That Aching Back!
Doctors take a new look at mankind's oldest, most stubborn agony
On a sunny day in Africa 10 million years ago, give or take a few million, Mr. and Mrs. Ramapithecus and their children were out foraging for food. Like their primate cousins in the forest, they usually swung gracefully from limb to limb searching out nuts, fruits and berries. But this day was different. A fierce rainstorm had knocked all their favorites off the branches, and the Ramas, alas, were forced to descend from the trees to find something to eat.
Moving awkwardly on all fours, knuckles bent, they were ungainly creatures on the ground and also extremely vulnerable. Barely 3 ft. high, unable to see over the tall grass, Rama suddenly found himself and his brood confronted by a snarling saber-toothed tiger. What to do?
The forest was too far off for a dash to safety. So, in an inspired gesture, Ramapithecus reached for a rock with both forefeet, reared back on his hind legs and heaved the stone at the predator. Startled to see this usually four-footed prey erect, the tiger cautiously retreated. But the ape-man's triumph was costly. Unaccustomed to the abrupt, upright position, he was left doubled over in agony with a piercing pain in his lower back.
A anthropological fable? Perhaps.
But there is little doubt that, when man's ancestors first learned to stand on hind legs, they exposed themselves to aches in the back that have been plaguing their descendants ever since. Today Ramapithecus' spinal distress is experienced millions of times a day around the world. Indeed, after headaches, pain in the back--usually the lower --is man's most common and intractable physical complaint. It is also the object of intensive investigation by doctors into new ways of curing this most ancient of ailments.
At one point or another in their lives, eight of every ten people on earth will suffer from this universal affliction. In the U.S. alone, as many as 75 million Americans have back problems, and there are 7 million new victims each year. Of these, 5 million are partly disabled, and 2 million are unable to work at all.
Backaches can strike almost everyone, the young and the old, males and females, people of all classes and professions. Thomas Jefferson suffered an acute case of backache when he rashly took it upon himself to show his slaves how to use a plow. Ernest Hemingway, who had a nagging back problem, chose to write standing up. To ease the pain of a wartime injury, John Kennedy spent hours in the soothing comfort of a White House rocking chair.
More recent victims of back trouble have included Cyrus Vance, Edmund Muskie, Elizabeth Taylor, Joan Sutherland and Barbra Streisand. Sports figures suffer from back pain too. Golfer Lee Trevino and former New York Yankee Infielder Tony Kubek have been strick en. Earlier this year Hockey Center Stan Mikita of the Chicago Black Hawks was permanently sidelined by his aching back.
No one except a victim can truly understand the complete sense of helpless ness and despair that overcomes a once vigorous adult who is suddenly struck down by this devastating, if usually tem porary, ailment. The victim's world quickly shrinks, often limited at the onset to bed or couch. Work and household chores are almost totally ignored, and every movement is fraught with peril. Dressing becomes torturous; a visit to the toilet is a major expedition. Sitting in a chair to eat or read can be agony. Sex becomes virtually impossible. Even after the pain sub sides, the sufferer wonders at almost every turn whether it will strike again.
Beyond the personal grief, back pain exacts a staggering social cost. In the U.S., 93 million workdays are lost each year be cause of back problems. In Sweden, where sick-pay benefits are liberal, backaches are the single largest cause of worker absenteeism. Americans, in their often fu tile quest for relief, now spend $5 billion a year for tests and treatment by a dizzying array of back specialists, including orthopedists, osteopaths, physical therapists and chiropractors, to say nothing of self-styled gurus who promote every man ner of cure. Billions more are paid out in disability claims, lawsuit awards and other settlements resulting from back injuries.
Why do backs ache? In part, it is the price that humans pay for insisting on standing erect.
Jays Orthopedist Hugo Keim of Manhattan's Columbia-Presbyterian Medical Center: "If you believe in evolution as I do, then you can trace all of our lower back problems to the time when the first hominid stood erect. If you're a creationist, you can look at it this way:
when Eve offered Adam the apple, he stood up to accept it."
But there is also a distinctly contem porary aspect to back trouble. As people grow more and more sedentary in an increasingly automated world -- doing most work sitting down, adding extra pounds of girth -- their backs become ever more vulnerable to injury. Ex plains Dr. Kenneth Casey, a pain specialist at the University of Michigan: "Low-back pain is largely a social problem. It's as much due to the way we live as anything else."
Almost anything can make the back go awry: sudden stops in vehicles, exertions in athletic competition, wearing high heels, bending over an ironing board.
