Tiger’s pain tamed?

From Golf Week:

Tiger: Back pain no longer ‘debilitating’

“Recovering from March 31 microdiscectomy surgery that dealt with a pinched back nerve, Woods said he has been able to chip and putt but that there is no timetable on when he can make full swings.

Woods said he had trouble getting out of bed before the surgery and wondered, “Am I actually going to be able to do this (play golf at a high level) again.” But he said the procedure provided “immediate relief.”

Since, he said he has undergone “tedious” daily workouts, fought the urge to do too much with his two young children and passed time by playing video games for hours upon hours.

Woods said he will make adjustments to his workout routine once he fully recovers but added, “I still want to feel explosive, strong and mobile.”

I’m always in two minds when I read these stories about sports stars undergoing back surgery. Will it encourage people out there contemplating their choices to be swayed towards the surgeon’s scalpel? Will it be the final bit of evidence that a keen weekend golfer, experiencing a bit of back ache, uses to decide to give up the game- “well, look at what happened to Tiger, he needed surgery, if I keep playing golf with my back I’ll end up needing surgery too”. Will it further entrench the biomedical/biomechanical paradigm of back pain, already so prevalent in the community, with phrases like “pinched back nerve” (what is a “pinched back nerve” anyway..?)and Tiger’s reports of “immediate relief”.

The reality for many people is that back surgery is not the answer- reading about Tiger’s concerns and doubts about returning to golf (his job), brought to mind a fairly recent study looking at the return to work of injured workers after spinal surgery. Harris et al (2012) undertook a retrospective review of data on 476 injured workers in New South Wales who underwent spinal surgery (interview with the lead author here).

The numbers aren’t good- at two years follow-up about 10% had undergone further surgery and 77% were still receiving treatment, including taking opioids. In regards to return to work only half had returned to any form of employment and even fewer, 14%, had returned to their pre-injury work. When the patients who had undergone spinal fusion were looked at in isolation, the return to pre-injury employment rate was an abysmal 3%. The authors concluded with a very strong statement- “The findings do not support the use of lumbar spine fusion or disc replacement surgery as a method of achieving RTW and relief of pain in patients treated under workers’ compensation.”

Of course there are differences at play here between microdiscectomy and spinal fusion and between Tiger, an elite sports person, and a 15 year veteran store person in a warehouse with chronic low back pain. But it seems that these distinctions can get lost along the way, and the story, or the ‘meme’, that spreads is a simplification – “Tiger had back pain, Tiger had back surgery, Tiger got better. My back hurts, maybe I should have surgery”.

On the other hand, maybe Tiger’s story will provide some inspiration to those who have already undergone spinal surgery of some kind? I have often used the story of Michael Klim’s (Aussie superstar swimmer) comeback after back and multiple shoulder surgeries as a source of possible inspiration for people on the road back from injury.

Time will tell whether surgery will tame Tiger’s back pain and determine if this is a Tiger’s tale that we want to grab a hold of for the clinic.

-Tim Cocks

www.noigroup.com

Harris IA et al. Spine surgery outcomes in a workers’ compensation cohort. ANZ Journal of Surgery 2012, 82:625-629

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