Back Pain, Empress of all maladies

If cancer is called the ‘emperor of all maladies’, back pain might well be the empress. The damn thing doesn't not kill you, nor does it make you any stronger. Not that it lets you live either. It's like being madly in love with someone who you can never be with.

Back pain affects 80 percent of people, and remains the toughest ailment to treat. Dr Rajat Chauhan gets to the heart of the problem, and explains how pain works, why we develop it, and how we can heal it. This book is sure to resonate with anyone who has suffered from back, neck and knee pain.

Almost always MRIs, injections and surgeries are not needed for back pain. You need to empower yourself with knowledge and become more aware of how to handle your pain. It is in no one else's interest but yours. 

YOU'VE GOT ONE BACK

Pain in the back and neck is by far the number one reason for Indians (and others too, worldwide) for the ‘years of life lived with disability’.

You need this book because you or your loved ones are suffering from pain. Stop outsourcing your problems. You need to solve them yourself. It’s your job to be better informed rather than blaming the ‘experts’ years later.

YOU MOVED TO BE BORN, KEEP MOVING

Let us go back in time—13.8 million years ago—when, leave alone life, time itself didn’t exist. The earliest universe was highly energetic. It was replete with random movements that created this universe. Does it not surprise you then, when you are told by the ‘experts’ not to move when you have back pain?
What is true of the universe is true of human beings too.

A long time ago, before you were born, the sperm ran towards the egg. This led to the foetus being formed, and soon enough you. Constant movement helped the foetus to grow in size and also caused its neuro musculoskeletal growth. The foetus moves instinctively, to survive in its given environment.

What happened after that? Why did we all become such slobs and went against the basic rule of nature? We moved to be born. We need to keep moving to stay alive, else we will merely exist.

WHAT DETERMINES OUR CHARACTER IS HOW WE RELATE TO WHAT HAPPENS TO US

Even though back pain seems to be the biggest bane
of modern society, you have the power to change your condition. You might not be able to change your genes, but you can change how those genes are expressed with some effort. Along with regular physical activity and exercise, you need to alter eating habits and other lifestyle-related habits.

There are two sets of people responsible for back pain being such a big nuisance in all our lives.

The first person is you.

Second is anyone who has directly or indirectly contributed to the environment that you live in. This includes your parents, teachers, partners, employers and your children. The cycle of life goes on. These roles are important because you could also be in one of these positions, affecting someone else’s life.

'It is not what happens to us that determines our character, our experience, our karma, and our destiny—but how we relate to what happens.’

By Dr (Brig.) B. K. Singh

a joint replacement surgeon, who established the joint replacement centre in Army R & R Hospital, Delhi

"The back is a complex structure made of multiple bones separated by discs and held together by strong ligaments and muscles. It is designed to provide flexibility in all directions through facet joints while protecting the spinal cord within it and nerves exiting through the neural foramina at each level. Each of its components is a possible source of pain which can be acute or chronic, of differing severity and sometimes associated with neurological deficit such as weakness, numbness or bladder/bowel incompetence.

Unfortunately, treatment today is based on Magnetic Resonance Imagings (MRIs), which, though extremely useful in eliminating serious disorders such as tumours, trauma and infections such as tuberculosis, are of little value in the common causes associated with day- to-day strain such as disc pain or age-related degeneration. Most of these can be managed conservatively by a good chiropractor or physiotherapist under the guidance of an orthopaedic surgeon to avoid complications.

Unfortunately, the tool which revolutionized diagnosis of the back is now being used to scare unsuspecting patients into surgery without informing them of the complications. This is often more disabling than the original problem especially in the elderly.

Keep an eye on your back — knife-happy surgeons are waiting to literally stab you in the back!"

HIPPOCRATIC OATH

Modern version of Hippocratic Oath — Written in 1964 by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University, and used in many medical schools today.

I swear to fulfil, to the best of my ability and judgement, this covenant . . .

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of over-treatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy and understanding may outweigh the surgeon’s knife or the chemist’s drug.

I will not be ashamed to say ‘I know not’, nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me so that the world may know. Most especially must I tread with care in matters of life and death. Above all, I must not play God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.
I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

ACKNOWLEDGMENTS

'If I have seen further it is by standing on the shoulders of giants.' — Isaac Newton

All my teachers, throughout the years, have been these giants for me. Thanks a million miles to all of you. Thank you Ira Leinonen and Jamie Skelly for showing me how overrated educational degrees are. I learnt more about movement, strength training and rehabilitation from you two than anyone else.

Below are names of other professional colleagues whom I very highly respect in medical fraternity. They have knowingly or unknowingly contributed towards my learnings of the subject.

Prof. Steven N. Blair, Dr Karim Khan, Dr P. S. Chandran, Prof. Stuart McGill, Prof. Timothy Noakes, Peter Halen, Dr B. K. Singh, Dr B. K. Rao, Dr Harsh Mahajan, Dr Raju Eshwaran, Dr Pankaj Surange, Dr Thomas Kishen, Dr Sanjay Dhawan, and my good friends, Dr Vikram Kumar and Dr Anurag Mishra.

Special thanks to Dr Peter L Gregory for showing me the path. 

‘If you want to master something, teach it.’ This old adage helped me immensely while I trained my team from scratch rather than expecting them to know it all from before. Most of the times, there was a lot of unlearning for them to do. Teaching them the basics made me question the obvious again and again, which otherwise is overlooked. All my team members have directly or indirectly contributed to this book. They also made me realize that I had become more of a student of pain for life rather than a master.

Below are names of colleagues, in no particular order, for all their contributions. If I have forgotten anyone, I apologize. You know who you are. I sincerely appreciate all your contributions:

Vishwanathan Sridharan, Kunal Vashist, Karishma Rathore, Ritika Chawla, Gagandeep Kaur, Sonam Taneja, Sunil Dahiya, Kishan Pesswani, Neha Kumar, Nimrat Kaur, Sumanth Kumar, Anuvrat Singh, Shibani James, Ishan Arora, Samridhi Saxena, Anika Kaur, Dipali Dhamija, Sumit Arora, Vidhushi Wadehra, Munesh Kumar, Dr Rizwan, Nandlal Pathak, Garima Chawla, Anjeline Dhaka, Krishna Prem, Debapriya Kapoor, Preeti Ashok, Sahrika Sankla, Anita Mathews, Princey, Magesh Kumar, Shahbaz Nawaz, Sudeep Gurang and Kieran Lowe.

Thank you Supreet J. Bargi for doing the photoshoot at such a short notice for the exercises. Thank you Ritika Chawla for agreeing to model, and Karishma Rathore, Vishwanathan Sridharan, Kunal Vashist and Gagandeep Kaur for all the logistics involved in making it happen. Thank you Catherine Withers for helping with editing my random thoughts and giving them shape. Thank you Saloni Mital for making sense out of it all. A special thanks to Shahnaz Singaporia for proposing this idea and helping me build the skeletal structure.

My brats Viren and Harsheath showed me that pain is simply fun. Befriend it and get on with life. Apologies to you both and your mom and my wife, Nidhi, for spending a lot of time on this ‘Taj Mahal of a book’, which should have come out three years ago.

I get too emotionally involved with my patients’ condition. At times it drains me, particularly when their pain doesn’t improve. Thank you so much dad for encouraging me to stay the way I’ve always been because, as you say, that’s what makes me unique. My mother has been my rock through thick and thin, and I can’t thank her enough.