Overloading the spine

It’s a good idea to change one’s lifestyle

People often ask me what is causing their backache. Often I can’t answer that question. Contrary to, say, bone fractures, backaches don’t just happen; rather, they develop over the course of years. However, with some patients, the question is easily answered. Just imagine that your spine is holding up the greater part of your body, much like a hat stand has to hold a certain number of coats. If you look at it that way, you’ll understand that the condition of the rest of your body matters a great deal to your back.

If your body is light and the muscle tissue surrounding the spine is in good condition, your spine is not being overloaded. Your muscles will help keep up your body. But if your muscles are untrained and weak and if there are a lot of very heavy coats hanging from your hat stand, your spine will have a hard time bearing the load. Excess weight places a heavy burden on all joints in the body, including the many joints that make up the spine. After all, the spine is basically just a stack of vertebrae that are held together at the back by small joints.

Some people think I’m too strict, but I regularly advise patients who are obese (BMI >32) to change their lifestyle before I will operate on them. Many patients find this a hard pill to swallow. On the other hand, doctors sometimes have to be the big stick the patient has needed for years.

A practical example

For instance, a while ago I was consulted by a patient who weighed about 150 kg. He suffered unbearable backache and wanted to go under the knife as soon as possible. Of course, I could have performed surgery on him the very next week, without giving much thought to his chances of recovery after the procedure. However, I feel that a good doctor must take an interest in the patient’s overall health. I’d be a superficial doctor, and I wouldn’t really enjoy my work, if I didn’t try to really improve my patients’ health, as opposed to simply curing them of this one problem.

As diplomatically as possible, I tried to explain to this patient that his lifestyle was greatly affecting the condition of his back. Thankfully, he realised at once that I meant well, so he patiently listened to the advice I was giving him with regard to nutrition and exercise. In the months following our first meeting at the outpatient clinic, he courageously took my advice and persevered with it. The next time I saw him, he was a different person. He’d had a hard time, but he was fit, incredibly proud of himself and he’d lost several dozens of kilos. In addition, his backache had become much less severe, exactly as I’d hoped all along. I didn’t even have to perform surgery on him any more.

There’s irony for you – sometimes we surgeons are the most satisfied with the operations we did not have to perform. Mutual respect, mutual listening and taking responsibility for a proper solution together – these are the things that can make a doctor-patient relationship truly special.

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