Golfer Jack Nicklaus' back hurts.
Many people will sympathize. Americans make an average 16 million visits a year to doctors complaining of pain anywhere from neck to tailbone. Back problems happen to couch potatoes as well as professional athletes. People who drive motor vehicles for a living are at high risk. Some researchers suggest the tendency to back pain is hereditary.Nicklaus has a herniated disc, which means the spongy pad of cartilage between his fourth and fifth lumbar vertebrae is protruding inward and pressing on the nerves of his spinal cord. This causes pain to radiate down his leg, weakness of the muscles and numbness. He also has bony, arthritic "spurs" that aggravate the situation.
"We see this very commonly in other people, but it's particularly a problem in golfers because of the stresses they put on their lower back over many years," said Nicklaus' doctor and friend, Palm Beach orthopedic surgeon Bruce Waxman.
Dr. Hubert Rosomoff, chief of neurological surgery at the University of Miami School of Medicine, who hasn't seen Nicklaus but who has treated a number of golf professionals, said, "They do have a tendency, particularly the long hitters, to develop certain changes in their backs after many years of playing." Wear and tear, said Rosomoff, causes the little facet joints that are part of the linkage of the spine to become knobbly, like the knuckles of some arthritic people's hands.
Nicklaus is 48 and his back shows some of those degenerative processes. But, Waxman said, it's not his age that is the problem: "A lot of people walking around at 70 don't have arthritis. It gets worse with age, but most people who get older don't have a ruptured disc."
Strangely, Nicklaus only has pain when he plays golf. He can still play tennis or basketball and run.
"Maybe when he twists (for a golf swing), he is pulling the nerve root right across the disc and causing pain," Waxman said.
And so, when the accumulated advice of several orthopedic consultants is given to Nicklaus, the champion golfer will face his biggest challenge: deciding whether to continue with "conservative" physical therapy or have surgery. The surgical options include a "minimal incision" operation, which inserts a tube and sucks out the disc material, or a major, open operation.
"Most people who have this kind of problem don't have to have any kind of surgical procedure," said Waxman. "Ninety-nine percent of people will get better without any kind of surgical intervention."
That takes time and the problem for professional athletes is pressure to get back to their careers.
"It's not usually the end of the world," said Dr. Mark Brown, chief of orthopedics at the University of Miami School of Medicine. Brown has numbered several golfers among his patients, including a woman professional he won't name who had somewhat similar problems to Nicklaus'.
"She had a bad disc and some arthritic changes in her back," Brown said. "About seven or eight months after I treated her, she went on to win the Elizabeth Arden Classic at Turnberry Isle and she is still a No. 1 money winner on the women's circuit." That golfer had the sometimes controversial treatment in which chymopapain - a medical relative of meat tenderizer - was injected to melt the offending disc.
"She did well, but I would have operated on her if it hadn't worked," said Brown. His favorite example of surgical triumphs for back problems is San Francisco 49ers quarterback Joe Montana, who, two years ago, faced retirement from football at 30. Instead, eight weeks after a California surgeon operated on his back, Montana led his team to victory over the St. Louis Cardinals.
As for Nicklaus, Waxman said, "he looks so good and does so well otherwise, I don't want to jump in and recommend something until several people we respect give us advice . . . .
"I am still not sure surgery is necessary, but it's just that Mr. Nicklaus has not responded up until recently to conservative therapies of different kinds we have been trying. Surgery in him or anybody else is the last step."
(BU) Want to avoid hurting your back while playing golf?:
Start right from the moment when you set the tee in the ground. Don't bend from the waist.
"Most of us bend as though our backs can take that motion," said Dr. John Diggs of the University of Miami School of Medicine's Comprehensive Pain Center. Instead, he says, "Squat down with a straight back and use your leg muscles. Simple things like that can make a major difference in someone who plays golf a lot."
How stressed are you during your golf swing? (Very stressed, maybe, if you are playing a round with the boss or an important client.) Watch out, your tightened muscles could mean you'll have pain later.