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Prevent Back Surgery

Monday, August 13, 2007
Jolie Bookspan, M.Ed, PhD, FAWM
I received an invitation to take a course to learn a new back surgery for damage to the facets. Facets are the joints at the back of each vertebrae (spine bone). The surgery was advertised as a good revenue producer.

In the surgery, the facet joint is cut off and replaced by "lumbar position preservation hardware" rigidly attached so that the area can no longer bend or arch backward. At right is an X-ray of the lower spine with surgically implanted hardware. The person is standing sideways facing to the right. Surgical facet rigid fixation surgery is considered innovative because it replaces the more drastic spine fusion. It also replaces repeated injections into the painful area. The seminar would teach me the surgery with a cocktail reception following.

Why does the surgery want to prevent arching the lower spine? The facets are in the back of the vertebrae. Chronically letting your spine arch (too much inward curve) squashes the facets in back. According to work I've done over years in the lab, the overarching, called hyperlordosis (or slouching backward), is a chief factor in damage and pain to the facets and surrounding soft tissue. That means that you can stop this yourself without the surgery.

Notice if you allow overarching when carrying things in back (1. left) and in front (2. right). The pictured overarching is not the normal curve of the spine. It is too much:
  1. The left photo above is from the Fitness Fixer article Healthier Backpack Carrying to Get Better Exercise and Stop Back Pain. You do not need to allow the pack to pull your upper body backward.
  2. Right photo is from Healthier Carrying - Get Free Ab Exercise and Stop Pain. You do not need to lean back to offset weight carried. In both examples, the hip tilts forward in front, instead of holding vertically.

Two examples above show allowing the spine to arch too much when reaching overhead:
  1. Left photo is from Change Daily Reaching to Get Ab Exercise and Stop Back and Shoulder Pain.
  2. The drawing at right is from Back Pain in Pregnancy - and Why Men Can Get It. Imagine lifting your baby overhead (or any weight) and allowing your spine to pinch backward on the facet joints instead of standing upright and holding neutral spine.


Two examples above are from Aren't You Supposed To Stick Your Behind Out to Sit Down or Do Squats? (1. left) and Overlooked Ab Muscles in Overhead Lifts (2. right).

You can stop overarching, thereby preventing crushing force on the facets, and instead, distribute the weight through the core muscles. It is a simple positional adjustment that takes seconds (shown below). It is a healthier approach than surgery over both the short and long term.

Following rigid fixation surgery, you will no longer be able to stretch your lower spine as far backward, even when you want to stretch for range of motion and better disc health. You will still be able to slouch your body weight backward - onto the implants. They may eventually wear, along with adjacent bone, from the chronic crushing. Because the surgically fixed area can no longer overarch, increased forces occur on the joints above and below which have to bend more. If you thought the spine in the x-ray above still looked overly arched, not neutral, you are right. The areas above and below the implanted devices are over-arching backward, and the backside is tilting out in back (hip axis is tilted anteriorly). After years, those facets may be next to break down. It is no surprise "when the pain comes back." The cause of the pain was never removed.

Instead of allowing your spine to be pulled into damaging position, use your muscles to hold neutral spine. Here is one easy way to learn to feel it:
  1. Stand with your back against a wall. Touch heels, backside, shoulders, and head. Do you feel a large arch in the lower back making a large space?
  2. Put your hands on your hips. Thumbs in back. Fingers in front.
  3. Roll your hip so that thumbs roll down in back.
The large space between lower back and wall becomes a smaller space. Do not flatten against the wall or round your back. Just feel the strain come off the lower back. Use the new neutral for daily positioning. Simple. Check the photo at right (spine positioning is shown standing sideways, not with back to wall). Left is arching. Right is neutral. A small inward curve remains with neutral spine (right). Neutral spine does not mean rounding the back (which pressures the discs). Make the belt line level, not tilting down in front. The photo is from the post Using Abdominal Muscles is Not Tightening or Pressing Navel to Spine. Click for additional ideas.

The muscles used to maintain neutral spine are your abdominal and core muscles. It is not strengthening ab muscles that stops pain or teaches you neutral spine. It is using them to prevent damaging spine position. You get built-in core muscle exercise through the same repositioning technique that allows you to avoid back surgery.


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Read and contribute your own success stories of these methods. Before asking questions, see if your answers are already here - click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. Subscribe to The Fitness Fixer, free. Click "updates via e-mail" (under trumpet) upper right.
For answers to personal medical questions - Replies to Medical Questions. Limited Class spaces for personal evaluation. Top students may apply to certify through DrBookspan.com/Academy. See Dr. Bookspan's Books.
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Xray by ryortho.
Photo credits for three arching composites appear in the original posts
Drawing of Backman!™ of hyperlordosis when lifting overhead and last photo of tilting to neutral spine copyright © by Dr. Bookspan from the book The Ab Revolution

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