Overview

If your back pain has brought you to your knees, you are definitely not alone. In fact, you’re one of 77 million people in the United States who experience back pain each year. A quarter of us suffer chronically. The pain may be present day and night, or it may show up the minute you pull a suitcase out of the closet, or surface whenever the relatives come to stay.

The Fragile Column aims to put an end to the confusion and hopelessness that has plagued the back pain sufferer. I know what it’s like, because I contended with nearly three decades of muscle spasms, sciatica, and eventually nerve damage before navigating my way out of the labyrinth.

As you sit down to read this—or lie down, or curl up in the fetal position, if that is all your back pain will permit—I expect that you are as uncomfortable, irritable, and impatient as I was when I began my research for The Fragile Column. You’ve spent acres of money and time trying to resolve your problem, only to discover that you’ve turned up another dead end.

Strictly speaking, this is not your fault. As a patient, you are locked into a medical and cultural paradigm that dictates an unending parade of ineffective treatments. One procedure leads to the next until you abandon your status as a functional person with a back problem and become nothing more than fodder for the back pain industry’s hungry machinery. Without you and your aching back, thousands of specialists, all of them engaged in a turf battle for patients, would find their waiting rooms half-empty. Hospitals’ highly profitable spine surgery centers would no longer supply a reliable source of income. The pharmaceutical companies that make painkillers and the device manufacturers that build the widgets used in spine surgery would have their coffers drained. Back pain, as you are about to discover, is a big business.

In The Fragile Column, the public health crisis we call back pain is explained in the context of the $80 billion industry that created it. Before you finish reading the first chapter, you’ll understand that the pain in your back (or your butt, or your hip or leg) also exists in a political, psychological, and economic context that greatly influences how you’ll be treated—and if you’ll recover. You’ll understand what you’re being offered and why—and I’m certain your thinking will be rearranged for good.

My goal is to deliver timely, accurate information that shatters widely accepted but nevertheless incorrect assumptions about the need for surgery, the usefulness of injections, and the benefits of pharmaceutical pain management.

For the last three years, I’ve been traveling the globe, interviewing the foremost experts in specialties ranging from spine surgery to ergonomics to a little-known branch of musculoskeletal medicine called “physiatry.” (If you don’t know what a physiatrist does, you will.) I’ve spent hours with rehabilitation specialists, exercise physiologists, physical therapists, Feldenkrais Method and Alexander Technique teachers, and Rolfing Structural Integration practitioners; not to mention acupuncturists in Seoul, South Korea; neuroreflexotherapy experts in Spain; and Ayurvedic specialists in Coimbatore, in southern India. I’ve stood on hard linoleum floors in operating rooms all over the United States, observing every kind of spine procedure. I’ve spent hundreds of hours talking with patients who are in hot pursuit of their own solutions. Most important, I’ve investigated—firsthand and often dressed in gym clothes—the approaches that have reliably brought relief to a lot of people. Thus equipped, I’ll be your guide on this journey from despair to repair. Please join me.