Interview Survey, and both conditions lead the list of disabilities, resulting in a staggering 291 million days lost at work in 2012 alone.

At the top of the list of so-called back problems is sciatica, a condition where the sufferer has sharp, radiating pain cascading down from the glutes to the back of the foot. Some 40 per cent of all Americans and British people will suffer from sciatica at some point in their lives. Often it goes hand in hand with back pain in other areas.

The standard medical approach is to consider sciatica a problem of the spine or a matter of ‘neuropathic pain’ – meaning nerve pain, the origin of which we haven’t a clue about.

According to Harvard Medical School’s health website: “A common culprit for sciatica is a herniated disc (also referred to as a ruptured disc, pinched nerve, or slipped disc). Discs can weaken over time. Or a vertebra can slip forward and the nerve fibres become compressed, like a garden hose with a kink in it. This can happen because of an injury or trauma, but is often the result of years of bending and sitting for long stretches.”

When the drugs don’t stop the pain – and they often don’t – and the pain worsens, doctors turn to surgery, which, like pain medication, is also burgeoning. Some 1.2 million operations are performed every year in the US, one-quarter of which are spinal fusions, the operation of choice for sciatica, costing some $60,000 apiece.

Approximately 50 per cent of those surgeries fall into the category of the ‘failed back syndrome’ – where medicine has singularly failed to do anything but make the problem worse.

The renowned British orthopaedic surgeon Professor Gordon Waddell once estimated that only 1 per cent of patients with low back pain can be classified as surgical success cases.

Maggie Hayward, for one, an exhibition manager from Southwest London, remortgaged her house to pay for the Œ£35,000 it cost to have spinal fusion, banking on the fact that it would end the stabbing, burning pain she had in her lower back and legs, which felt like an electric shock. It was a last-ditch effort, since she’d tried everything from acupuncture to traction without success.

Like so many others, the operation did not affect the pain in any way. Maggie was forced to retire and was never able to work again.

One reason for all these failures, at least when it comes to surgery, is the simple fact that the pain radiating down your leg has nothing to do with your spine.

Physiotherapist Mitchell Yass is one of a growing number of forward-thinking physiotherapists who have concluded that sciatic pain isn’t coming from your back – it’s from your hip.

Muscle imbalances surrounding the hip overwork certain muscles that ultimately strain or enlarge, eventually impinging on certain nerves, causing radiating pain down the leg.

As Dr Yass has discovered, the answer is simply to rebalance those hip muscles so that the ones causing the problems shrink back to normal and play again as a team. No surgery, no drugs – just a series of short exercises to get those muscles back into line.

And that’s possibly why medicine has it so wrong when it comes to sciatic pain. Compared to drugs or surgery, there’s not a lot of money to be made from telling people that they can sort themselves out by doing a few exercises. No big drug patent, no heroic surgery. Just, like most medical issues, a simple problem with an equally simple solution.

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