COLUMBUS, OHIO — It's the midway point of the city's annual marathon, 13 miles to go, when I detect a slight tightening in my back.
I add the sensation to the list of twinges to monitor: possible blister on left middle toe, ache in left hamstring.
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A back-pain sufferer makes a run at getting a cure
THE NATION
Lower spine ailments are commonplace. One man skips surgery, opting for cortisone shots, therapy, exercise.
I liken this mid-run analysis to absentmindedly absorbing those quirky sounds the car makes and ranking them in order of concern. Click. Ping. Clank.
Something every adult American experiences at one time or another, back pain, is the clank. It's the pain you fear may never go away, the one that plagues you sleeping or awake, the problem that can stop you in your personal and professional tracks.
For me, the clank came four years ago, out of the blue and debilitating beyond belief. What I went through during the long and painful months that followed is on my mind now as I run past the appreciative crowds watching the marathon in downtown Columbus.
The day before Christmas 2002, I could barely take two steps.
Frequent disability
Studies show that eight in 10 people in the United States will suffer from lower back pain at one point in their lives.
Back pain is the leading cause of disability in people under age 45 and the third-leading cause in people older than that, after cancer and heart problems. It's the second most common reason after the sniffles to see a doctor.
Back injuries are the most frequent source of workers' compensation claims nationally, accounting for one of every five claims, according to the National Council on Compensation Insurance. The average cost of each claim is about $13,300.
Surgery for back pain is also on the rise, leading some doctors to question whether they're seeing an epidemic of back pain or an increase in back pain complaints and treatments.
Whether the spike in treatments is a result of an increased number of sufferers or more complaints, researchers agree that a more sedentary lifestyle combined with the country's obesity problem isn't helping people's backs.
Americans also are staying active longer, which puts new strains on old backs.
"A lot of people think about herniated disks and some sort of serious trauma," said Dr. Richard A. Deyo, a professor of medicine at the University of Washington. "The truth is, it's just the result of aging and wear and tear on the disks, and bad luck."
How it happens
My problems began on a ski trip to Upstate New York in February 2002. At the end of the day, my back was sore.
A month later, a stabbing back pain hit during a run, and soon it was difficult to stand straight.
My doctor prescribed pain pills and back-strengthening exercises and suggested an over-the-counter anti-inflammatory such as ibuprofen.
The pain slowly diminished. I did the exercises -- most of the time -- and started running again, though I rarely took any pills.
About to turn 41, I didn't do my back any favors.
I started mimicking the front flips I saw kids doing at the pool. I would swim into the shallow end to toss my 7-year-old twins in the air a few times -- "Air Daddy," we called it. I did my best to ignore the almost imperceptible twinge in my back each time I lifted them.
As I learned too late, this type of repetitive activity is one of the leading causes of back injuries. Among male workers, carpenters have the highest incidence of lower back pain; among the major occupations of women, it's nurse's aides -- people lifting patients all day.
"It's sort of like taking a paper clip and bending it over and over," said Dr. William S. Marras, executive director of Ohio State University's Institute for Ergonomics.
I stopped doing back exercises and my right leg started to hurt.
By October, I had stopped running and was having a hard time walking more than 100 yards without stopping to rest my aching leg. It was especially disheartening for someone who'd been running for more than 30 years.
My doctor, Columbus osteopath Tom Peponis, diagnosed the new problem quickly: a herniation in which the soft material inside the disk bulges and puts pressure on nerves running down the leg.
In technical terms, referring to the position of the spinal segments, I had an L5-S1 herniation. In other words, this was the vanilla ice cream of back injuries.
The engineering of that joint "makes it most susceptible to herniated disks," Peponis said. "It's the fulcrum that transports the weight of the upper body to the lower body."
Dr. Scott M. Otis, a Columbus-area specialist in back pain, laid out my options: rest and possibly some physical therapy; a round of injections with steroids; surgery.
Constant pain
It turns out that surgery for back injuries like mine is a hot topic. What's called a diskectomy -- or trimming the offending bulge to ease pressure on the nerves -- is the most common surgery in the United States for people with back and leg pain.
Yet two big government-funded studies published in the Journal of the American Medical Assn. last fall found that patients with herniated disks saw substantial improvement over two years whether or not they had surgery.
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