‘With back problems you have to keep moving’

Orthopedic surgeon Edwin Diepeveen has already helped many people with their back problems. The best thing about his work in the Gelderse Vallei Hospital and the Iprenburg Hernia Clinic: “My patients have dramatic pain and I can get them largely pain-free again. They often stumble into the clinic. During the operation we see them improving. hernia cannot lift his leg more than 30 degrees and I remove the hernia, I can already lift the leg to 90 degrees during the operation without it hurting. Then such a patient walks straight out of the clinic and smiling.”

You specialize in minimally invasive spine surgery, what exactly is that?

“With PTED surgery, a kind of keyhole surgery, I make a small incision on the side of the body. Then I remove a hernia or repair a canal stenosis, a narrowing of the spinal canal. The big advantage of the PTED operation is that it recovery takes shorter and less tissue and muscle damage, and the risk of complications is lower.”

What do people with canal stenosis suffer from?

“The complaints due to such a narrowing are slowly getting worse. It starts with lower back complaints and radiation to the buttocks and legs when you stand and walk for a long time. At a certain point people can only walk short distances. They always sit or sit for a while. they bend over to stretch.Then they can walk again until the pain starts again.Sometimes it takes years to get help, often because they assume it’s just part of getting older.People think: Me take it a little easier. They stop walking and cycling, which makes the complaints worse. But with back problems you have to keep moving.”

Why is it so important to keep moving, even if the pain is killing you?

“The muscle corset around your spine must be optimally trained and used. If you don’t do this, you will assume unnatural postures and the complaints can worsen. Moving with back problems is different from putting an extreme strain on your muscles. You should not rest or lie down. , as was previously prescribed for a hernia, but try to keep moving as much as possible. If you have severe or long-term complaints, it is important to receive guidance.”

According to you, people with back pain quickly think that they have a hernia. Too fast?

“Often. If you have a hernia, an intervertebral disc has a bulge that pinches the nerves. As a result, you get radiating pain to one leg and possibly also failure in an arm or leg. If that radiating leg pain is not there, you can assume that that there is something else going on than a hernia. Often it is lumbago or another cause that has to do with the muscles. In some cases it can be a back tumor. Or there is no clear cause to be found, that also happens often. We can’t pinpoint a complete cause for about 80 percent of back complaints.”

How do you visualize what is going on?

“First of all, I listen to the whole story to discover whether there are ‘red flags’, signs that are reminiscent of an inflammation or a tumor, for example. I do a physical examination to further visualize the complaints and the functions of the nerves in particular. We also take an X-ray. If I see a vertebra rocking back and forth, there is a good chance that a displaced vertebra is causing the complaints. If the complaints are disabling, I will have to stabilize it with an operation.”

Quality of life

People who have already been examined before usually come to the Iprenburg Hernia Clinic. According to Diepeveen, they usually have already completed “pathways with physiotherapy, a pain clinic and morphine tablets and other nasty medication”. When they come to him, they often already know that they need (hernia) surgery. But: in 70 percent of people with a hernia, the complaints go away on their own and there is quite a bit of discussion about people who do need surgery. They would go under the knife too often unnecessarily.

What about your clinic? Have you ever performed an operation that made you think afterwards: was that really necessary?

“That has never actually happened before. We operate on people with permanent, disabling complaints. They have waited a long time to see if it would go away on its own, did exercises, took painkillers, to no avail. Fortunately, not all people with a hernia need surgery. But for others it is much needed, it drastically improves their quality of life.”

Do you have an example of such a drastic improvement?

“Recently there was a young mother here with a huge hernia, which arose during pregnancy. Then it probably became a weak point. During the delivery, during the pushing, it had shot in at once. Since then she had had invalidating leg complaints, a lot of pain, so much so that she couldn’t even hold her child. She was on morphine and was – in her own words – half a zombie. When I operated on her, I removed a large hernia. The pain went away immediately. Later I got a card on which she wrote that she could hold her child again. She also sent us a cake. Beautiful!”

Children with a hernia

The greatest burden, says Diepeveen, is not in the supposedly redundant back operations, but mainly in complaints that cannot be helped. About 90 percent of people will suffer from lower back pain at some point. “Think of lumbago, an attack of low back pain that occurs in many people. It costs society a lot of money in physiotherapy, pain relief and absenteeism. For the patient himself, the pain that comes with it can be disabling. If we cannot identify a clear cause. finding, and that’s the case in about 80 percent of those patients, is the frustrating message that it can’t just be solved.”

90 percent, that’s just about everyone. Why do we suffer so much from our backs?

“A lot of sitting in front of the computer, long car journeys and too little exercise, those are the main causes. You can do a lot of desk work or travel by car, as long as you alternate it with short breaks where you move. When you sit behind a desk , you should actually get up every twenty minutes and get a glass of water or a cup of coffee. Or alternate working while sitting with working standing. People often know that, but they don’t do it. Only when they are confronted with the consequences, they feel how disabling low back pain can be. But then you already have a big problem. I also see young people and children, sometimes only 12 years old, with back and neck complaints because they spend so many hours a day bent over their mobile or tablet They also don’t play outside enough. I’ve had children aged 13, 14 with a hernia in my doctor’s office.”

So it’s better not to sit on the couch in the evening after traffic jams and watch Netflix, and we have to take our children’s mobile phones?

“Whether the latter helps, remains to be seen. Perhaps schools could do prevention with good physical education, so more than an hour a week. They could also provide information about how important your back is for you. Adults can spend a night out. relax on the couch, as long as they also exercise enough. Alternate it with a walk after dinner, exercise a few times a week.”

Does the large percentage of back complaints for which no surgery or treatment is possible argue in favor of patiently waiting to see if it will get better on its own before going to the doctor?

“We know that 70 percent of hernias go away on their own and that low back pain can also be reduced without physiotherapy or medication. But I am certainly not in favor of just waiting. In fact, I think that too often people wait far too often for it to go away without it is based on a good treatment plan. I see too often that people go through a long time with hernia or canal stenosis complaints before they have hernia or canal stenosis complaints before they are sent to a specialist by the GP for a diagnosis. You must first know what you are talking about before “wait and see” can be the treatment plan. Moreover, if you continue with some complaints for too long, they become more difficult to treat. All this time you can’t work, play sports or walk behind the pram.”

So ‘looking at it for a while’ isn’t a good strategy?

“It depends on the way in which that happens. It is especially important that there is a good diagnosis first. Recently, for example, I saw someone with a drop in the foot: a hernia with a painful appearance to the leg and a foot that no longer did anything. Nine months he had been dealing with physical therapy for a long time, it only got worse. When he was referred, I had a patient with a foot that will probably never feel the way it did before.”

Can patients do something about this themselves? For example, should we demand a referral as soon as we have back pain?

“That is not always necessary, but pay attention to certain signals: a painful radiance to your leg, your ability to walk less well, not being able to use an arm properly. This really needs to be looked at critically. For example, agree that if it happens after six or eight weeks of physical therapy does not improve, you go to a specialist. People should not only take better care of their backs by exercising more, but also by standing up for themselves when they are in pain.”

This article previously appeared in +Gezond February 2022. Want to subscribe to the magazine? You can do that in an instant!