The $100B per year back pain industry is mostly a hoax
qz.com
qz.com
I don't mean to be smug, as back pain really is an individual thing. There's an element of searching for what works, and I was lucky in that I was pointed directly towards an effective treatment.
This result was science based, in that I was treated by a general practitioner who specialised in back pain and insisted on an evidence based approach. (This doctor also wrote the manual for NSW's worker's compensation scheme and lectures at a major university on the topic.)
Edit: My doctor's rule was "pain free exercise". Go as far as you can, but stop if hurts. A test of whether you've really overdone it is whether the new pain goes away overnight. He also reckoned that it would be difficult to do a further injury whilst doing exercises, as the pain would make me self limiting.
Further edit: My initial physio, and a cortisone injection, at the time of injury, weren't aimed at a long term fix, but at providing enough temporary pain relief to begin exercising.
I think this is extremely important for everyone to remember. People tend to (correctly) scoff at anecdotal experience, but often that's all you can work with. When studying health problems, most studies will tend to find the "best" thing overall for a varied group of people, but basically forces the solution to be the lowest common denominator. You see this all the time with different diet studies, were people "prove" that some diets are better than others. Of course the true answer is that there is no solution that's best for everyone.
Really you need to experiment and just learn a lot about your body. For example, I've been able to rid myself of my back problems by running. If I stop running for a few weeks all my really painful back problems start to come back. Since I mentioned the diet example earlier, I should point out that for myself the most effective way to lose weight is basically just starvation. I exercise a lot and track calories and only consume between 1500 and 2000 a day (I probably need at least 2500 a day and maybe closer to 3000). It's always been much easier for me to just be constantly hungry for a couple months than to play different diet games and figure out which foods are most filling.
You need to learn to listen to your body.
> My doctor's rule was "pain free exercise". Go as far as you can, but stop if hurts.
1000 times this! If I'm running in form, I'll probably run 6 days a week, but I've learned to just quit if I feel acute pain or if my muscles are very tight and I can't get them to loosen. You gotta know when to fight your battles. An injury today means no exercise for a while and that's way worse than whatever gains you'll get by continuing.
Maybe I'm misunderstanding your point but this is the only effective way to lose weight. If your body needs 2500 calories a day and you eat 2000 you'll lose ~1lb a week.
Put another way, mine is the stubborn bull-headed weightloss plan. Basically I just try to climb the mountain the fastest and most painful way and then be done with it.
Very few people require 2500 calories a day, particularly with modern sedentary lifestyles.
Plus, aside from the thermodynamics component, from a nutrition standpoint not all calories are the same.
That doesn't have anything to do with my point. (Although mercifully my TDEE is closer to 3kCal)
"Plus, aside from the thermodynamics component, from a nutrition standpoint not all calories are the same."
Again, we're talking about weight loss which pretty much is thermodynamics.
+1000 for this one!
Which only reduces the back pain problem for overweight people to a known-intractable weight loss problem... :-/
And the drug analogy is a good one, because just like quitting drugs, you can't quit overeating (barring the aforementioned option of someone physically preventing you from doing so - which is literally what gastric sleeve surgery and the like are doing) until you actually choose to. When you wake up in the morning, look at yourself in the mirror, and instead of "oh I'm so fat" or "it's not fair" or "I wish I could lose weight", you think "I choose to lose weight by controlling what I eat", then you lose weight. And it stays off for as long as your choice holds.
taneq didn't suggest that.
[1] [trak-tuh-buh l] .. easily managed or controlled; docile; yielding:
Overeating is a stress response for a lot of people, and overeating often occurs among people in high-stress situations. The US is a country that tolerates a very high level of poverty, inequality, and insecurity, and this results in high obesity rates in some sectors. Obesity isn't the same problem for people who shop at Whole Foods and spend hours at the gym on weekends; it's a more severe problem among people who have to work a horrible job 60-80 hours a week to avoid really desperate poverty, live in decrepit housing, spend hours on neglected bus lines, and are physically insecure.
I meant the comparison with addictive drugs to illustrate how difficult it is to resist the urge to overeat. And I believe the two cases are essentially the same - you can't save an addict who doesn't want to be saved, and you can't convince a fat person to diet if they don't want to lose weight more than they want to eat food.
(it's a strong beer with a pink elephant logo, very good stuff)
Claiming weight loss is "simple" is like claiming that climbing Mount Everest is simple because you simply put one foot in front of the other and repeat until you reach the top
Indeed, weight loss is "simple", as you said. The problem arises when you have managed to get to your target and you realize that, short of amphetamines or similarly dangerous drugs, there is no known way to keep your weight stable with an acceptable life quality.
Obese people are not stupid when they choose to keep eating; they've just learnt by experience that, unless you solve the hunger problem, loosing weight will not yield a better life.
By the way, surgery actually looks like an option.
Firstly, why does your weight need to be stable? Personally I tend to go on yearly (maybe biennially) cycles with shifts between 170 and 195 pounds. Basically I force myself to get down in the weight (my weight-loss method is to restrict calories pretty dramatically). After that I will have eating habits that tend to keep me low for a while, but over time as I go back in my regular eating style (I am naturally a bit of glutton), I'll usually go back up in weight. After that the cycle starts again. I think that this is a much easier approach than trying to stick to a target weight. It also allows you to "live" (most people don't want to count calories forever).
Secondly, what is an "acceptable life quality"? Like I said, I lose weight by restricting calories greatly. This leaves me pretty much constantly hungry for a couple months, but I quickly am able to just push it into the background mentally and accept it. For me this is acceptable. But yes if basically any approach that _works_ is considered _unacceptable_ to you, you're basically screwed. (I don't want to sit on a high horse. You might have stress in life or obligations that make it basically impossible for you to be productive and hungry for a couple months, so I can totally understand my method as being unacceptable to many.) In the end, you do need to figure out how to take action somehow, or you'll never solve the problem.
> By the way, surgery actually looks like an option.
Yeah most don't realize how extremely successful gastric bypass is. It's way more successful on average than any popular weight-loss routine. Obese people should seriously consider the possibility. It can be life-changing.
Your method is indeed interesting, as you basically found a way to concentrate "suffering" in few months per year, still it is another example of a cure that lacks an important bullet point: it never ends.
Solving the hunger problem would let obese people loose their excess weight, no matter the sacrifices involved, and then forget they ever were obese.
You will absolutely lose weight with gastric bypass. Full stop. And usually a ton of weight. Which is good! And the surgical complications have fallen way down over time. Those are the good bits. The BAD bits that aren't emphasized in the literature (and that a poor doctor will gloss over):
1) A lack of focus. Universally the people I know that have had gastric bypass seem to have a greatly reduced ability to concentrate on complex tasks and recall. Its almost like 'pregnancy brain' but for men and women and seems to persist long after the surgery.
2) Gastric issues. Everyone knows that people that have gastric bypass spend a lot of time vomiting after their surgery while they adjust to what kinds, and volumes, of food that their greatly reduced stomach can handle. What isn't discussed is that often times your stomach is reduced to such a point where food gets into your intestinal track partially digested, leading to diarrhea and a host of other digestive issues. Also, depending on where the band is placed there might not be enough 'drop' in your stomach for food to easy make it further into the digestive tract. This can lead to further surgeries and even shortening of the intestine. I don't know about you, but going through the rest of my life fighting explosive diarrhea. I'd rather be obese then run the risk of vomiting and intestinal distress for the rest of my life.
3) A general listlessness. I don't know what the cause of this is but I've observed it in everyone that I know thats had it done but no one as much as my mom. She was quite overweight my entire life, but almost disgustingly energetic and just generally full of life. She rarely got sick, and could work a full day of manual labor with no complaint or sign of slowing. After her surgery she shrank way down lost all of her, for a lack of better word, vim. After the surgery she didn't seem to have the energy or interest in pursuing any of the pursuits that made her get the surgery in the first place.
4) Long term results. Long term results for gastric bypass are not great. Most people will shrink down over the course of a year or two to a low weight and then will start packing the weight back on. Slowly at first but usually more and more rapid as time goes on.
I'm not trying to say that gastric bypass isn't an option for a lot of people-but I wish people (obese and non-obese) would stop looking at it as a cure all. Its at best a staving off. Lack of willpower, deep seated problems with food, and self-esteem are almost always the demons at the bottom of the obese pyramid and until you exorcize them, surgery is going to just paper over your problems.
