Brian Mandelker had experienced low back pain before. “Mostly standing around coaching kids’ baseball and hockey teams,” says the 64-year-old entrepreneur from Thornhill, Ont. But nothing like the constant, searing pressure that hit him in the autumn of 2017.
“I couldn’t sit through dinner, I couldn’t sit at my desk to do my work,” recalls Mandelker, who was unable to put in the usual long hours at his family business, AFL Display Group, which designs and manufactures store fixtures and displays. “I was miserable.”
He’d dealt with flare-ups in the past with massage, or anti-inflammatory medications prescribed by his family doctor, but this time nothing like that helped. A physiotherapist’s treatments and exercises seemed to work, “but then the pain came back with a vengeance,” and this time it was also shooting down his legs. An MRI he had after a frustrating five-month wait showed he has spinal stenosis, a narrowing of the spaces within the spine that puts pressure on the nerves travelling through it. A subsequent appointment with a spinal surgeon, which Mandelker says “also took forever to get,” was over in less than five minutes. “He said surgery was not going to do me any good.”
Meanwhile, Mandelker was referred by his family doctor to a Toronto-based chiropractor, Dr. Joel Weisberg, who started him on a “boot camp” regimen for lumbar spinal stenosis. It included cycling on an upright stationary bike to get blood flowing to the area alongside stretching and strengthening exercises. There were also two sessions a week in which Dr. Weisberg gave him manual therapy, with deep stretches and adjustments.
When he “graduated” after six weeks, “I felt like I was a new guy…It was night and day,” says Mandelker, who continues the daily cycling and stretching routine. “It’s something I need to do for the rest of my life.”
That’s a conclusion many patients and health care practitioners are coming to, with the rising incidence and cost of chronic musculoskeletal (MSK) disorders such as back pain, neck disorders and arthritis.
“Low back pain is a human condition that is not curable, but it is manageable,” says Toronto chiropractor Dr. Andrew Bidos, program manager of the Inter-professional Spine Assessment and Education Clinics (ISAEC) program. Developed at the University Health Network in Toronto and now being rolled out across Ontario, ISAEC is overhauling the way our health system deals with low back pain. In its “team approach,” chiropractors and physiotherapists with advanced training rapidly develop personalized plans for people to better manage their back problems.
“The key is to have the right level of care from the right provider at the right time,” says Dr. Bidos, noting that such cases have traditionally been “siloed,” with primary-care physicians referring patients with back pain to get MRIs and see specialists, often unnecessarily. Long wait times mean their pain and anxiety can become unbearable, affecting quality of life and burdening the health care system.
Low back pain is a leading cause of disability worldwide, according to the World Health Organization, and a 2014 study shows that one-third of all lost time from work is related to it. In 2015, researchers at Hamilton General Hospital found that almost 65 per cent of patients receiving long-term opioid therapy for non-cancer pain had chronic low back pain.
Back pain is one of the most common reasons that patients see doctors, says Dr. Bidos, with enormous costs in terms of medical care and lost productivity. “They bounce around from specialist to specialist,” he says, “who often can’t do anything for them.”
Dr. Brian Drew, an orthopaedic spine surgeon at Hamilton General Hospital, says chronic back pain can vary. Some people “can still work, play sports, maybe take a Tylenol or use an ice pack and go on with their life,” while others find it quite debilitating. “They have to be managed in a variety of ways,” he says. “You need a multidisciplinary approach.”
Some chronic conditions may call for a surgical fix, but “surgery is always the last resort” and it doesn’t always work, cautions Dr. Drew. He notes that some chronic pain sufferers can also end up having symptoms of depression or become withdrawn, but that there are often solutions to help them overcome these issues. “Of course, that patient does need to take meaningful steps to try to fix it.”
Mandelker has done just that. Indeed, he’s semi-retired and structures his lifestyle around his low-back exercise routine each morning. “I’ve made it a priority that nothing gets in the way of, or I know the pain will come back.”
If it does, he intends to return to Dr. Weisberg for further chiropractic treatment and guidance. “Knowing that I’ve got somebody I can relate to who can come up with a solution that can make me feel better if I have trouble is comforting,” Mandelker adds. “He’s got my back.”
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