| Are
Bed Rest and Surgery Necessary?
For
more that 50 years, orthopedists have believed
that most lower back pain and sciatica were caused
by herniated discs. The "dynasty of the disc"
led to the typical medical advice of bed rest
and medication. Gordon Waddell, a renowned British
orthopedic surgeon, wrote in the journal Spine,
"There is remarkably little scientific or
clinical evidence to support the value of bed
rest for low back pain or even sciatica."
Bed rest is now known to cause prolonged pain,
muscle weakness, joint stiffness, and depression.
If
bed rest failed, surgery was the usual next step.
Unfortunately, due to poor patient selection,
many unnecessary surgeries were performed. Waddell
said, "surgical successes unfortunately only
apply to approximately one percent of patients
with low back pain." According to Alf Nachemson,
M.D., editor of the journal Spine, bulging
discs are found and taken as an excuse to do a
lot of surgery and percutaneous discectomy. Discs
are made to bulge; that is a normal finding."
Back
and even leg pain can arise from the muscles,
joints, or ligamentous structures of the spine.
Whatever the cause, evidence is growing showing
that rehabilitation not surgery is the treatment
of choice for most lower back disorders.
What
Treatments Have Been Proven to Work?
A
recent study from a leading orthopedic center
in San Francisco demonstrated that more than 90
percent of patients with disc herniations responded
to non-surgical treatment. Most of these patients
had already been referred by neurologists for
immediate surgery. Their treatment included simple
pain control methods in combination with rehabilitation.
According to Nachemson, "All the structures
in the back fare better with early, controlled
motion....if something is injured and you start
to slowly move it under controlled conditions,
then the structure heals quicker and better."
Modern
Management of Back Pain and Sciatica
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