If you're already fit, it's incredibly easy to stay fit.
Also, most of the time, obese people don't only eat to satisfy hunger, but much past that.
You are right! Thanks for pointing it out.
> obese people don't only eat to satisfy hunger, but much past that.
They surely don't eat for the pleasure of adding some more fat to their body.
As I understand it from a study [1] that someone here posted the last time I mentioned it, the training changes our body's way of dealing with oxygen. It basically does naturally what happens to athletes that take EPO, though without the dangers of that rightfully-banned substance. That raises the body's basal metabolic rate, which should help in losing weight and keeping it off.
Like most other things weight-loss-related, it's probably not a magic bullet, so YMMV, but my sample size of one resulted in my accidentally losing 20% of my body weight and keeping it off for about a year now.
The guy's reasoning was: You exercise for an hour doing something like walking or golf, then reward yourself with a snack? Net intake of calories [1]. And it's easier to cut a snack from your diet than to find the time and motivation to do an hour's exercise.
To put it another way, when you're obese exercising is like a job that pays ten cents an hour.
Of course, once you've become thin and athletic, you gain access to more time-efficient types of exercise. But that snack might still need 15 minutes of vigorous cycling, or competitive soccer or basketball.
[1] e.g. an hour's dog-walking or golf are roughly equivalent to a 16 fl.oz can of Coca-Cola and a 2 oz packet of skittles, respectively.
Plus getting buff costs a lot of effort, it's easier to reduce intake.
But, besides weight loss, anyone should probably do both, especially if bound to a computer; back pain isn't primarily caused by obesity, but also due to under or overdevelopment of certain muscles, posture, movement or lack thereof, etc.
And being on a healthy weight whilst still being weak or low in energy is no fun.
http://www.runnersworld.com/tools/calories-burned-calculator
I could gain those calories back and more in 15 minutes just eating a burger. A lot of people do exactly this and sabotage themselves a bit.
Personally if I bump up my running training and want to lose weight, I can never depend on it happening naturally. I always gain weight if I don't actively try to lose it. So I think no matter what you need to be careful. If you exercise more, you'll be able to eat more, but if you want to lose weight, you'll still need to eat less than your body wants. So I still think fundamentally losing the pounds starts in the kitchen.
In general, you probably can't get rid of a little hunger. If you want to lose weight and be in a calorie deficit, you might be 500 calories short. If you add 1,000 calories of exercise, and 1,000 calories of food, you're still 500 calories short, and still likely to experience hunger.
I feel stupid for how long it took me to "see" my own evidence. Like many people, I have a mental aversion to paying extreme attention to what I eat, to eating less, and to counting calories. The very idea of doing that is off-putting, and I didn't notice how subconsciously strong that mental aversion is until recently. It wasn't easy, but I did the hard mental work before I started the diet. Once I got going and formed some new habits, I didn't have to think about it much. One of my mental tricks was to realize that a little hunger is exactly how I'm supposed to feel. Rather than focusing willpower on combating my hunger and reminding myself not to eat, I came to the realization that not being hungry at all is the bad state, that is the feeling I have when I've eaten too much. Being a little hungry is a good thing.
Counting calories worked for me relatively quickly, and it worked regardless of whether I was exercising (as long as I tracked my exercise calories too.) It took less time than exercising, and it helped me see the differences more clearly between losing weight and getting strong. Those are two mostly different things. There's some cross-talk between them, but the main way to target each of them is different. Gyms all advertise weight loss, but now I see gyms as a place to get strong, and eating less as the way to lose weight.
it is very simple physically.
as for where to set it, I have nothing to say about it just as you have nothing to say about how to make a choice.
/s
The fact is, a choice fat people can make is "I will get gastric sleeve surgery" and this "commit" is statistically enough.
the "commit" that parent suggests is the same as my suggestion at the top. I give no practical advice at the top of this comment and neither does parent comment.
if there were a variable that would set someone's appetite and saciety then it would work. if there were a variable for commitment then parent's advice would work.
parent ignores the hard work of finding and setting that variable, and parent ignores statistics that most fat people have spent a few dozen hours looking for how to set that variable and have failed to do so.
your advice is as bad as when people defend some totally useless setup on the grounds that it's turing complete. yes, you can make a social media app with a custom backend written in C++. No that does not work statistically and most people who set out to do so fail.
but physically it's very simple.
reasonable people don't ignore the statistics.
Apparently, boffins are starting to realise it's not that simple.
Quitting some drugs cold turkey can be dangerous, so "simple" isn't quite correct.
Locking people up away from food is even more intractable!
So is cutting your arm off with a hacksaw. "Simple" does not mean "easy."
Started exercising gently and worked up to a fairly intensive callisthenics (starting with basic stuff and using a pull-up bar, pressups handles). Takes me 40mins every other day to do a full 'routine' (quoted routine because it varies every time).
The end result was that I only take my medication on a night to sleep now, during the day I'm drug free which is fantastic because the medication wrecked my ability to focus.
The funny part is I didn't lose the weight because of my back but because I was having other health issue (and had metabolic syndrome, a big warning sign for diabetes), at my last checkup all my results where slap bang center of normal for my age.
My doctor told me pretty much the same thing when I asked him about exercise "listen to your body, if it increases the pain the next day back off that exercise".
For the first time in 3 years my health is level enough to live a completely normal life, I will never put the weight back on (kept it off for nearly 2 years now by calorie counting and using an accurate scale tied to my phone, I get weight every morning and night at the same time and it shows me a nice graph).
Gave me some exercises, and a month later back pain was all gone and my back felt stronger, with better posture. Crazy what can be done when you just have go for it
Start in a crawling position. The purpose of this is to give you more control of the pelvic position with independence from the chest. Quote from the PDF: Start in a crawling position. Without moving your head and shoulders, roll your hips so that you arch your lower back. Do not push into pain. Only go as far as you feel comfortable with, then relax. Try not to move your upper body & chest. If this is difficult, rest your shoulders, chest and ribs on the couch or bed, keeping your tummy clear. This will help to restrict the movement higher up and help you to localize the movement to the pelvis.
The other thing my physio did was sat with me and showed me what my posture _should_ be like, and made me sit like that for an hour or so. It was then up to me to keep sitting/standing like that outside the office. The first day, I was exhausted after about 2 hours. Now, it's painful to sit slouched.
EDIT: Even though this is a thread about the industry being a scam, I'd still recommend seeing a professional (even just your GP). As other people here have alluded to, you'll probably get some drugs to get you to be able to exercise pain free, but it could also rule out other issues (kidney problems being a good example), and ensure that there's nothing more serious going on.
I'd also recommend taking up a pilates class.
What I've found helps with back pain, sciatica, knee pain, are stretches, and free weights. Then again, I've been lifting for about 41 years, so its not a surprise to me that changing my regimen provides positive outcomes.
Specifically, for me, dead lifts for lower back, squats and leg presses for legs and knees.
Speak to your physician first about whether you can do this. Speak to a PT person about what stretches/weights you should do, and what you should avoid.
This was part of the reason we bootstrapped our app - MoveWellApp.com - to give people easy-to-understand routines to stay mobile and pain free at home.
It's a free download at http://MoveWellApp.com/download for iOS, so if you have any specific feedback, I'd love to hear it.
/blatant-self-promotion
On a more serious note, I think an app that motivates people to be more active isn't a bad thing or scam per se, though I can't speak to the quality of this particular one.
Take a look at the app for 5 seconds ;)
Which is the opposite of science. What other 15m routines have you tried, in a double-blinded manner?
Something can help you, and still be a hoax. No contradiction.
> Spinal fusion surgery, for instance ... costing a total of $40 billion per year ... ... with a price tag averaging $80,000, [and] has a success rate of about 35%.
That's not a success rate of 0%. If you look around, you'll find tons of people (175k/year if my math is right with the numbers above) who have had success with spinal fusion surgery -- one such person actually posted below!
At least this particular approach (light mat exercises) can't be properly called a scam, since it doesn't really try to trick you out of money. The fact of the matter is that the back is tremendously complex, and this approach, when analyzed across a large sample of back pain sufferers, might have an even worse success rate, especially considering the symptomatic divergence of people reporting back pain.
