Discussion on 'Crooked' by Cathryn Jakobson Ramin
‘Standing on the shoulders of giants’
- Bernard of Chartres
Ergonomic considerations aside (or perhaps let's assume that the giants have undergone thorough training and risk assessment) - this 12th century metaphor describes exactly what is hoped for this blog. Here we’ll aim to share and discuss some of the valuable work we have read up on from the world of manual handling.
For this short post I wanted to discuss a book named ‘Crooked: Outwitting the Back Pain Industry and Getting on the Road to Recovery’ by Cathryn Jakobson Ramin. In it the author documents her experiences with chronic back pain, and explores the nature and evidence for almost every approach to treating it.
Pointing out the scale of the problem (by her estimates $100 billion per year spent on spine medical treatments in the US alone) she balks at most of the touted remedies. Old school Chiropractic techniques can make things worse (such as a risk of stroke in high velocity ‘neck cracking’), benefits of epidural steroid injection are not sustained over time and evidence is scant for the efficacy of back surgery in alleviating most back pain. En masse long term pain relief is also considered - and decried. Since the book's publication in 2017 the ramifications of widespread prescription Opioids are still unfolding, with an addiction epidemic and a measured decrease in average life expectancy in the United States posited as a result.
So what does work, according to Ramin? She spends the entire second half of the book exploring this and boils it down to a few approaches she believes carry the weight of evidence. Monitoring mental health and attitudes around back pain may be key (if challenging). Many back pain victims are warned of ‘permanent damage’ and so have very guarded behaviour around their movement - this can have the adverse effect of causing tension and increasing pain. This tension can be exacerbated in people prone to anxiety. Other interesting approaches are discussed - from the specific (MedX machine) to the general (building good posture habits).
Physical rehabilitation and strengthening of the body (done with a high quality practitioner) are given a special focus as a treatment - and are explored the best preventative to avoiding back pain in the first place. This is in line with the output of many physiotherapists who recommend strengthening (such as writing by Fiona Wilson of Trinity College Dublin). The author documents her time spent working out under the supervision of qualified trainers (such as Stuart McGill and his disciples).
In summary ‘Crooked’ is a useful primer to a complex health issue and the resulting ecosystem humanity has built around its treatment. Interestingly Ramin’s profession (a journalist) is not one typically associated with regular workplace manual handling. Although not unusual in any profession lifting at work is considered an important risk factor for back pain.
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