The healthcare system in the United States for lower back pain right now is just simply not good enough. If you look at the statistics, they are overwhelming. Right now we see that over 265 million prescriptions last year were written for pain medication. We have got 89% of the population in the United States that at some point are going to have back pain in their lifetime. We have got spinal fusions. The surgical rates have increased by 150% in the last 10 years. And you have got 50% of those spinal fusions are successful 2 years out. Only 50%. Imagine that.
My name is Andrew Gorecki. I’m a Physical Therapist and I have been a back pain patient in the past. In fact, I’m here to tell you a story about my back pain and how I went through the system and my perspective of what the current system is like. My hope is to also offer some new ideas, new strategies and new solutions for people that are suffering from lower back pain. My story begins back in 2006. I was 24 years old. I was a college student. I was very active, very healthy. I lifted lots of heavy weights on a daily basis. I was a runner and I was a cyclist. I thought I was in the best shape of my life. Little did in know that one morning I would wake up with extreme shooting pain down my leg. Having no idea what I had done and thinking that it was just going to go away on its own, I ignored it. And I ignored it for several weeks but the pain continued to get severe. I had extreme shooting, burning pain from the back of my hip all the way down to my toes. In fact, I remember that my big toe was actually so painful that it was throbbing.
Finally, I went into the campus medical center. I had student insurance at the time. I was very poor. I believe it was a 70/30 policy where I had to pay 30% as a college student. I go into the community center and I meet with a doctor and tell him about my big toe and how painful it is. He informs me that it is not my big toe but it is my sciatic nerve. I have sciatica. He prescribed me some Vicodin and some ibuprofen and told me to go home and take these and they should help. At that point, every daily activity was painful. I couldn’t put my socks on. I couldn’t sleep at night. I couldn’t sit in a chair or bend over to lift up the toilet seat. Life was a drag. Of course, the medications helped me but they only helped for about 5 hours. So what happened was my pain medication became how I told the time of the day. I could tell you exactly what time it was based on how I felt physically. A month goes by and I go back to the follow up with the physician. He says how is it going? I tell him that I am in a lot of pain and things have not changed. He says let’s try another month and he gives me another prescription for Vicodin and ibuprofen. And he sends me on my way.
As I continue to go about my life, things get worse and I can’t wait for my next follow up appointment. I call him 2 weeks later and he gets me in. I tell him how painful that I am. He says that I should go to physical therapy. And as an undergraduate student who was thinking about going into physical therapy, I was very excited. So I show up at the physical therapy clinic on my first day. They describe to me what the sciatic nerve is and why my lower back hurts. And they begin to prescribe to me movements and exercises that make my lower back move more. As you can imagine, when you have lower back pain and you move it more, typically that hurts more. I was hurting during physical therapy, after physical therapy and I was reassured that this was normal, all part of the process and that things would just magically get better. As I was in physical therapy, I noticed a trend, I would be feeling ok sometimes. Maybe the physical therapy would relieve my pain slightly while I was at physical therapy but then the pain would return. This was kind of the pattern that I was seeing. I would feel better for a short period of time then the pain would come back. That was very frustrating for me.
About 4 weeks later, I went back to the primary care physician and told him my story. He looked at the report from the Physical Therapist and looked at me and said, “You know what? I don’t think that you have anything wrong with you. I think that you are just here trying to get pain medication to use it recreationally.” At that point, I sat back and I was completely shocked. I have never been accused of being a liar before. That is how I felt. I felt I was being accused of being a liar. So he actually did not give me pain medication and he sent me away. A couple of things happened that day and the next day. I began to have increased pain of course because I didn’t have pain medication. But I also started to go through withdrawal symptoms. I was sweating. I was very irritable. I couldn’t sleep. The next day I go back into the office of the physician and I basically just demanded that he reassess me and that I was truly in pain. I was also an exercise physiology major so I understood the basic principles of the pain response and how that stimulates the sympathetic nervous system. Things like your eyes will dilate and your heart rate and your blood pressure will increase and you will sweat. I pointed those things out to the primary care physician. He said, “You know what? You are right. You do have symptoms that would make sense that pain would be part of the problem.” He said, “I’ll tell you what. I will give you one more month of the pain medication. But I want you to stop physical therapy and I want you to go to a chiropractor.” I said, “Ok, I will do whatever you say.”