After treatment and remission a year later, I still had the severe back pain. The cancer pain management doctor I was seeing was perfectly happy to keep prescribing godlike levels of opiods. (50+ mg of oxycodone on top of 30+ mg of slow-release morphine pills).
After a few months, I lamented that I was tired of taking pills and dealing with all the side effects. He offered to send me to Physical Therapy, but explained that most of his patients preferred to stay on the pills and that PT rarely worked.
After 3 weeks of twice-weekly 30 minute PT sessions, my back felt amazing. No more pain and I was able to quickly wean off the drugs.
At some point, my cancer had caused back pain, which I'd continued to worsen by avoiding exercise and sitting at weird angles to alleviate the pressure.
As a humorous aside, I had to pay for several weeks of PT out of pocket because my insurance did not consider it important. They would prefer to shell out $500+ dollars every month to see a pain management doctor and continue taking pills.
Of course you could easily have sold those pills to pay for the PT :-)
The insurance provider (or management / shareholders) probably get a kickback from the pharmaceutical industry.
The spine is a maddeningly complex assembly of bone, nerves, cartilage, articular surfaces, vasculature, packed tightly, subjected to immense forces, and articulable is many directions. It is a miracle of evolutionary engineering and a miserable failure. We needed to crawl longer before we stood up and walked as a species.
I have been through 2 spinal fusion surgeries. First, L4-L5, L5-S1. Then L2-L3, L3-L4. One surgery was nine hours the other was eight. Recovery was approximately 1 year for each surgery to complete return to maximum function. It was the hardest thing I've ever done. And news of the need for a second surgery almost crushed me.
But...
I am virtually pain free for 3 years now. My activities are virtually unlimited. No boxing. No golf. Oh boo hoo. I can hike, scuba dive and travel.
Your mileage may vary, but the real question is why? The quality of both surgeons and diagnosticians varies widely across institutions and geography. I am fortunate that I live in a city with the best orthopedic hospital in the US and my surgeon is world renowned in the area of spinal surgery.
It took me ten plus years to get the right diagnosis and find the right clinicians but when I did they repaired my spine to provide me maximum function and pain relief but it is not a new spine. It is never like new. But it'll do what I need it to do.
For anyone in pain. I hope and pray you are relieved of it. Search for the professionals who really know what the fuck their doing and GET WELL!!! Be a zealous and merciless advocate for your own healthcare.
P.S. the back pain industry is a sham, but there are a few of us out there that legitimately need help, but can't get it due to the opioid epidemic and snake oil salesmen.
I kept seeing experts, getting more opinions, and aggressively pursuing all options. Eventually I was referred to an amazing back doctor who took me through all my options - first PT, then a series of epidural cortisone injections, and finally surgery.
Worth noting though, I did a ton of research about failed back surgeries (it has its own name - "Failed Back Surgery Syndrome"), and while you can put the odds in your favour, there's no sure thing. However, getting a highly rated doctor and surgeon working together to get a very accurate diagnosis, combined with the latest surgical techniques will maximise your odds of success. The microdiscectomy with metrx is pretty incredible for being minimally invasive and keeping recovery time as short as possible.
Hospital for Special Surgery in NYC is consistently ranked number 1 in orthopedics in the US. They have spine surgeons and neurosurgeons who excel in implementing mechanical solutions. Perhaps I should have mentioned first that the pain clinic at HSS is fabulous for diagnostics and they are extremely conservative when it comes to opioids.
Getting a proper diagnosis is essential. I was diagnosed incorrectly for years before learning my underlying problem was a spondylolisthesis. Appropriate imaging studies (x-ray, MRI, CT, myelogram as needed) read by superb radiologists will get you a clearer picture of what is really going on.
Surgery may or may not be required. It all depends on the cause. If your doctor recommends diet and exercise/PT be relentless with your implementation of the program (being mindful of what your body tells you).
Finally I would have to say that my sister who is an MD helped me realize one very important thing. The susceptible human back gets "tweaked" from time to time. If your back goes into spasm for a couple of days once in a while (and deelowe I am speaking more generally here than of your specific circumstance) you could spend tons of time running it to ground, when it the long run a form of radical acceptance may bring greater peace of mind. Accepting - I am a person whose back fails me from time to time forcing me to be debilitated for a few days may be less anxiety provoking and frustrating. Good doctors can help you decide what option is best. As Aaron Sorkin said in the Steve Jobs meeting, and I think it applies to all of us, accepting "I am not well made" can be useful to all of us.
Dr. Srinivasan in Seattle did my spinal fusion. She's the best. http://seattleneuro.com/about_dr-srinivasan/
If you are trying to find a neurosurgeon near you... Ask Srinivasan for a referral. Or find other doctors that learned, practiced, taught where she did (birds of a feather).
It is important however also to hear the "No", as the article explains: Most doctors would say "No" when it comes to their own backs. There are certainly a lot of spine doctors out pushing procedures but anyone who is on the desperate search for a solution likely also heard from another doctor the word "No" and did not properly listen. Understanding the "No"s is important to weight the alternatives and risks.
I've been sick (chronic life threatening illness) my entire adult life. I've done some very stupid things, knowingly and unknowingly. And a handful of my doctors, care providers have harmed me. But what else you gonna do?
I've also had severe back pain that got worse over the years. Finding solutions that worked for me required lots of trial and error.
Now comes my second most important piece of advice:
Everyone must have their own patient advocate. To fight for you, to keep track of what's happening. And to keep you honest. Self assessments are notoriously unreliable.
I'll spare you the full story, but I've tried just about everything - Chiropractor, Osteopath, Yoga, Pilates, Exercise of all sorts, Physio (NHS in the UK), etc. Nothing has really helped - more paper the cracks than fix the wall.
Very little worked, and the pain has increased in frequency and intensity over the past 10 years or so - culminating in a prolapsed L4-L5 disc, and some nasty sciatic pain episodes around 7 years ago. The NHS treatment (pain killers and exercises) didn't help. I did all the exercises they gave me, and they did nothing. They discharged me without any improvement.
Three things HAVE really helped. Firstly, learning Alexander Technique [1] which got rid of the sciatica (and the need for daily pain killers) in a couple of weeks. Much later (in the last 6 months) some really specific exercises targeting the multifidus muscles [2], and reading "The back pain bible" [3] was eye-opening - having a good idea of what's going on in the back helped, and there were some exercises in there which with hindsight did help. I read somewhere (can't find it now) that once you lose the tone in your multifidus muscles, you don't spontaneously regain the tone/strength in them; other muscles cover for them and then you're in trouble.
At the end of last year I was at my wits' end - pain all day every day, no-one understanding what was going on, and being told by the chief physio of my NHS trust that "this is just how life is now" - despite me being the kind of obsessive person who actually does the exercises I've been set. So I decided to try things for a month and see what helped - some things did, some didn't (including a very expensive piece of mobilisation equipment). And the multifidus exercises (with leg weights) seemed to just 'switch on' the rest of me, allowing me to maintain good posture and protect my spine. I'm definitely not fixed yet, but I'm not in pain all the time - in fact I had a nearly 3 week period without a twinge last month, which was like being on holiday away from the usual hell. I really think the weakness in those muscles is the key to me actually improving for the first time in a decade (they were pitifully weak initially, and I'm sure there will be other areas where that's true). Maybe something that specific could help you?
For context, I'm 6'1 and around 90Kg with a fairly muscly build - I -look- fit and I'm certainly not overweight, but there's more to bad backs than appearances.
Anyway, hope that helps someone.
[1] - http://www.alexandertechnique.com/ [2] - https://www.amazon.co.uk/Multifidus-Back-Pain-Solution-Exerc... [3] - https://www.amazon.co.uk/Sarah-Keys-Back-Sufferers-Bible/dp/...
My earlier incorrect diagnoses included many of the usual suspects. Bulging disc, piriformis muscle entrapment/impingement, muscle strain, somatization etc.
Treatments attempted included injections, muscle relaxers, tens unit, NSAIDS, opioids, PT, and other things like spinal cord stimulators were recommended but not implemented.
2011 and 2013 fusion, laminectomy, foraminotomy, discectomy, placement of hardware.
And the story has a happy ending. Scuba, hiking, touring all successfully re-integrated into life. Hopefully it will last a lifetime but all this taught me that every pain free day is gravy.
90% of the doctors you see will have no clue about treatments you can find in a 5min search on youtube. I don't mean hack treatments or miracle cures but basic physiotherapy, prevention etc.
