Marc Darrow MD,JD

There is countless research surrounding low back pain and the golfer. Many studies suggest many causes and theories as to what can be causing low back pain. In this article I want to draw attention to research that suggests more rare or lesser known causes of your golfer’s low back pain. Spinal ligaments.

Is it always the golf swing? Higher average club head speed and low back pain

The most researched and the most discussed cause of low back pain is usually the golf swing. A 2020 study came out of the University of Chicago (1) which hypothesized that professional golfers who achieved a higher average club head speed had more lower back injuries. The theory was tested on male professional golfers who suffered lower back injuries while playing golf. The injured group was composed of 14 Professional Golfers’ Association (PGA) golfers who withdrew from a PGA tour event due to a back injury during the years 2017-2019.

What the researchers found what that age, height, weight or Body Mass Index did not play significant factors in causing low back pain alone. The injured group had a higher mean club head speed than a control group of golfers who had no lower back pain. This study concluded then that: “average club head speed was significantly higher in PGA golfers who suffered back injuries while golfing.” It was the swing.

But what would cause it to be the swing? In some people, the energy needed to strike the ball at a high head speed would come not only from core muscles but core ligaments. Ligaments are often an overlooked factor for pain during a golf swing.

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Marc Darrow MD,JD

I am an avid golfer. People who are my patients understand my great passion for this game. Many of these people are my patients because of a back pain problem that is impacting their ability to play golf. In April 2019, Tiger Woods, arguably the greatest golfer of all time, won the Pro Golfers Tour (PGA) Master tournament after years of physical decline and back surgeries. Woods’ victory was considered remarkable and miraculous because of the numerous failed back back surgeries he had. For Woods, it was the fourth surgery that was the “charm.”

Some of our patients have asked us about the spinal fusion surgery (the 4th surgery) that Tiger Woods had 4 years ago in 2017, this was the “successful” surgery. They want to know if this surgery may be right for them? We tell our patients the reality is very likely not. How come? I will let the spinal surgeons and back pain researchers discuss this with you now in this article.

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Marc Darrow MD,JD

When someone contacts our office and they tell us that they have been diagnosed with Post Laminectomy Syndrome we have to get information from them that will allow us to make a realistic assessment if they are someone that stem cell therapy can help. We can help some people with Post Laminectomy Syndrome, we may not be able to help others. How do we know who we may be able to help? We talk to people on the phone, we discuss their pain and symptoms and what happened after the surgery. If we think we can help someone, we tell them to come in for a consultation.  If we do not think we can help, we don’t.

I want to turn this article over to the surgeons so they can explain how a patient may develop Post Laminectomy Syndrome. This first study was published in the medical publication Biomed Central research notes.(1)

Although not well known, post-laminectomy syndrome is an important cause of chronic back pain, which may lead to decreased quality of life, disability and psychological disorders. The prevalence of post-laminectomy pain was 60 % (in this study group). Most of the patients assessed in this study were male. . .  their mean age was 45 years. All of the patients presented with chronic, intense pain that had lasted an average of 7.22 years. None of the patients exhibited high levels of physical fitness.

Lumbar laminectomy is one of the surgical procedures used to treat intervertebral disc protrusions (a bulging or herniated disc). It consists of removing the vertebral lamina to expose and allow access to the disc that is responsible for the nerve root compression. Although the vast majority of lumbar sciatic pain is mechanical in nature, the surgical procedure is required in only 1–3 % of cases.

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Marc Darrow MD,JD

There is a difference between a “true” sciatica and the phenomena of “pseudo sciatica,” or “fake sciatica.” If you have been diagnosed with sciatica you may have been one of the people where it took some time and a lot of tests and examinations to confirm that in fact you had sciatica or you did not have sciatica but you had sciatica like symptoms. Even then there may be still be some doubt about your diagnosis.

This article will discuss possible treatments for sciatica-like symptoms. If you do not have back pain, but you do have numbness, burning pain, weakness or other neurologic type symptoms that radiates into your legs and feet, treatments such as Platelet Rich Plasma Therapy and Stem Cell Therapy will likely not be effective for you. What this article will focus on is if you have a true sciatica or a pseudo sciatica. In the case of pseudo sciatica, Platelet Rich Plasma Therapy and Stem Cell Therapy may be able to help this condition.
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Marc Darrow MD,JD

Patients will often come into our office with an MRI, low back pain and a diagnosis of sacroiliac joint dysfunction. They are in our office because they may have been told that they should consider a surgical recommendation to spinal fusion. For many of these people, the MRI was the confirmation that their surgeon needed to go ahead with the surgical recommendation. For many patients, this may have been the same doctor who had taken them through a course of conservative treatments. These treatments may have included long bouts with anti-inflammatory medications, back braces, physical therapy, and cortisone injections.

