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CHAPTER 1
THE BRAIN AND THE SPINE
FIX IT EVEN IF IT AIN’T BROKE
PICTURE YOURSELF as a fifty-year-old man who recently had a minor heart attack. What would you do? How would you live?
I’ll bet that you would feel frightened and vulnerable. You would be motivated by that fear to follow your doctor’s advice. You might also pray that the medications that reduce inflammation, blood pressure, and cholesterol would protect your heart. You would likely modify your diet and exercise habits (at least temporarily).
Sadly, you would likely accept that you’ve been cursed with a “bad” heart and hope that today’s high-tech medical system could come to your rescue and keep you ticking.
Alternatively, how many of you, after that minor heart attack, would methodically train for, and begin running, marathons? How many of you would radically change the way you eat and, say, become a vegan? How many of you would reduce your body weight down to your weight at age eighteen? How many of you would not accept that you’ve been cursed with a “bad” heart, but rather set out to change your heart? How many of you think that you could actually change the size and flow of your coronary arteries?
You can. You can also change your back—for the better.
THE “ANTIFRAGILE” BACK
This book is about changing your back.
Before your back can be changed, however, your mind must be changed. The very activities that you imagine will make your back hurt can make your back stronger—and fundamentally different.
The transformation of both your back and your mind can be accomplished by leveraging the almost magical synergy that exists between the brain and the body.
That transformation also takes advantage of our (and many other creatures’) innate capacity to change in response to stress or any other factor that disrupts our equilibrium. As an example of that capacity, when groups of rats are placed in two different environments, the brains of those in the more varied and challenging environment flourish more.1
Conventional wisdom views stress (and resulting inflammation) as the foundation of disease and aging. Rather than viewing stress as eroding or weakening, however, we can and should welcome it as a source of growth and health. Stress has a “sweet spot,” however. Too much, and we will be weakened; too little, and we will fail to grow and attain health. Stress also needs to be coupled with adequate “recovery” periods to allow the body to adapt and flourish as a result of that stress.
In his recent book Antifragile: Things That Gain from Disorder, Nassim Taleb defines the concept of antifragility as a state that not only resists, but also thrives on, uncertainty and stressors.2 This is a perfect description for our backs—not fragile, but antifragile!
The first paradox or “hidden truth” I’ll share with you involves the title of this book, The End of Back Pain. This book is actually not about the end of back pain. You will learn that back pain cannot be “ended.”
Hidden Truth 1: The End of Back Pain Is Not the End of Back Pain!
The book will, rather, switch your focus to mitigating the back pain that will invariably rear its head. Even though back pain has no end, you will learn how to significantly reduce pain’s frequency, duration, and intensity during the inevitable flare-ups.
Roth’s Rx: Back pain is part of life. You need to learn how to maximize function and reduce pain by strengthening your back.
Focus on Philosophy
The Nietzsche Principle
For many of you, this prescription will not be instinctive, but it’s perhaps the most powerful of all the tools that I’ll offer: Be confident in your body’s remarkable ability to adapt. I call this the Nietzsche principle, named for philosopher Friedrich Nietzsche’s famous utterance, “That which does not kill you makes you stronger.”3 The Nietzsche principle will be referred to throughout this book. It presents a double-edged sword that is difficult to handle: When you push yourself, you open up both the possibility of improvement and the simultaneous possibility of setback. I believe that there are times when improvement is not possible without taking this risk.
The Nietzsche principle forms the basis of my Hidden Core Workout. In other words, I will teach you how to strengthen your back—even while in pain—in order to ultimately control your pain. This is in contrast to resting your back—while in pain—in order to protect it. Working through pain isn’t like banging your head against the wall with a total disregard for the pain; rather, it’s a willingness to feel some pain while you slowly progress with exercise.
THE BRAIN-BODY CONNECTION
Mens sana in corpore sano is Latin for “A healthy mind in a healthy body.” For the purposes of this book we should perhaps modify this to Mens sana in spina sana, or “A healthy mind in a healthy spine.”
The brain and the spine are intertwined—not only developmentally, but functionally. One of the themes of this book is that we can leverage this relationship by applying a biological “bait-and-switch.” If we rewire the brain with regard to the spine, for instance, the spine will follow suit and change. Likewise, by equipping the spine with strength, posture, and technique through exercise, we can effectively rewire the brain.
CHANGE YOUR BRAIN, CHANGE YOUR BACK AND SPINE
The brain has a crucial role in enabling health. Education has consistently been shown to be an independent enabler of health. In fact, the human brain’s capacity to learn and become educated may be its most important link to health. One of the obstacles we encounter with education, however, is that some of the things we learn from our culture are outdated or even counterproductive to our health.