Overprescription and unnecessary procedures are the norm. Patients are milked for money rather than being treated. The fear of litigation and desire to make a profit are the primary factors, not patient health.
I've suffered multiple sports related injuries. Consulted a number of doctors, out of pocket and covered by insurance. The physiotherapy they recommend is almost always the most basic and didn't do much. Doctors refuse to discuss other options or refer you outside their 'network'.
The whole system positively reeks.
I had very bad back pain before my first daughter was born. I wanted to be able to carry my daughter when she was born so I decided to try everything, whether I believed it would work or not.
I had massages, shots injected directly in the back, manipulation, and basically lots of different doctors and specialists. Nothing worked.
Since I said I'd try everything, I made an appointment for accupuncture as a kind of last resort. I had zero faith that this would work but carrying on with the theme that I'd try everything, I tried it.
The session was extremely painful. Note that subsequent sessions afterwards have not been. I think this was a function of my muscles being locked in spasm during that first session or something. Anways, immediately after the session, there was a marked improvement. It was the only thing that worked. It only took a few more times before it was back to normal.
If you haven't tried it, even if you don't believe, please give it a try.
I think one clarification to make is that acupuncture directly into the problem points to release a spasm muscle is more mainstream. Acupuncture where you poke your foot to fix your liver is perhaps more controversial.
I'm sure I'm trivializing or getting some of this wrong but just wanted to share my experience with solving my back pain. I hope it will help others.
I'm not advocating homeopathy here, but acupuncture, shiatzu, anything involving the phrase "trigger point" - worth a look. Apart from anything else, they're comparatively inexpensive and non-invasive so the cost of testing them is low.
Trigger point therapy gets a particular shoutout here for being one of those things that resolves 10+ year problems in about 15 excruciatingly painful minutes, sometimes. See http://www.goodreads.com/book/show/137795.The_Trigger_Point_...
My physiotherapist's approach is to engage in a variety of horribly painful activities to get those muscles to unlock, and then teach you how to do the exercises that will help you stop it happening again.
Two months with not a hint of pain and I'm pretty sure this is yet another example of the medical industry being incentivized into ignoring existing solutions. MD I went to prescribed 4 meds (pain killer, muscle relaxant, topical gel, something else), did and xray before telling me I have arthritis at 30, and referring me to a list of acupuncturists. If there's a lot of profit to be made in treating back pain, why would anyone ever fix it in a for-profit system?
A couple of years ago Telepravir (Schering/Merck) and Boceprevir (Vertex/J&J) came to market. The price for a course of treatment has nothing to do with the cost of development and everything with the cost of a liver transplant, it's slightly less than that.
Even before prices for HCV drugs went down due to competition, they offered a cure for a life threatening disease for less than $100K in the US with minimal side effects, typically in 8 weeks, and with 95% effectiveness. The agent is a small pill taken twice a day. Price is scaled to personal income in country of treatment.
That's more like 1/10 of the monetary cost of a transplant, which is a scarce and rationed treatment.
The truth is more complex than that. The reason that you don't see investment in antibiotics is that the low-hanging fruit is picked and you cannot use the new compounds unless as a treatment of last resort, and sales would be far too low to be profitable. They will be needed, though, in the medium term. The financing model in pharma is broken and there is no change on the horizon in that department.
Not sure about Malaria or stomach ulcers, but likely because those who developed the drugs were not acting to maximize their economic interests? Malaria seems like a relatively well understood parasite, whereas "back pain" could really be a symptom of nobody-really-knows-what.
Yeah, surely if you were the first company to work out how to cure e.g. back pain or cancer you'd make an insane amount of money so you wouldn't keep it under wraps. Who exactly would stop you going to market with it? It's a silly conspiracy theory in my opinion.
I guess we need another cure cancer walkathon with pink ribbons cause those smart scientists almost have that cure...
Perhaps there is a cure (or at least the causes are well-known), but it's being withheld from the public. Why would we ever want to fix problems that employ so many people & give them nice houses & yachts?
The idea that we haven't found "the cure" to cancer is silly because cancer isn't one disease, it's many, down to the point of everyone's cancer being genetically different, and in fact different cancer cells being genetically different within an individual.
Cancer is all statistics. You slowly accumulate mutations in your tissues over your life time and if you accumulate enough mutations (especially in oncogenes[1]) you will get cancer. The only way to avoid it is to die of something else first.
What is not emphasized is nutrition, environmental toxins, bioaccumulative effects of "safe" compounds that we interact with daily (plastics, chemicals, hormonal (estrogen) mimickers, Electromagnetic pollution, Stress, side effects of drugs) & their effects throwing monkey wrenches into biological processes & causing these mutations.
We can study the effects & create drugs to combat the effects or we can address the causes. One strategy is more profitable, has a more defensible market position, & creates a more dependent consumer base than the other.
This will be my last post as I've already done enough damage to my HN karma on this topic. It's a pretty obvious argument if one takes an honest look at motivations of the different parties. It's all too easy to get bogged down & distracted by the details at the tail end of the system; when it's the inputs that really matter.
The issue is a multi-domain systemic issue that we are trying to solve in a single domain (pharmaceutical drugs/medical procedures). A Belief system is a great tool to handle the complexities of life & choosing an effective Belief System is a tool that will help one achieve optimal results. Our culture has atomized existence into domains & degenerated holistic belief systems to our detriment.
But of course we're left with the same conundrum: why has the modern pharmaceutical industry cured any disease? Every time they do, they kill another cash cow.
Before doing that doctors would give me injections and muscle relaxers all the time. I am pretty sure I either would already had had surgery or would get it at some point if I had followed doctors' advice.
The trick is that you have to adjust your exercise routine to your specific problem and adapt constantly. This is not easy.
This is very individual and probably won't work for other people.
In general look at the DVDs by Gary Kraftsov. His stuff is very simple but very effective.
For the same reason any other problem gets solved in a for-profit system; the best solver of problems will be the best getter of dollars. See for instance Apple, Honda, Nike, Harvard, etc.
The idea of health care as a product like a jug of milk is just ignorant, idealist, nonsense.
Edit: see the linked article on ACLs.
https://www.hss.edu/conditions_acl-injuries-then-and-now.asp
Apple actually supports the argument. Why innovate when you can make more profit removing functionality and releasing new colors while coasting on brand recognition?
Don't want to spam HN with this as I mentioned it earlier, but this is one of the issues we're trying to address with http://MoveWellApp.com - which is basically a personal mobility coach.
Sadly you can, and many people do.
I'm already a big fan of mobilisation exercises, so my thought process went "sounds great - where do I download?"..."iPhone only. Meh. Oh well."
I know you're working on it, just wanted to give you some feedback to help prioritise.
We usually build iOS first for the reasons outlined here - https://impossiblex.com/ios-first/
Have now fixed that by learning to train in moderation / be more consistent - as I get older, there really is no excuse good enough for not going.
So yes: Learning to squat (deep / a2g) as well as perform deadlifts, done properly and with respect is the best thing I ever did for my health (now in my mid 40s). I must emphasize _properly_ - learning technique from good PTs, youtube videos, books like Starting Strength, is highly recommended.
A side benefit is all the mental health positives the training gives, as well as making you more competitive in the somewhat / sometimes age biased work force.
Pairing weightlifting with McKenzie Method work is great if you suffer from lumbar flexion back pain; the most common out there. Also, weightlifting works best for that type of pain as well due to it getting rid of anterior pelvic tilt over time and reinforcing a neutral spine, to say nothing of the increased muscle gain and postural support you get from pushing iron.
Wow. They charge $80k for a surgery they wouldn't even use themselves for the very condition they recommend it for?
To reverse the famous quote: "you know what they call ineffective procedures that persist solely on inertia and avarice? Medicine."
I imagine there are similar health groups in other parts of the country.
I was skeptical at first, but just reading his book and thinking through what he presented healed my lower back pain.
Occasionally I get flare ups where I'll feel a little discomfort in my arms, but reminding me of the lessons within Sarno's books makes it go away within a day at most, and ever since I read Sarno I have never felt that I was in too much pain to work on a computer.
I don't know if Sarno got everything right, but typing this comment without pain proves to me that he is on to something.