All of these treatments did not help them. Why? A recent study in the Clinical Spine Journal (1) offers the suggestion that sacroiliac joint dysfunction patients do not get treatment relief because they do not have sacroiliac joint dysfunction. This may be somewhat difficult for you to believe because all along you have been told you have SI joint pain.

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Marc Darrow MD,JD

Systemic and local side-effects of corticosteroid injections including joint destruction

A patient will often come into our office with conflicting ideas about cortisone injections. The patient will tell us that his/her other doctors told them that cortisone injections are safe, effective, and will help their pain, if used sparingly. But, intuitively, the patient had doubts and concerns.

But as this patient continued to wait for a surgery, decisions had to be made as to how much pain management would be needed to “hold them over,” until the surgical date.

Corticosteroids are powerful anti-inflammatory substances. They are not used to relieve pain, but rather, to reduce inflammation, which in turn can lessen a patient’s level of discomfort. Numerous studies over the years have shown that prolonged use of cortisone will eventually cause degenerative joint disease in the joints they are injected into.

Understanding the possible complications of corticosteroid injections

Here are some of the most recent papers reminding doctors about the possible side effects of corticosteroids:

A January 2021 (1) study issued this statement:

“The current evidence would suggest that the use of corticosteroids provides moderate short-term benefit for reducing pain and improving functioning. These benefits generally last several weeks without long-term effectiveness. In addition to its limited short-term effectiveness, there are multiple potential adverse effects including toxicity to articular cartilage and numerous systemic side effects such as increases in blood glucose levels, a reduction in immune function, and an increased risk of infections.”

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Marc Darrow MD,JD

Many people email us about their hip and back pain. Some have been recommended to a hip replacement, some have been recommended to a spinal surgery. Some have been recommended to both surgeries and they are in the process of choosing between one or the other and exploring options to help them avoid one or the other surgery, even both. Some at this point are not even deciding which to get first, they may simply take the first one that is available.

The question that comes in to us is about stem cell therapy as an option and “which would you treat first? My hip or my back?” The benefit of stem cell therapy is that in the same visit, if you are a good candidate for treatment, we can treat both of your pain challenges at the same time. In this scenario, both areas can begin a simultaneous healing process. You do not have to wait for you hip to heal to start spinal treatments, you do not have to wait for your back to heal to start hip treatments. Below I will discuss the science behind these treatments.

Research: The question of which to have surgery on first, the hip or the spine, is much more complex and risky than thought

The option to have lumbar spinal surgery and hip replacement at the same time is clearly one that is not recommended for obvious reasons. So a decision has to be made. Spinal surgery or hip replacement surgery? One has to come first and one has to wait.

At Washington University School of Medicine, Departments of Orthopaedic Surgery and Neurology and Physical Therapy, surgeons and therapists wanted to examine patients who had hip osteoarthritis and back pain. The hip-spine complex can be a tricky and complex area to diagnose. Finding the true source or sources generating a patient’s pain can be equally complex. This makes the first surgery decision even more difficult.
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Marc Darrow MD,JD

We receive many emails from patients who have undergone numerous spinal procedures. These people are in continued pain and are looking for help. Because of the complexities of spinal surgery, especially in patients with numerous procedures, this question must be answered following a physical examination and consultation where realistic healing options can be discussed.

When a person contacts our office looking for options to a second or even third spinal procedure we do want to help them because research has made it clear the more surgeries, the worse off the patient is.Let’s explore the research in support of that statement.

The more surgeries the worse off the patient

Some people will get benefit eventually from surgery. Some will not. Doctors, including those from the University of Bern in Switzerland published their research findings (1) on patients who had to undergo multiple spinal surgeries. When they examined patients 12 months after their last surgery they found that the more surgeries a patient had, the less likely they would have clinical success.

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Marc Darrow MD,JD

In our practice we often see patients who are in severe back pain. These people have an MRI, X-ray and/or scan that may show an inaccurate picture of what is causing their pain. What do I mean by inaccurate picture?

• The MRI cannot show muscle spasms from a simple back strain which can cause excruciating pain.
• Conversely, the MRI can show a large herniated disc which may be completely asymptomatic.

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Marc Darrow MD,JD

Epidural steroid injections do not heal a bad back. Some researchers consider epidural steroid injections to be, at best, a very short-term painkiller that sometimes prevents a patient from getting the proper treatment for his/her back pain.

The one thing that surgeons and regenerative medicine specialists agree on is the question being raised in the medical literature asking whether patients have been informed of the poor likelihood of long-term epidural injection treatments success for disability. The same question is also being raised about spinal surgery.

In the research below from some of the leading medical universities in the world, we see that the goal of epidurals and surgery is to provide pain relief. Unfortunately improving disability and function may not be an attainable goal with these treatments.
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