A couple of days later, I go to a chiropractor. He examines my lower back and tells me that my lower back has segments that are out of alignment. And that he needs to readjust my lower back to put it back in alignment. He said that it was going to take me a long period of time and that I would probably need to see him for 3 months. He proceeds to manipulate my lower back which you get the nice snaps and the cracks and the pops. Immediately when that happened, I had an intense shooting pain in my lower back as well an increased pain down my leg. Additionally, I started to feel numbness in my leg after that visit. So of course, I went home and I was very upset. The next day, I called the chiropractor’s office and told them about my experience. He said that was normal and all part of the process. My gut feeling told me that I should not do that so I stopped. I waited 2 more weeks then went back into the primary care physician’s office again, for the fourth time. He said, “Well, you know what? It is time for you to get an MRI.” I go in and get an MRI. At the time I think that the MRI was $2,000 and I had to pay 30% of that. So I wasn’t looking forward to that but I went in and got the MRI. Three days later when the MRI came back, it showed that I had a disc herniation at the level, L4/L5 in my lower back. I go 3 days later to the primary care physician again for him to explain to me the MRI. He said, “You have a disc herniation. Here is the problem. The next step is you need to get a cortisone injection at that segment to make the pain go away.”
So I scheduled a cortisone injection. A week later, I get the cortisone injection. Now it has been about 4 months of pain, no sleep, no exercise. My quality of life is very poor. I get my cortisone injection and the radiologist tells me that I should feel relief immediately. So they inject me and I leave the office and for about 2 hours I was completely pain free and very happy. Then that actually lasted for about 2 days. During those 2 days I felt so good that I just started going back to life. I was walking. I was exercising. I was riding my bike to class. Then on the third day, I wake up in the morning and all of the pain has returned. As you can imagine, I was very frustrated. I was very upset and very discouraged. So I call my physician again. I think it was another week before I could get in. I go in and tell him my story how the injection only lasted 3 days. And he tells me, “You really need to try 3 of them. Research shows that you should try 3.” Of course I listen to him. I go back and I get 2 more injections over a 2 week period. Each injection had the same effect about 2 days I had no pain and went back to my life with hope then the pain returned. Again very frustrating and discouraging and expensive.
At this point, going into the primary care physician is getting very boring, very discouraging. And on my next visit, he tells me that I need to have a consult with a neurosurgeon. Now the neurosurgeons are usually very busy. So it took me about 4 weeks to get in to see the neurosurgeon. This was an experience that I will never forget. I’m sitting in the neurosurgeon’s office and he comes in. A very busy guy in his white coat and stethoscope, he walks in the door and without introducing himself he says, “Alright, when are we going to do surgery?” I said, “Whoa, wait a minute. Hold on a second. What are you talking about?” He goes, “By the time you get in my office, that means that you are ready for surgery.” I said, “Well, I would like to know about the risk factors and the outcomes and what you do during the surgery.” He looks at me and he says, “You know what? I really don’t have time to tell you all about that. But when you are ready, you’ll know. You just give me a call when you are ready.” He walks out of the office. I think we had an interaction of less than 2 minutes. His nurse comes in and I tell her how upsetting that conversation was. So she spends a little bit of time with me explaining the spine anatomy and what a disc herniation means and what they do during the surgery. So I leave the office kind of thinking gosh, I’m not really sure what I’m supposed to do. I’m just going to stick it out. I’m just going to live my life and hope this thing goes away.
Another month goes by and I am having less and less relief from the medication that has been prescribed. So I take it upon myself to start taking twice the Vicodin. What ends up happening to me is one night my wife wakes me up and I’m upset because she wakes me up. I ask her, “What’s the problem?” She says, “Well you are not breathing very well.” I said, “What do you mean I’m not breathing?” She says, “Every minute or so you are gasping for air. You are making me nervous.” I said, “Well, gee that is not good.” She said, “I want you to stay up and I am going to make you some coffee because I want you to stay up because you are making me nervous. I’m scared for you.” What was happening was I was taking so much Vicodin that I was on the edge of overdosing. When you take too many opiates, what happens is it depresses your breathing and you just basically fall asleep and you can die from that. I knew that as an exercise physiologist. I knew some things.