Don't suffer for years like I did! If you are interested, I would recommend watching this 20/20 segment with Dr. Sarno: https://www.youtube.com/watch?v=vsR4wydiIBI (13m35s). If you search for "RSI" on Hacker News, there are some great threads in which Sarno's theory is discussed.
See also https://en.wikipedia.org/wiki/Tension_myositis_syndrome
Given that, why are we so convinced that our mind (i.e. our prefrontal cortex, seat of "high level" thinking) _couldn't_ be the cause of persistent inflammatory pain? Do not ideas and stressors persist in our mind, just as pain might?
Sarno's simple thesis is that stress in our daily life could, in fact, be the underlying trigger for inflammatory pain. The mere realization of this, for many people, can resolve chronic pain problems that last years and are resistant to treatments that assume the cause of the issue is structural.
Here's a success story from one of the creators of EtherPad (acquired by Google) on his recovery from wrist pain (diagnosed as RSI) from reading Dr. Sarno's book:
http://www.rsipain.com/success-story-severe-forearm-pain.php
It's not just reading the book. "Reading the book" makes you understand the way the brain works and can induce and "help" sustain "real pain" in places you think it to be. He also makes it clear that the advice "it's all in your mind" is just not going to help and only an insult to the sufferer.
If I understand correctly, he does not exclude physical examinations and advises to go through scans to determine anything serious and attend immediately. For the rest, he outlines the process by which, your brain can trick you into "induce real pain" and sustain real pain.
Any kind of relaxation or - a) reading the book = understanding the process b) relaxation/ meditation which takes away your concentration away c) letting out your aggression on some contact sports etc., can help.
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806...
After months of intense low back pain, I was recommended this book. I read it and thought it made sense. I know our mind is powerful and stress can cause dis-ease. I completely jumped into his program spite the intense pain I endured. After 6 weeks I did not experience any shift in my pain. And, the pain intensified to the point that sometimes I couldn't even stand. I decided to seek medical help. What I found out was that my L5-S1 disc was collapsed and the (almost) bone on bone rubbing was why I was experiencing so much pain.
I wonder why it's at 4.5 stars.
- Did squats and deadlifts for the first time at age 33. Did them for 1 year. At age 36, again did them for 3 months. (I'll get back into it again once I'm done with my current hectic schedule. Planning on doing at least 3-6 months every year).
- Here's how I sleep: No mattress. I create layers out of (bottom to top):
- Solid floor,
- Carpet or rug,
- Gym mat,
- Thick korean type blanket (mink blanket?), folded twice or thrice,
- a comforter folded twice,
- Regular bed sheet
In addition, I take two large towels, each twisted into a thick rope, then rolled into something resembling a cinnamon roll. One supports my back, one my tummy/abs area. When I lie upright, they're on my left and right. When I lie on the side, one is next to my back and one in the front next to my abs. Every time I twist or turn while sleeping, I've developed a habit of pulling both in to keep them packed tight next to my body.
I'm 39 now. Have been sitting in front of a computer all day for the last 20 years. Never experienced back pain.
Disclaimer: try this at your own risk.
Be careful with on/off/on type modes. Squats and deadlifts will stretch large muscle groups. You can tear these more easily as you get older.
I know. I am recovering from hernia surgery 8 weeks ago. I was doing my normal leg press and squat portion of my routine. I didn't feel anything tear. Though I was pushing about 600lbs on the leg press. 2 days later I am in the ER with severe pain.
Granted, I am not a spring chicken, but I've found that after I crossed 35, my injuries took longer to heal. And if I took time off from my routines, I had to start building back up.
I started that building back up (only 9 weeks off so far, but still, I don't want it to be longer) yesterday and today.
Just saying, be careful. I think of myself as a kid. My body thinks other things.
No idea if it's good, bad or neutral for my back health overall. Doesn't seem to be hurting and I've no history or experience of back pain, but like you say, single data point here too.
it just takes one moment of being tired, losing concentration, forgetting the form, failing to maintain stiffness and strength in the core, forcing a rep out of a bad position, not getting enough rest and nutrition on a high intensity program, and that's it.
I never had an issue before but now I do. massages, physio, painkillers don't work. I can still walk and work and do everyday stuff, but I will not be participating in powerlifting meets for a long time.
I used to spend a lot of money at the chiropractor/osteopath, and while they do give relief I don't see them as a long term solution. That said, I think they can be valuable for acute episodes.
What cured my back pain is Yoga. Not overnight, not over a week, but months of adding strength and flexibility to body as a whole. I'm now pain free.
This may not work for all symptoms, but I think it's important to realise (in most cases it seems) you cannot expect the medical professional to heal you, only to help you temporarily. You must heal you.
It's something I'm working on in physiotherapy, because although I went to see her because I was having horrendous knee problems (now in full retreat thanks to some very simple, well-chosen exercises), she looks more holistically than that and identified some back issues as well. More exercises.
The back ones are harder to do though, and don't seem to be as effective, but I'll be bringing that up at my next visit.
I then decided that I need to carry on working on a desk for decades ahead (I'm on early 30s) so I had to tackle the problem.
Was recommended by my daughter's pediatrician to look into Pilates classes. I'm now pain free and results came very early on in practice.
Also, random pain spots that appeared frequently (for instance knee pain while driving) are mostly gone too.
I actually started weight training and cycleing and feel much better.
Dr. Bigelow: What can I do for you?
Louie: Uh, well, I hurt my back today really bad. Uh.
Can you help me with my back? I mean...
Dr. Bigelow: What's wrong with your back?
Louie: It hurts.
Dr. Bigelow: My professional diagnosis is your back hurts.
Louie: Well, what can I do about it?
Dr. Bigelow: Nothing.
Louie: Nothing?
Dr. Bigelow: The problem is you're using it wrong. The back
isn't done evolving yet. You see, the spine is a row of
vertebrae. It was designed to be horizontal. Then people
came along and used it vertical. Wasn't meant for that.
So the disks get all floppy, swollen. Pop out left, pop
out right. It'll take another. I'd say 20,000 years to
get straightened out. Till then, it's going to keep hurting.
Louie: So that's it?
Dr. Bigelow: It's an engineering design problem. It's a
misallocation. We were given a clothesline and we're using
it as a flagpole.The spine is similar to a set of disks stacked on top of each other. There's no reason that sort of structure can't be fairly stable when held upright. A wide variety of movement arts, martial arts and healing arts mention the damage involved in letting one's spine sag forward (or backward).
Of course getting the spine, neck and head to work together harmoniously is more complex than just "holding yourself upright". Just willing one's body to hold particular relaxed, upright stance can often result in the opposite.
That's why a lot of body work, body awareness, martial arts and etc work on an indirect principle. Meditate so your conscious mind stops screwing up your body and mind. Allow another person to show you the right stance and accept it without judgment.
Which is to say the process of trying to practically engineer the body to work effectively has been going on for a long time. Unlike a cure or prescription, this kind of engineering pretty has to be specific to the person, requires the person's active participation. And so-forth.
See, Tai Chi, qigong, the Alexander Technique, the FeldenKrais method, etc, etc, etc, etc...
Technology may help though, assuming we don't do something stupid and stop our technological progress. (like, for example, electing a president that thinks saving money in the short term is more important than long term sustainability)
> It was designed to be horizontal. Then people came along and used it vertical. Wasn't meant for that.
There were no designs involved.
Humans are the largest bipedal walkers, but not the only ones. Here's an interesting survey:
I've been a desk jockey for nearly a quarter century, and have had constant low back pain for nearly as long. My back feels terrible every day, particularly when deadlifting, or standing up from sitting on the throne for a bit. Chiros haven't helped (100% quackery imho, I've tried a dozen, and really want it to work), X-rays show nothing wrong.
The only thing that has helped has been classic "80's ladies" leg movements (bird dogs, fire hydrants, movements like shown in the linked video), along with foam rolling out tightness in the hips.
I suspect my hip flexors are extremely strong in one direction, and extremely weak in the opposing direction (medial glute), pulling my pelvis out of whack, and thereby hosing up my lower spine.
Anyway, sometimes barbell work doesn't help. YMMV.
The exercise economy is the real back pain industry.
I do heavy deadlifts. I can't tell you how many people told me that it would hurt my back. But it turns out having a muscular back to support my spine was exactly what I needed.
It's more than just muscle. Deadlifts really do a hell of a lot for the body. (They also stimulate growth hormone!)