Even routine activities like brushing teeth or reflex actions like sneezing and coughing can knock the back out of whack. The horror stories abound. In Alexandria, Va., Anne Moffett, 37, a mother of three, found herself stricken while bending over to make a bed: "Minutes passed, but I was too terrified to straighten up, even to withdraw my hands from the covers. Finally my mother came and coaxed me, inch by painful inch, into the bed."
In Columbus, two winters ago, Furniture Executive Ernest Stern, 57, had helped his employees lift a cabinet. Then he pushed a stalled car in front of his house and shoveled snow from his driveway. These exertions made his back feel somewhat stiff, but he decided to keep a tennis date anyway. That was a mistake. After the first serve, Stern's back gave way, and he had to be helped off the court.
In San Francisco, Barbara Gordan, 41, a housewife, was similarly immobilized: after wrenching her back while storing books in her attic, she lay there undiscovered for eight frustrating hours.
Despite its occasional failures at inopportune moments, the back is a marvel of biological engineering. It is not only the body's principal scaffolding, on which the skull, ribs, pelvis and shoulder bones are all anchored. It also serves as the major conduit for the bundles of nerves--the spinal cord--that link the brain with other parts of the body. When doctors speak of the back, they usually mean the spinal column. Sweeping from the base of the skull to the pelvis in a graceful yet extremely strong doubleS shape, this natural architectural masterpiece consists of 33 building blocks, called vertebrae. So artfully are they sculpted that they fit neatly into one another. An intricate system of muscles, tendons and ligaments keeps the column from collapsing. The lower portion of the spine, known as the lumbosacral region, is the site of the pain that bothers most people. It can withstand pressures of hundreds of pounds. Yet the entire column is so flexible that it can be bent to form two-thirds of a circle.
Gymnasts and dancers can make the move look natural, as it is.
Though the back is thus elastic, its parts are in delicate balance; any damage in one area can disrupt the whole complex machinery. Sometimes the trouble starts in youth. If one leg, for instance, grows significantly longer (more than half an inch) than the other--a not infrequent occurrence --it puts unequal pressures on the spine. If certain of the vertebrae have failed to form properly, the result may be a pronounced sideways curve called scoliosis, a condition that causes disability and pain. Tumors can grow in the confined regions of the spinal column, pressing or pinching nerves. In cases of rheumatoid arthritis, the cushioning discs that act as shock absorbers between the vertebrae prematurely degenerate, losing their sponginess and eventually disappearing.
Indeed, the possible causes of back pain are so numerous that pinpointing them may pose an almost Holmesian diagnostic challenge. Says Orthopedist Edwin Guise of Henry Ford Hospital, physician for the Detroit Lions: "You have to think of everything from poor posture to cancer."
As varied as the back's problems may be, up to 80% of those who complain of lower-back pain are victims of one of three syndromes. The most common of these involves nothing more than overworked muscles. Normally, as the body moves, its muscles contract and relax in quick succession. But if they are strained beyond their limit, they rebel. An overtaxed muscle suddenly goes into a sustained contraction, or spasm. It becomes a hard, knotty mass. The tiny blood vessels that bring it oxygen and nourishment and carry off wastes constrict. Soon some of the cells in the stricken muscle die, and the body sends out a distress signal in the form of a sharp pain.
Excruciating as it may be, the pain is nothing compared with what usually accompanies the second major source of back pain: what is commonly, and incorrectly, called a "slipped" disc. In fact, the disc has not slipped. Rather it has herniated, or ruptured. Its gelatinous central region bulges out, sometimes even breaking through its surrounding wall of ligaments. The discs most likely to rupture are the one separating the two lowest lumbar vertebrae and the one separating the last lumbar from the sacrum, the next lowest region of the spine. The dislocated material often pushes against the spinal nerves, which are extremely sensitive to any pressure. The slightest movement, even a laugh, can trigger an excruciating wave of pain.
In the 1970s, some doctors became convinced that there is another source of backaches that rivals herniated discs as a cause of grief. It is called the facet-joint syndrome. Facets are small flat surfaces on the vertebral arch (the knobby outer structure of the arch can be felt by touching the back). In the normal, healthy back, the facets of one vertebra line up precisely with those of adjoining vertebrae, creating smoothly functioning facet joints. But sometimes a facet dislocates; all it may take is a sudden twist or bend. The bone may begin to press on the tiny nerves that run to it from the spinal cord. Like a herniated disc, facet-joint syndrome can be accompanied by severe pain.