The next morning, I called the surgeon and said, “You know what? I’m either going to overdose from pain medication or I have got to have surgery.” He said, “I’ll see you on Wednesday.” This was Monday. His schedule must have been open to get me in that fast. I go in. I go through surgery. It was a very scary experience. I wake up from the surgery and my pain is gone. So I am very hopeful. This is the best thing that I have ever done. It was a $100,000 surgery. So I’m paying $30,000 of it plus the MRI, plus the medications, plus the physician visits. But that is ok. I would do anything to get rid of the pain that I was experiencing and return to my quality of life. So the surgeon instructs me that I’m not supposed to do anything for the next 4 weeks. I can’t lift over a gallon of milk and I’m to do nothing. So I follow his strict guidelines and I basically lock myself in my apartment. I go from my bedroom to the kitchen to the bathroom on a daily basis. My wife takes care of me. I did not go to classes for a month. Interestingly, 2 weeks later, I wake up one morning and all my pain has returned. I call the surgeon and say, “It is an emergency. I need to see you.” He gets me in that day. Again, he spends 2 minutes with me but this time he is a little upset. He starts to lecture me about how I must have done something wrong because his surgery was successful and I did not listen to him. I did not follow his guidelines which I know is not true. I know that I followed his guidelines very well. So he was very upset and said, “You know what? I have to do surgery again on you but I can’t even do surgery for another month because you have to heal. The scar has to heal.” I just leave feeling very discouraged and kind of confused and upset. Afraid I was going to be like this forever. I felt like there was no hope. I was very depressed. At that point, I had gained 35 pounds. I couldn’t sleep. I though life was over at 24 years old. Very emotional time for me.
It was the same time that I had just gotten accepted into physical therapy graduate school. I began physical therapy graduate school a month later. I was the kid in the back of the class who couldn’t sit down, who couldn’t really do a whole lot. I had let all of the professors know that my back was an issue. What happens in physical therapy school is you become a guinea pig. So I get all of these professors and all of these students who want to help people, they started looking at my body and trying to help me. Immediately, one of the professors finds that my right hip has no degrees of rotation inward. It is typically supposed to have 30 degrees of rotation inward. So knowing that that is not going to hurt my lower back, they begin to work on my hip mobility. About 2 weeks later, they restored my hip mobility to 30 degrees and guess what happened, my lower back pain and sciatica went away. Now I didn’t know why at the time. I don’t even think they knew why at the time.
But the point of this story is that the entire healthcare system right now is set up to focus on the symptom and the site of the pain. So in this case everybody was focused on my lower back as the problem. I’m here in this book to tell you about new evidence, new science, new treatments that are out there that are proving that the lower back is almost never the problem. It is a result. It is a symptom of a dysfunction elsewhere.
Einstein’s famous quote says “Doing the same thing and expecting different results is the definition of insanity.” I would argue that right now the treatments for lower back pain are insane. Right now the traditional treatments are starting with medications, moving to injections. Then maybe physical therapy and if physical therapy is prescribed, it is usually traditional physical therapy that is focused on the site of pain and not looking at the entire body. And then ultimately surgery. That is the normal sequence right now for lower back pain. We have been doing the same things for years and years and years. I would call that insane.
Twenty-five years ago for lower back pain the standard treatment was putting people in the hospital for 2 weeks on traction where they would strap the legs and the upper body and pull them apart which would provide space in the spine. And that is what we did for years and years and years until evidence came out that showed that that was the incorrect way of going about it. So things evolved, they changed. In 1957, it was proven that abdominal strength, doing crunches, doing sit-ups had absolutely no effect on lower back pain. But yet to this day, we still see commercials and products and traditional Physical Therapists teaching people how to strengthen their abdominals to make their lower back pain feel better. So to me these things are insane. The system has to change and for whatever reason, it is not changing fast enough. I would argue that there are lots of people that are making money off of the stagnation of the system. I’m here to share my ideas, my experience and hopefully change the system of low back pain treatments for once and for all.
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