I have done a bunch of research and have tons of anecdotes which indicate that with proper form deadlifts are far safer and more effective for a wide range of people than is commonly imagined. And the form is rather easy to get right.
Although there are many people who do manual labor for whom the inability to move properly threatens livelihood, which is a very serious situation, lower back pain does not rank with late stage cancer, COPD, crippling mental illness, or any of the other health impairments that let the sufferer see the grim reaper unsheathing his scythe or turn every waking second of life into a mythological torture.
Back pain can be tough, but can be adapted to. You move more slowly, carefully, and adjust yourself when you plan to rest or sit for a while. This rush for invasive treatment is embarrassing to see in my fellow Americans when we've had a reputation for toughness and independence.
- Speaking as someone who's had acute episodes of lower back pain so bad that I've involuntarily collapsed, and could not walk freely for days at a time.
In this part of the world, insurance-covered doctors are very sceptical when you turn in with the back pain, and physio offer very basic things, no real relief.
I did take a scanner and other tests, to evaluate the situation.
Disclaimer: this is not a medical advice, I am not a doctor, "back pain" is a very broad definition.
Works for me, probably because it keeps all the little muscles between the ribs working smoothly. Humans are not built for comfort but paradoxically, avoiding modern comforts will have you sleeping like a baby, avoiding back pain, and give you reserves to climb a mountain when you feel like it.
I injured my lower back quite severely 5 years ago while lifting something at work the wrong way. Entirely my fault. Physio, chiropractors, etc did not fix it in the long term - a lot of money spent on temporary fixes. Swimming and gentle weight lifting over the course of 6 months made a huge, lasting difference. Occasionally, I still feel some tightness in that region but a run or yoga session fixes it up very quickly.
Another supplement that had a huge impact on me is Magnesium. It helps me sleep well, reduces anxiety and chronic fatigue. Also increases libido. It's as if it shaves a decade off my age.
So maybe it was all because of the water I was drinking - too filtered, lacking normal minerals that are found in natural water.
Water is an interesting piece of our diets and lives. One thing I've noticed is that people seem to love ice-cold, filtered water (even in NYC, where we have exceptionally good tap water, my roommate bought a water filter and keeps it in the refrigerator). I personally like the idea of cold water but I realized I can't stand drinking it -- I'd rather have cool/room temperature tap water 9 times out of 10 times. People always give me funny looks when I say that or ask for it, though.
I'd totally believe that different mineral concentrations in water could lead us to different health outcomes. I also started taking a (highly bioavailable, to avoid diarrhea) magnesium supplement occasionally and the first time I tried it, I recall waking up the next morning feeling more relaxed than I'd felt in years. Maybe I'll try calcium, although I do consume a pretty solid quantity of dairy.
Spinal fusions in the lower spine are mostly done laproscopically these days, and usually don't involve abdominal surgery. That's a huge difference -- I had a 6 week recovery vs over 4 months for an abdominal procedure.
My L4-L5 was fused at age 25 due to a degenerated disc that failed completely. Fortunately it was very successful for me. Hopefully we make progress with artificial discs and vertebrae to improve outcomes for others.
It's clear that some amount of realignment of the spine happens naturally; I feel a small pop here or there almost daily. The spine is a complex structure with many forces acting on it. Getting it adjusted as needed doesn't strike me as any more "woo woo" than getting my car's wheels aligned.
ETA this amusing tidbit: the worst back injury I ever had was from playing pinball.
In theoretical wonderland, yes, that's how it happens.
Would begin with a few rounds of sun salutations, and the fundamental positions. And of course, get a teacher and/or proceed very slowly and very carefully, as with many exercises, you can injure yourself if you don't do it correctly.
You can youtube any of the positions in the pdfs below and get quite detailed explanations on how to do them properly.
https://www.ashtangayoga.info/fileadmin/01_Praxis/04_Downloa... https://www.ashtangayoga.info/fileadmin/01_Praxis/04_Downloa...
That lesson has generalized very well. For other injuries, and for age-related arthritis. Basically, if I notice pain somewhere, it tells me that I'm not exercising that area properly.
Pain is wildly complex though, and the causes are not always understood or easily helped. Some people require pills and other treatments. The amount of media animosity towards pain medication and related vitriol spewed at doctors is shocking and totally unwarranted in most cases.
https://youtu.be/bCMNMHBY1Dk?t=46s
I wanted to share this as a first-step, almost as easy as nothing type of thing that could help someone considering a more serious commitment to "real" exercise.
- stop eating sugar and flour (and limit rice, potatoes, pasta) - this way you cut excessive weight quickly and become healthier overall
- do basic back exercises at least twice per week - or even better do crossfit
- stretch your legs and calfs often - tension from your legs translates to your lower back and causes spine issues
With these 3 you're good forever :)
The benefits of the deadlift cannot be over-stated. All adults, especially the elderly, should deadlift on a regular basis. As a compound movement it strengthens so many muscles, results in excellent strength gains, and contributes to quality of life improvements.
4 and 5 are free. The medical industrial complex can't make money by telling you to go to yoga or run. They would rather preform surgery or give a patient drugs. Unfortunately, people take the easy route.
I have been free of back pain for nearly 14 years. Sure some of it comes back here and there but it goes away with stretches, exercise and proper sitting / standing awareness.
I switched to elliptical training. As you don't lift your feet, impact free.
Swimming is also fantastic for the back of course.
Evidence: had a microdiscetomy 4 years ago, lots of rehab, and now pain free. Every doctor said don't run!
The elliptical machine gives me shin splints and I don't get a really good cardio work out.
You are right swimming works wonders as well.
Never had any doctor told me not to run, but they all told me to have surgery?
My personal experience is that with some proper exercise and corrective action, the majority of people can beat the need to have significant back surgery. I just want people to know there can be alternatives out there.
This book "Foundation: Redefine Your Core, Conquer Back Pain, and Move with Confidence" did almost magic to my problems. The exercises are dead simple and I'm still amazed how well they help.
Agreed, the infomercial nature is a bit off putting but don't let this distract you, the exercises are working
I am not a doctor and this is anecdotal but strength training has been a serious positive for me. As a desk jockey I had developed various posture and functional deficits as a human being. I have been strength training for 8 years now and my mood and physical wellbeing is starkly different.
Pros of strength training over other kinds include: low rep count, no silly ab curls, everything is very pragmatic and logical, no unfounded health fads required. Should there ever be a wild barbell blocking the path of emergency services or exit from a fire, with proper form, you could be the hero of the day.
Also, jogging or running would often make things much worse for me.
The Chiropractor I visit utilizes x-rays & a thermographic scanner to identify the subluxations.
From consistently seeing my x-rays, it's obvious where my subluxations lie. The thermographic scanner analysis also corresponds with what I feel & what my x-rays show. The targeted adjustments increase my range of motions, blood flow, & "good feeling" in the areas of the subluxation; in a progressive way. The spine (especially the neck) is a complex biomechanical system, so it takes iterations to enhance. I've also tried yoga (ashtanga) & exercise in the past, but my back was still messed up.
While it's healthy to be skeptical, it's also healthy to be skeptical of the skeptics.
During the turn of the 20th century, the robber barons (i.e. Rockefellers) financed a campaign to promote the nascent allopathic medicine & to discredit the traditional naturalpathic medicine. They financed universities, including politically maneuvering in allopathic faculty & ostricizing naturalpathic faculty. They also utilized the new science of propaganda (later renamed to public relations) to convince the population of their worldview.
Allopathic medicine tends to be more profitable large companies (monopolies) for a few reasons:
* it has an innate subscription model (i.e. medication)
* it can utilize patents & professional associations to control markets
* by attending to the symptoms & not the root causes, it can create long-term or even lifetime customers who become dependent
* side effects can be masked & non-obvious via bioaccumulation
* masking side effects creates new symptoms to create demand for new medicine
* having a monopoly in practitioners & capital allows companies/markets to control the funding & dissemination of research results
* since it relates to health care, populations demand government subsidies funded by taxpayers & other government funds (i.e. ObamaCare)
* since it's health care, laws can be passed to "ensure the public good". These laws are often written by the lobbyists to restrict competition. For example, in many states, it's a criminal offense to be a Naturalpathic Doctor.