To the hapless victim of any of these ails, the quest for help may be as exasperating as the pain itself. Too often, each specialist who is consulted has a different explanation of what is wrong and, more vexing, a different way of setting it right. For example, some doctors still speak of lumbago and sciatica. But these are notoriously imprecise terms for generalized pain in the lower back or neighboring areas that may be the consequence of various difficulties. Says Murray Goldstein, deputy director of the National Institute of Neurological and Communicative Disorders and Stroke: "All treatments are controversial, and the reason is an almost complete lack of controlled clinical trials. Treatments have been based on the bias of the particular physician."
If there is indeed bias, among those responsible for it are orthopedists, who are conventional medicine's chief authorities on the back. When consulted by patients, these and other back specialists will usually start off with some rigorous questioning. When and how did the pain begin? Where is it now located? What treatments have been tried? Do other family members have similar difficulties? The doctor will also inquire closely into the patient's general health, past illnesses, work and leisure activities, even sexual habits. Orthopedic Surgeon J. William Fielding of New York City's St. Luke's Hospital says that he can usually pinpoint the patient's problem from this ritual alone. He also points out that the pattern of pain is itself a diagnostic tool. Reason: the nerve pathways branching off different areas of the spinal cord have been so well mapped that any pain along them can be used to point back to the spinal injury.
The actual physical examination begins even before the patient crawls onto the examining table. Says Columbia's Keim: "I like to watch the patient undress, see how he moves, sits, stands." The doctor may ask the patient to perform various exercises --walking on heels and tiptoes, bending from the waist, twisting, reaching as high as possible with the hands. Lying on the table, the patient will probably be made to continue the gymnastics with movements of the legs and hips. The doctor will feel around the abdominal area for tumors, which may be the real problem. He will also probe for pain around the kidneys and explore the rectum (purpose: to look for growths and check the condition of the coccyx, the lowermost four vertebrae, which are the evolutionary remnants of a tail). Finally the doctor will test the patient's reflexes with the time-honored taps on the knee and ankle, measure the muscles and test sensation with pinpricks.
When all the prodding and poking are done, the patient's spine will be Xrayed. If this does not reveal the exact nature of the problem, the physician may turn to a more complex radiological examination: the myelogram (from the Greek word for marrow). In this discomforting form of X ray, a dye that blocks the radiation is injected into the lower portion of the spinal canal, the passageway for the spinal cord. The patient is tilted forward so that the dye runs up along the canal; and if, say, a disc or a tumor is protruding into the passageway, it will show up as a tiny indentation in the sinuous shadow representing the canal. To avoid the risks from the intrusion of the foreign dye, more and more doctors are opting for the CAT scanner. This computerized X-ray marvel can provide amazingly detailed cross-section views of the body, including the spine, clearly showing both soft and bony tissues. In fact, it is this controversial and expensive machine that has helped doctors identify hard-to-detect facet joint problems as a major source of back pain.
Even after the trouble is diagnosed, the patient is confronted by a baffling choice of therapies. A vigorous approach may be recommended by osteopaths, who belong to a tradition of medicine that says many ailments are a byproduct of disturbances of the musculoskeletal system. Chiropractors may be of a similar mind; they are practitioners who hold that illnesses can usually be traced to misalignments in the spinal column. Both may advise manipulation, the application of quick, sharp pressure with the ringers and hands to move a misaligned bone into place. Many satisfied patients, including benefactors of osteopathic education like the late Nelson Rockefeller, have extolled their therapists' skills. But, says NIH'S Goldstein, himself an osteopath: "So far there is no evidence that manipulation is better for a patient than whistling Dixie."
M.D.s, on the other hand, almost universally recommend bed rest, at least for acute back pain, plus aspirin or a muscle relaxant. Some also suggest heating pads or ice treatments, although their value is in dispute. The best healer is time. Says Dr. George Hyatt, chief of orthopedics at Georgetown University in Washington, D.C.: "Most back problems will correct themselves within three weeks, no matter what we do. So the object is to make the patient as comfortable as possible."
Even so, there may be more trouble in the future. Says Orthopedist Leon Root of the Hospital for Special Surgery in New York City: "Once your back is injured it is never cured. Low back pain is your warning that something is wrong. The next time it hits it will be worse. What you have to do is heed this warning and take steps to prevent the problem from ever occurring again." Those steps: use a firm mattress or bedboard, lose any excess weight, and do low back exercises daily. Unfortunately, most patients do no more than change their bedding. Says Keim, who exercises faithfully every morning: "People want pills and drugs. They want surgery. They want corsets and braces. What they don't want is to exercise. It's boring and people are lazy."