The term memes, coined by evolutionary biologist Richard Dawkins, refers to culturally relevant ideas or behaviors that are passed on from generation to generation.4 Our brain development is profoundly affected by these cultural abstractions. As our collective view of the world becomes more sophisticated, so do the memes that are passed on to the next generation. This, in turn, allows for more sophisticated brain development in that next generation. Surprisingly, memes play an important role in pain. You will later learn that pain is significantly influenced by culturally derived expectations. In other words, your brain is developed, in part, by the culture in which it matures, and that development influences the actual pain that you feel years later when your back hurts.
Core Question
Can the Brain Be “Rewired” to Eliminate Pain?
There is evidence that it can. One interesting experiment, which involved patients with severe arm pain on one side, had each patient place both arms into a mirrored contraption that made the patient think that the “good” arm was the “bad” arm. When the good arm was put through range of motion, it looked to the patient as if it was the bad arm being manipulated. Since there was no pain with the range of motion (it was actually the good arm, remember), the patient was “tricked” into thinking that the bad arm was moving without pain. After several weeks of this therapy, the bad arm was no longer painful with movement.5 This suggests that the “pain” arose in the brain and that the brain could be “rewired.”
The reason I present many of the ideas in this book as “hidden truths” is to disabuse you of many of these cultural assumptions. As you shed faulty assumptions, your education can better serve to enhance, rather than diminish, your health.
In addition to education, the brain can promote health via three related essential attributes: self-efficacy (one’s ability to maintain health), a willingness to take responsibility or action, and a fascinating mind-body phenomenon called embodied cognition. Let’s take a look at each of those attributes in turn.
SELF-EFFICACY
Labeled by Albert Bandura, a psychologist and professor at Stanford University, self-efficacy is the capability and confidence to effect change or bring about positive results. In the promotion of your health—especially when dealing with back pain—self-efficacy is essential.6
How do you nurture self-efficacy? In his book Next Medicine, Walter Bortz, a physician who is a wellness and longevity expert, describes four key ingredients of self-efficacy:7
1. Small steps: This ingredient is emphasized in the Hidden Core Workout, where patience and slow, steady progress are paramount. In fact, I’ve designed the program in four stages so that you can target specific muscles at the right times for your strength level.
2. Peer examples/role models: This involves seeking others around you who have overcome pain and allowing the wisdom of their experience to guide you.
3. Social persuasion: This refers to learning the science and philosophy that pertain to your pain and becoming an active participant in the decision-making process. Just by reading this book, you’re already one-quarter of your way to self-efficacy.
4. Diminished cues of failure: If your back hurts when you run, don’t stop running. Instead, find a way to run without pain.
TAKING RESPONSIBILITY AND ACTION
Many a false step was made by standing still.
—ANONYMOUS
The brain can profoundly influence health by assuming responsibility for the promotion of health. Resolution of pain is best achieved by the individual’s gaining a state of independence—independence from doctors, therapists, medications, and cultural dogmas. This state requires the brain to take action—to become an active participant by learning about the cause of the pain, when possible, and analyzing and evaluating each therapy as it’s proposed and utilized.
Hidden Truth 2: Healthcare Is Not Health Care but Disease Care!
Our healthcare system spends too much time and money on treating disease. We have made fantastic progress in various disease states, such as certain infectious diseases and cancers. The time has come, however, to prioritize the promotion of health over the eradication of disease.
As a surgeon, I’ve been trained to understand and treat pain from a mechanical standpoint. My job is not only to interpret the relevance of a pathologic disc herniation (for example) with regard to a specific pain, but also to decide if the pain has a structural or mechanical cause. In order to root out mechanical malfunctions, I’ve dedicated my career to utilizing a patient’s entire history—as conveyed by the patient, the physical exam, and the MRI—to determine the cause(s) of pain. No doubt I’ve had many successes, as there are many patients with clear structural or mechanical causes for their pain. On the other hand, I’ve taken credit for many successes that could more accurately be attributed to the human body’s capacity to heal itself.
Voltaire once said, “The art of medicine consists in amusing the patient while nature cures the disease.” Obviously, as a surgeon, I don’t fully subscribe to such an impotent philosophy, but I do believe strongly in the power of nature and thus in the power of each patient.
Roth’s Rx: Every back pain sufferer can become an active participant in facilitating the body’s natural healing and shielding ability and mitigate back pain for good. To do so, put your energy into changing your body and not into seeking either a specific cause or a quick solution.
Focus on Philosophy
The Kierkegaard Principle
You need to start your back pain treatment even before you can be sure that you’re starting in the correct place. If you’re provided choices, you will likely start with the more conservative treatment option. That’s fine. What is essential is that you start somewhere. Once started, pay close attention to how you feel and the progress you make, and you can then modify and adapt your treatment plan accordingly.
This need to commit is often thwarted...