* there's been a recent epidemic (~60 from 2015-2016) of Naturalpathic & well known critics of the allopathic medicine industry/science with mysterious deaths
I'm sure there are many other strategems that I'm missing; but this shows how allopathic medicine is quite a lucrative business with heavily dependent customers. It's also politically incorrect to call out the state of affairs as it's an involved & emotional topic with massively capitalized special interests who want to keep their golden goose.
"In this investigation, cervical spine films gave rise to radiation doses that are similar to those of chest x-rays. However, lumbar spine radiographs generated effective radiation doses that were approximately an order of magnitude greater than these other studies. In both the cervical and lumbar regions, AP views resulted in significantly greater radiation exposure than corresponding lateral images."
via https://www.ncbi.nlm.nih.gov/pubmed/18679095 . Remotely regular exposure to high levels of radiation is bad, and not good.
Well said. Skepticism is important, but it's not an unerring guide to truth.
anecdotal evidence, but after a few years there I had weekly visits to chiropractic just to function. one week out of the country, anywhere else, and I am good as new again. back to the usa, back to chiropractic. I already tried to change everything I can think of. even doing more exercise in the us caused a nerve pitch that was hell.
why? why?
The licensure is a government run monopoly, which always leads to higher prices and lower quality care.
The fact is good doctors will be good doctors regardless of licensure because they will put in the effort to learn what's needed to treat the patient. Bad doctors will be bad doctors, becaude their motive is money, and they won't care about patients welfare either way. In some ways a license gives a false sense of security.
Still, he most frustrating aspect imo is they act as gatekeepers of (effective) drugs and sick leaves.
However, don't rush to condemn acupuncture as a treatment for long term pain. Here's one recent analysis showing advantages over placebo: https://discover.dc.nihr.ac.uk/portal/article/4000672/acupun...
Where are you seeing that? I didn't see it. What I see is "I had acupuncture and got better, therefore acupuncture works for me", which is a much weaker claim. Moreover, it contains a great insight: treatment for back pain needs to be highly idiosyncratic.
https://en.wikipedia.org/wiki/Anecdotal_evidence
> Anecdotal evidence is evidence from anecdotes, i.e., evidence collected in a casual or informal manner and relying heavily or entirely on personal testimony. When compared to other types of evidence, anecdotal evidence is generally regarded as limited in value due to a number of potential weaknesses, but may be considered within the scope of scientific method as some anecdotal evidence can be both empirical and verifiable, e.g. in the use of case studies in medicine. Other anecdotal evidence, however, does not qualify as scientific evidence, because its nature prevents it from being investigated by the scientific method.
> Where only one or a few anecdotes are presented, there is a larger chance that they may be unreliable due to cherry-picked or otherwise non-representative samples of typical cases.[1][2] Similarly, psychologists have found that due to cognitive bias people are more likely to remember notable or unusual examples rather than typical examples.[3] Thus, even when accurate, anecdotal evidence is not necessarily representative of a typical experience. Accurate determination of whether an anecdote is "typical" requires statistical evidence.[4] Misuse of anecdotal evidence is an informal fallacy and is sometimes referred to as the "person who" fallacy ("I know a person who..."; "I know of a case where..." etc.) which places undue weight on experiences of close peers which may not be typical. Compare with hasty generalization.
I agree that it's frustrating to see so much anecdote in threads like these.
https://discover.dc.nihr.ac.uk/portal/article/4000672/acupun...? Kindutm_content=buffered7fb&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer
Why would there be a treatment right now that works well but can't be shown to work in a controlled study? There's nothing special about back pain that makes it impossible to scientifically study.
Personally, I think the signal you mention is more because back pain is susceptible to placebo effect, coming and going by itself, clearing up by itself or because something else you recently changed around the same time is helping it. These reasons and more are why you have to do large scale controlled studies to find out if something works rather than relying on anecdotes.
I don't see many people giving anecdotes for how alternative medicine fixed their broken leg or cured their cancer.
Why does this matter? You ask the patient to report on their subjective experience the same way you would in studies about cures for depression and headaches.
My point is that 1) only when no surefire scientifically backed cure exists will most people take alternative therapies seriously and 2) problems that can resolve on their own (self-limiting) are very susceptible to generating unreliable anecdotes about cures. Back pain fits these two so generates many unreliable anecdotes which you should be highly skeptical about.
The reason why I'm replying is because I don't want people that can be helped by Acupuncture to reject it based on a misunderstanding of the claim.
I think there are several specific reasons why both the article which you link to can be true and also that acpuncture worked in my specific case and can work in cases that are similar.
First of all, as another reply alluded to, the article isn't testing for effectiveness for a specific problem. In fact, I believe, and continue to believe personally, that acupuncture may not solve for general problems. My half-joking, poke your foot to fix your liver being an example.
I would also like to point out that of all the things I tried, I had the least confidence in acupuncture. In terms of placebo, I was expecting and perhaps even hoping that it wouldn't work to prove myself right. In fact, I tried it almost mainly as a way to say that, "Hey! I tried everything. Even acupuncture! That's how you know I tried everything."
I had much higher confidence in everything else I tried.
I would also like to point out that the specific thing I think it solves is in releasing a muscle locked in spasm (though I may be getting the language wrong). I think if you don't have a muscle locked in spasm, it probably won't help.
My initial reaction to the improvement was that perhaps it was a coincidence. Although this seemed unlikely given that I had been trying for months with different practitioners and there was a difference before and after the session. I also thought that it was temporary and that maybe a day later things would revert, which they didn't.
I also felt that this was becoming more mainstream because I had some rehabilitation for an injured knee a few years later. Apparently I had a muscle locked in spasm (not the knee) and they used a needle to unlock it. Basically, put the needle into the locked muscle, move it a little, there is a physical jerk, and the muscle becomes unlocked.
Edit: Weakened some points to better reflect my position
Anyway, the physical therapist put me through motions and he showed me on the skeleton how it was actually supporting muscles that were much weaker on one side of my body. He gave me basic exercises to do every day to strengthen those muscles, and in the end it worked beautifully. No more knee issues.
I'm glad you found something that worked, but I'm also curious if you tried out PT, and what they told you?
Posture can also be helped with muscle strengthening. Years ago a PT gave me a ton of exercises to combat sitting at a desk all day. I still do them at the end of my usual workouts.
Calling it a "medical technique" or even "alternative medicine" was ludicrous. It wasn't even coherent.
The key part of that paragraph being "Good quality trials have not been done for all of them".
It's a shame that Western science seems so intent on dismissing non-western treatments and techniques, rather than committing to running the same detailed trials that they do on profitable drugs.
Second, they have run good trials on many of the conditions acupuncture claims to cure. You picked the one paragraph that might be interpreted to support your claim:
> It's a shame that Western science seems so intent on dismissing non-western treatments and techniques, rather than committing to running the same detailed trials that they do on profitable drugs.
So here's a few quotes that contradict you, all from the same article:
> after decades of research and more than 3000 trials, acupuncture researchers have failed to reject the null hypothesis, and any remaining possible specific effect from acupuncture is so tiny as to be clinically insignificant.
> Large multicenter clinical trials conducted in Germany7–10 and the United States11 consistently revealed that verum (or true) acupuncture and sham acupuncture treatments are no different in decreasing pain levels across multiple chronic pain disorders: migraine, tension headache, low back pain, and osteoarthritis of the knee.
> Vickers et al.14 did a meta-analysis for 29 randomized controlled trials, with 17,922 patients. The patients were being treated for a variety of chronic pain conditions. The results were very similar to those of Madsen et al.12Real acupuncture was better than sham but by a tiny amount that lacked any clinical significance.
There's no reason to not try acupuncture, if you've got the money for it, I guess. It's not likely to hurt you. But don't disregard other treatments.
And bitch all you want about "western medicine", but if you have a heart attack, or need a kidney transplant, or break a bone - you're probably going to choose the western system.
I always find it weird that people can't see alternative medicine is only used by advocates on problems than tend to come and go by themselves or are susceptible to placebo effect but any time something serious comes up like the problems you mentioned, people will turn to real scientifically backed techniques. Acupuncturist and chiropractors for example claim to treat much, much more than just back pain as well.
And here's a large, we'll run, study showing acupuncture is more effective than sham accupuncture
https://discover.dc.nihr.ac.uk/portal/article/4000672/acupun...