Lack of exercise leads to a loss of muscle tone. The potbelly puts staggering pressure on the spine.
Says Dr. Ronald Taylor of Detroit's Troy-Beaumont Hospital:
"Ten pounds of extra weight on the abdomen is equal to 100 lbs. of weight at the disc." Reason: as the belly thrusts out, the buttocks push back to offset the excess weight in front, and the spine's normal curve deepens.
For women the problem becomes especially acute in the last months of pregnancy, when many suffer severe back pain.
On the whole, back specialists applaud the current physical fitness craze with its emphasis on conditioning, proper weight and diet. But they also warn that nothing succeeds like excess in inviting spinal injury. Indeed, the sometime jock, who embarks on sudden spurts of activity, is especially likely to be hit by back pain. Says Dr. Richard Stauffer of the Mayo Clinic's back center in Rochester, Minnesota:
"There's the attorney who sits around all week and then engages in a vigorous weekend of tennis or handball. On Monday he can't get out of bed." The message: exercise if you will, but do it cautiously, with proper warmups. Start on any difficult new workout warily.
Very few people, though, follow the exercise prescription. Even if they engage in proper conditioning programs, they frequently slack off after their backs feel good again. Such lassitude invites disaster. Paul Hendricks, 53, a Philadelphia wholesale-food broker, first injured his back as a young Marine. Just short of his 30th birthday, he reinjured it while playfully swinging his four-year-old in the air. For 1 1/2 years, Hendricks followed his exercise regimen. Then he tapered off. While driving to work one day, he paid the price. Stopped at a traffic light, he reached back for a newspaper. The light changed, horns honked, traffic moved. Not Hendricks. It took a state trooper half an hour to extricate him from his car. After three weeks of traction and seemingly endless consultations with doctors. Hendricks has been doing his exercises faithfully.
For patients like Hendricks, the nagging memory of their past pain may be enough of a prod to exercise. But Orthopedist Root tries to provide additional incentive. Seated across the desk from a patient, he outlines the exercise routine, then picks up a scalpel and hones it a few times on a small whetstone. "Remember," he says, "if you don't want to be bothered with exercises I also do surgery."
Operations are in fact a common way of dealing with back pain, especially the agony of herniated discs. Introduced in the 1930s, the surgical removal of a disc, called a laminectomy, is performed nearly 200,000 times a year in the U.S. In perhaps a third of all cases, patients have additional surgery to firm up the damaged spine. The follow-up operation is called a fusion; bone chips, usually taken from the pelvis, are lined up like little splints across adjoining vertebrae. The chips eventually form a permanent bond with the bones, and that section of the spine becomes rigid.
The operations can be extremely effective. Six weeks after his ruptured disc was removed last fall, Detroit Lions Punter Tom Skladany was back on the playing field practicing his kicks. But the procedure is also risky. Except in the hands of the best surgeons, it offers only a moderate rate of success, and in the opinion of some doctors it is often performed unnecessarily. Urged by one physician to have a laminectomy, a New Jersey man received this second opinion from an orthopedist friend: "I do the best laminectomy of anybody I know, and if I were you, I wouldn't even let me do it." As for fusion, says Dr. Ernest Johnson of Ohio State University, "It's like killing a fly on the windowpane with a sledgehammer. The fly is dead, but you've also broken the glass." Why so many operations? "When you have a hammer in your hand, everything looks like a nail."
Even more controversial than surgery is the injection of an enzyme called chymopapain into a ruptured disc. Extracted from papayas, a popular tropical fruit, the substance is similar to one of the ingredients of meat tenderizers, which are made from the same plant. Developed in the early 1960s by Orthopedist Lyman Smith of Elgin, III., the treatment is designed to dissolve the disc's gelatinous pulp and eliminate the need for an operation. But a decade later, in 1975, after a controversial study that disputed the chemical's effectiveness, the Food and Drug Administration pressured the manufacturer to withdraw the substance. Chymopapain, however, is still available in Canada, and many Americans go there for treatment, sometimes with their doctors' blessings. Says the University of Miami's Dr. Mark Brown: "Ninety percent of the patients I send there come back fine; they don't need anything else."