Make sure they wipe the injection sites with alcohol and use properly sterilized or disposable needles. (Give it with the same expectations you have for an injection.)
I think western medicine is excellent when it comes to determining specific details about many individual bits are supposed to be working, and fixing those specific things when they're broken or malfunctioning. It's not as successful when it comes to understanding how all of those specific bits fit into place as part of a larger complex system. There are too many variables and interactions, and we've only very recently had the computational power to create models of these systems, let alone understand them.
Where western medicine takes a bottom-up approach, from details to system, non-western medicine usually takes a top-down approach, observing how the overall system behaves and reacts. With enough observations, it can become very good at predicting reactions, but still totally fail at being able to explain why the reactions happen.
Take acupuncture: in western medicine, we know that the body has pathways and circulatory systems for blood, lymph, and other fluids, and that our cells communicate using electrical, chemical, and hormonal signals that are passed through the pathways and circuits. We know a lot about small details, like how one nerve cell uses ions to pass an electrical charge across a fluid-filled gap to the next nerve cell, but we don't really know how it all works as a whole. But it stands to reason that poking conductive needles into these pathways and using them to cause stimulation could insert signals into the system or interrupt existing signals. Western medicine can't model that, and it can't predict for sure what possible effects it can have. Without a theory, all we can do is perform random experiments in the dark and hope something noticeable happens.
Chinese medicine, on the other hand, has done the random experiments over thousands of years, and has determined specific places to put the needles and how to manipulate them to get the desired effect. That's straight-up observational science. But to explain it the Chinese came up with the idea of qi as an energy that flows through the body, which is vaguely right as a very blurry view of western medicine's understanding of our nervous system and other systems, but mostly it's completely fictional.
The point I'm trying to make is that different approaches to understanding can both be right and both be wrong, except they tend to be right and wrong about different parts. The top-down, systemic, wholistic approach is good for understanding the big picture and the 'what', while the bottom-up, componentized, analytical approach is good for understanding 'how'.
First, you describe Western medicine as detail oriented, or bottom-up, but this creates a false contrast.
Western medicine studies all sorts of interactions between systems. Yes, there are tons of specialists, but they all have to study how all the different systems interact in early coursework, precisely because the West does value insights gained from how systems are plugged together, and borrowing techniques from some contexts/scales and applying them in others.
The real distinguishing feature between "Western" and traditional medicines, and this is really only a very recent phenomenon in the West, is just the recognition that we constantly, unwittingly, lie to ourselves about what is effective. So we design methods to test results, and throw out things that don't work.
If there's one dominant feature of "Western" medicine it's RCTs.
But note the scare quotes, included for two reasons:
First, the roots of Western medicine have nothing to do with scientific rigor. If anything, the West's medical history was so thoroughly unreliable with ramblings about demonic possession and poisonous snake oil that it made the abundance of quackery obvious, making serious practitioners demand proof for everything.
This idea isn't "Western," it's just a natural human reaction when you want better information. Make people prove what they claim.
Sure, there are specific tools that help, like randomization and extra controls (placebo, blinds, peer review, etc.). But those aren't "Western" anymore than fire or levers or wheels are regional possessions. They're just working tools anyone can use, and China is using them today.
And that gets to the bigger problem here, not the mischaracterization of Western medicine, but reducing China's medical research contributions to "traditional Chinese medicine." Most people unfortunately do this, but it completely undermines the brilliant scientific contributions of modern Chinese researchers, who use the best tools available (like RCTs) to contribute to humanity's scientific knowledge.
And note, these aren't traditional Chinese practitioners, just dabbling in Western methods, anymore than Watson and Crick were really exorcists who dabbled with chemistry.
It's true that some Chinese research may be inspired by traditional medicines, like Tu Youyou's pioneering work on antimalarial drugs. But what's the root of her contribution? It's not merely popularizing an old remedy that makes her brilliant. She's great because of all the thousands of possible old remedies, she conducted rigorous animal studies to identify one useful treatment. She sorted the chaff from the wheat, and she did the hard work to prove her result, and create conditions that could be replicated.
(It would be the wrong lesson to conclude her story validates folk remedies generally. Her story validates rigorous scientific testing. There are so so many worthless folk remedies. Rigorous scientific testing was the useful and unique ingredient here that led to a usable result.)
More and more often, others like Junjiu Huang, are conducting groundbreaking stem cell research (a field completely unrelated to traditional medicines).
Part of this discussion may stem from discomfort at comparing rigorous modern RCTs with Chinese traditional medicine, maybe a fear that this becomes a cheap way to make China look backwards. But the real problem is the comparison. There's no reason to compare those things.
Apples to apples would be to compare traditional Chinese medicine to bleeding and trepanning. Or more recently, while we were well past China's stage of economic development, we were using stuff like preorbital lobotomies and insisting schizophrenia was caused by bad parenting.
And those were doctors and hospitals. If you include hobbyists and folk remedies, you get people in the West swinging a dead cat over their head in a graveyard to get rid of warts. You get people faith healing on TV by shouting "demons out!"
Once you're satisfied that folk remedies have issues in every country, then compare modern with modern.
At the worst, you can criticize some Chinese schools as paper mills. But China's sheer number of researchers means its upper ten percentile is already twice the size of the US top ten, and the number of researchers and quality of research in China are both rapidly improving. The sheer potential is staggering throughout Asia, based on population and how rapidly countries are progressing economically (so they can move larger portions of society out of agriculture and basic industry and into more prestige fields like science).
Based on demographics alone, the smart money would be that China will develop more "Western" medical advances in the next 50 years than the West itself.
That's what we should be celebrating about Chinese medicine. Not stuff from a thousand years ago, a double standard when we consider Western medical advice from a thousand years ago to be laughable nonsense. But all the real stuff they're doing now, today, and what they will inevitably do in the near future, to push forward the frontiers of not Western but human knowledge.
https://en.wikipedia.org/wiki/German_acupuncture_trials
https://well.blogs.nytimes.com/2012/09/11/acupuncture-provid...
The site you provided is run by a small group of doctors who seem to have beef with acupuncture, judging by their tone. https://sciencebasedmedicine.org/category/acupuncture/
A lot of western folks who get acupuncture treatment do so with great deal of skepticism. Despite that, it's gaining traction in the West. Why? Because it works pretty well for some people.
I wouldn't dismiss it as a sham.
I've seen placebos work too - most of my childhood homeopathic medication was probably placebos.
For a single person, the important factor for treatment is outcome - not statistical significance. If something makes you feel better, the outcome is achieved. I've also seen doctors exploit it, because their goal is aligned with your outcome - not studying the causation.
However, the problem is when you offer advice to a skeptic, the placebo effect is out of the picture.
And it can be worse, the time spent with the placebo might be lost time to the sufferer where it plays out as "If only you'd come to us earlier" elsewhere.
There are long-term consequences, when you offer medical advice without the expertise beyond your outcome ... outcomes heavily bifurcate for people who trust you (strong placebo effect or time lost waiting for results).
A little over four years ago, I had a ton of shoulder pain. I went to two doctors, had an MRI scan, and was prescribed physical therapy. After all of that, I was still in pain, and neither of the doctors could figure out why, so I decided to try acupuncture for the first time. I went to Chinatown, got needles put in me, and got some electricity sent to my shoulder. I left the shop about 30 minutes later, and about 70% of my pain was gone. I woke up with next morning with only a tiny bit of pain left.
The pain didn't come back, even after months. I eventually found a doctor who figured out what was wrong, and through a better round of physical therapy, I was able to eradicate my shoulder pain permanently.
Maybe acupuncture didn't solve my problems completely, and of course it doesn't work for everything (e.g. weight loss, cancer, etc.), but to simply say that it "doesn't work" is ludicrous.
https://discover.dc.nihr.ac.uk/portal/article/4000672/acupun...
(On mobile, apologies for the weird URL).
For lower back pain I think the advice is, after seeing a doctor, to start exercising.
There, fixed it for you.
https://discover.dc.nihr.ac.uk/portal/article/4000672/acupun...
Like chiropractic, there is "something" there, but it's mostly mild physical relief + belief/placebo effect.
That's not necessarily a bad thing, especially for pain relief where the alternatives are pretty high impact (surgery, ineffective narcotics, other treatments that lose efficiency over time). The problem is there are practitioners who claim to cure cancer, etc, and there's no way for anyone to vet that.