Toronto Surgeon Ian Macnab reports similar results. In the past ten years, chymopapain has been used on 2,000 back patients in the Toronto area. Eight of every ten cases, says Macnab, require no follow-up surgery. In a recently published study, Dr. Manucher Javid of the University of Wisconsin in Madison found that 83 of 114 patients who had received chymoppain for herniated discs had little or no back pain three to six years after the treatment. Still, many orthopedists remain skeptics. They worry about possible side effects; as a foreign substance, the enzyme may cause allergic reactions, including shock. The dispute may some day be settled when a study pitting chymopapain against two placebos is completed at a number of U.S. medical centers.
The latest addition to the repertory of medical treatments for backache is called gravity traction. It is an updated form of a treatment that goes back to the time of Hippocrates. In those days, people with bad backs were strapped to a long ladder, then turned upside down and lowered suddenly to the ground. That may have been somewhat jolting, but all the stretching--what modern doctors would call traction--presumably relieved the problem by opening the spaces between the vertebrae.
At the Sister Kenny Institute in Minneapolis, patients are strapped to a tilting bed--mercifully, head up--and rotated to an almost standing position. Explains the technique's innovator, Dr. Charles Burton: "For hundreds of years, people told their doctors they got relief from hanging from their arms." Now, he points out, they can get the same benefits in the comfort of a hospital bed. The technique seems to work for many people, but critics say that traction is effective simply because it removes the patient from daily stresses and enforces rest.
In many cases of back pain, nothing seems to help. Bed rest, exercise, surgery and traction--all fail to bring relief. Why? To some extent, the answer may be medical ignorance; despite years of examining and dissecting, doctors still find many aspects of the spine and its associated muscles and nerves to be something of a mystery. More important, doctors have lately made a surprising discovery. From all indications, a major aspect of lower back pain appears to be psychological. Some back specialists say that in as many as 80% of all cases the pain is due not to any overt organic problem but to such elusive factors as stress, worry and other mental attitudes. Dr. John Basmajian of Canada's McMaster University puts even greater emphasis on the psychological aspect of backaches.
In fact, some people seem to have a heavy emotional investment in continuing their pain, which is quite real to the patient, even if it is of psychosomatic origin. Explains Dr. John Bonica of the University of Washington in Seattle, co-founder of the first major pain-relief clinic in the U.S.: "Take the case of a middle-aged lady who has been married for about 20 years and whose children are grown and have left home. She has an emotional need for love and affection, but her husband is always busy with his work. One day this lady falls in the snow and complains of lower back pain. Suddenly her husband is attentive to her. Subconsciously she perceives that she is rewarded for her painful illness. The original injury heals, but she still complains about the pain."
Back pain can also be a byproduct of difficulties on the job, problems in personal relations, or grief over the death of a loved one. Such "masked depression," notes Psychiatrist Thomas Hackett of Boston's Massachusetts General Hospital, can go on for years. Boredom can have similar effects, says New York Osteopath Richard Bachrach. As he explains it: "A lot of my female back patients are bored, lacking in direction. Back trouble gives them an excuse for their behavior. If they're not getting on with their husbands, they can say, 'Oh, I can't have sex because my back is bothering me.' It's better than a headache. And if their backs aren't bothering them, they can avoid sex for fear of triggering back problems." There is no small irony in such excuses. As it happens, the pelvic movements of conventional intercourse are regarded by some orthopedists as an ideal preventive exercise for back pain.
Some medical observers, like U.C.L.A. Psychiatrist Charles Wahl, insist that there is even such a thing as a "backache personality." People in this category tend to be hard driving but lacking in self-confidence. They are also likely to repress anger and avoid conflicts, traits they share with many victims of ulcer and headaches. Says Basmajian: "Back pain is just a tension headache that has slipped down the back."
In desperation, such patients are turning increasingly to the growing number of pain clinics across the country. Because of the psychological component of pain, these centers include psychiatrists, counselors and social workers in multidisciplinary medical teams. Back pain can account for half or more of their patient loads. Their principal strategy is, as Dr. Steven Brena of Emory University's Pain Control Center in Atlanta puts it, to convince patients that pain is "a perception, not a sensation." Translation: they train patients to deal with their pain, if it cannot be eliminated, and live around it.
That may be an extremely difficult task. Many of the patients have been in pain for years and sometimes have undergone three or four operations. Often they are unable to work or accept family responsibilities. Some are dependent on tranquilizers or, worse, addicted to pain-suppressing narcotics. Dr. Burnell Brown, director of the University of Arizona's pain clinic in Tucson, says that patients sometimes arrive carrying bags filled with a dozen or more bottles of different medications that doctors have prescribed for them.
Many of the methods used at the clinics are unconventional, at least by ordinary medical standards. They include hypnosis, biofeedback and acupuncture. Some new approaches are also being explored. To numb sensitive areas of the back by killing nerves, the pain doctors have been injecting alcohol into the tiny nerves of the vertebrae. For problems with facet joints, they sometimes insert heated needles into the area's nerves, an acupuncture-like technique called surgical diathermy or facet denervation. Another popular tool of the pain clinicians: pocket-size electrical stimulators that patients carry around with them. Held against a painful area these gadgets provide a little shock that produces a tingling sensation and temporarily blocks the pain.
In cases of severe chronic pain, a highly sophisticated variant of such stimulators can be embedded in the body itself. The technique has been used since 1974 by Neurosurgeon Yoshio Ho-sobuchi of the University of California in San Francisco. He implants one to three hair-thin electrodes in the brain or spine; these wires lead to a small radio-activated electrical source placed just under the skin of the chest. To get relief from pain, the patient presses a small radio transmitter against the chest. The transmitter's signal activates the little power plant, which promptly shoots a tiny electrical current into the brain or spine and thus fires critical nerve cells. The object: to release a flow of beta-endorphin, a morphine-like substance produced by the nerve cells that acts as the body's own internal painkiller. With only 15 minutes of such self-stimulation, says Hosobuchi, a victim of chronic low back pain may be able to obtain relief for a period ranging from a few hours to several days. However, patients may develop a tolerance to the process.
By such tactics some clinics are able to return as many as 65% of back sufferers to productive, if not pain-free, lives. Robert Sumpter, 45, of Modesto, Calif., sought out Hosobuchi after four back operations and a bout with the bone infection osteo myelitis that left him in such great pain that he required constant medication with narcotics. At first, Sumpter had to use the transmitter four times a day. Now he resorts to it only once daily. He also has resumed a life-style that he had totally abandoned because of his addiction. Says he, with undisguised relief: "I drive my car now and I mow my lawn."
In some cases, when nothing seems to help the pain, the patient is malingering. He uses an injury, often minor, to press lawsuits, collect workmen's compensation and Social Security, and pick up insurance disability payments. The problem is not confined to the U.S. In Sweden 25% of workers who retire early do so because of back troubles--in many cases on the basis of obviously phony claims. Keim says facetiously that such people are suffering from "green poultice syndrome": "These patients often respond miraculously to the application of $100 bills. When the pile of bills reaches the proper thickness, the 'poultice' takes effect and the patient is cured." Though malingerers are often adept at mimicking symptoms of true back pain, they sometimes outsmart themselves. One trick doctors use to trip them up: they ask the patient to kneel on a stool, lean over and try to touch the floor. Even someone with a severely herniated disc can usually perform the stunt, but the fakers will more often than not refuse to do it on the grounds that the pain is too great.
The prevention of backache, like that of other difficult ailments, remains the best--some doctors would say the only --cure. Until recently, public knowledge about proper care of the back was virtually nonexistent. Now the word is beginning to get out. Since 1974 the Toronto-based Canadian Back Education Units have been offering a series of four 90-min-ute talks on back care for sufferers in American and Canadian cities. The topics include anatomy, posture, emotional factors in back pain, relaxation techniques, abdominal exercises and the proper way to lift objects.
In New York, Bachrach has been holding regular Wednesday afternoon workshops for his patients, many of them dancers. As they go through movements before a mirror, Bachrach and Movement Therapist Glenna Batson point out potentially back-damaging flaws and suggest corrections. In Atlanta, Physiotherapist Stanley Paris and the staff members at his Atlanta Back Clinic have been giving lectures and demonstrations to employees of local firms. A back-education film is being prepared for use by major corporations. How effective are these programs? Says Therapist Connie Grondona, who conducts a monthly program at the University of California's Lawrence-Berkeley Laboratory: "People in my class don't get backaches."
As the human body continues to travel along the evolutionary pathway that began, perhaps, with Rama-pithecus' move, more structural changes will occur. These may enable the back to cope better with the hazards of an upright stance and those of civilized life. Yet until that far-off day, men and women must look elsewhere for ways of avoiding backaches. Clearly the answer lies not only in the spine but in another organ that also suffers from occasional neglect: the brain. It surely has developed sufficiently since Ramapithe-cus' time to watch over so essential a part of the anatomy as the back. And that's no fable. --ByAnastasia Toufexis -By Anastasia Toufexis
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