Essay:Spinal Treatment Based on Evolutionary Theory Fails

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Response to Spinal treatments based on evolutionary theory fails From EvoWiki By Jerry Bergman, Ph.D.

Abstract

A recent entry on the evolution apologetic web site EvoWiki attempted to criticize my article titled “Back problems: how Darwinism misled researchers.”(TJ 15(3): 79-84. 2001) TJ stands for the publication Technical Journal published by Answers in Genesis. This article was written to respond to the claims of this EvoWiki review.

Introduction

My article claims, according to EvoWiki:

A treatment for certain back conditions, Williams flexion exercises, recommended decreasing lordosis as much as possible. It was based on evolutionary theory, specifically that humans evolved from quadrupeds and that back problems are a result of our new upright posture. This treatment protocol often impeded healing and caused great pain. Robin McKenzie's exercises, which recommended restoring normal lordosis (anterior convexity of the spine), are much more effective.

Actually my article claims that

Darwinism has misled researchers into developing a set of therapies that have proved detrimental to treat certain back problems. These therapies were based on the Darwinian conclusion that humans evolved from primates that walked on all fours, and that back problems were produced primarily by complications resulting from humans’ newly evolved upright posture. In short, Darwinism teaches that our vertebral structure evolved to walk on all fours, and back problems exist today because humans now walk upright on vertebrae that originally had evolved to walk quadripedally. This theory has led to a treatment protocol that is now recognized as impeding healing, and has caused enormous pain and suffering. The orthodox treatment used today is, in many ways, the opposite of the older, now disproven, Darwinism-influenced theory.


The EvoWiki Response to my Article and my Response to EvoWiki’s Critique.

The first claim of EvoWiki is that

“humans are not best off adopting a quadruped position is no more proof that they didn't evolve from quadrupeds than the fact that a baby will drown is evidence it didn't spend 9 months in a sack full of fluid”.

I did not argue in the article that “humans are not best off adopting a quadruped position” is proof humans did not evolve from a quadruped animal into a bipedal one, only that the conclusion that humans evolved from a quadrupedal animal to bipedal one has mislead researchers. My article summarizes the literature that responds to the claim that back problems of modern humans are often, in part, due to the fact that bipeds evolved from tetrapods by Jury rigging (making something with only the tools and materials that happen to be on hand), a design which, Darwinists argue, does not work very well due to this fact.

The EvoWiki claim that "’Chiropractic medicine’ (or "physical therapy" if you prefer) is not scientific, let alone medicine” is both name calling and irresponsible. First of all, my paper does not discuss chiropractic treatment, a topic never mentioned except off handedly in one quote. Secondly, numerous scientific studies have been completed on chiropractic by medical doctors and others. This research finds that this system of treatment is more effective for some conditions, such as certain types of back pain, than medical treatment. Nor did I claim that chiropractic is the same as “physical therapy.”

Physical therapists (PT’s), according to The American Physical Therapy Association, are health professionals who diagnose and treat people of all ages who have health-related conditions that limit their abilities to perform their daily activities. PT’s also help to prevent loss of mobility by using treatment programs that help to achieve healthy and active lifestyles. They examine and develop treatment techniques that promote the ability to move, reduce pain, restore function, and prevent disability. PT’s usually provide therapy in hospitals, clinics, schools, and sports facilities.

It should be stressed that PT’s are specifically trained to treat back problems and usually receive their training at medical schools, and most work with physicians at clinics. Referrals are usually by a physician. MDs usually prescribe medicine as needed and the PT’s role include the nonmedical aspects of treatment. The program is rigorous and involves training by Ph.D.s and M.Ds in areas including gross anatomy in a cadaver lab. My paper was reviewed by four licensed physical therapists, all who were trained at leading medical universities including the University of Michigan and Northwestern University. PTs must have a minimum of a Masters of Physical Therapy, and many institutions now offer the Doctor of Physical Therapy (DPT) degree. Licensure is required in each state in which a physical therapist practices.

The claim that “Williams Flexion Exercises are still in use because they actually have no significant impact on the spine at all, and are merely effective at stretching buttocks, abdominal, lower back, and hamstring muscles” is also irresponsible. Note that not one source was given to support this claim. My article stressed the impact of exercise on back pain, not the spine as EvoWiki claimed. Exercise strengthens the relevant muscle system, allowing the whole back system to function more effectively, important to control back pain.

“McKenzie Extension Exercises are still in use because they, also, have no significant impact on the spine at all, but some people ask for an alternative to the WFEs.” Note that no source was given for this claim either and I have not claimed that exercise has any impact on the spine. A central tenet of the McKenzie Method is that self-healing and self-treatment are important for long term patient back pain relief and rehabilitation. Medical modalities—such as drugs or pain control injections—are not the focus of the treatment.

The long-term goal of the McKenzie Method is to help persons suffering from back pain learn how to manage their pain by using exercise and other strategies. In contrast, Medical doctors often treat back problems with medicine, includes muscle relaxants and pain relievers such as Oxycontin. Each has a different role to play in treatment. Actually, more and more doctors recognize this fact and refer the common type of back pain patient to a PT.

One review of the research (“The Role of Activity in the Therapeutic Management of Back Pain: Report of the International Paris Task Force on Back Pain”. Supplement Spine. 25(4S) Supplement:1S-33S, February 15, 2000. by Abenhaim, Lucien; Rossignol, Michel; Valat, Jean-Pierre; Nordin, Margareta; Avouac, Bernard; Blotman, Francis; Charlot, Jacques; Dreiser, Renee Liliane; Legrand, Erick; Rozenberg, Sylvie; Vautravers, Philippe) found that exercise can play a significant positive role in back health.

The article “Nonoperative Treatment of Low Back Pain” by Gerald A. Malanga, MD; Scott F. Nadler, D.O. (Mayo Clinic Proceedings. 1999;74:1135-1148) concluded that:

Although there may be some beneficial effects via pain modulation and reduction of intradiskal pressure when a patient is prone, bed rest has many detrimental effects on bone, connective tissue, muscle, and cardiovascular fitness. The proactive approach emphasizes activity modification rather than bed rest and immobilization.

Another study that looked at the differences between exercise programs (“Does it Matter Which Exercise?: A Randomized Control Trial of Exercise for Low Back Pain”. Audrey Long, BScPT Ron M and Donelson, and Tak Fung, PhD Spine. 29(23):2593-2602, December 1, 2004) found significant differences in exercise programs A total of 312 acute, subacute, and chronic back pain patients underwent a standardized assessment classifying them by pain response. Significantly greater improvements occurred in subjects using "patient-specific" exercises compared with both other treatment groups in every outcome (P values <0.001), including a threefold decrease in medication use. Consistent with prior evidence exercises tailored to the subjects significantly and rapidly decreased pain and medication use and improved in all other outcomes. If repeatable, such subgroup validation has important implications for LBP management.

In response to the claim “Neither form of exercise does what it initially claimed to do: consistently relieve back pain.” I consulted a dozen leading books and articles on back pain and every one of then recommended exercise. These include:

1. Howard Nigel. 2000. Alternative Answers to Back Problems: The Complete Conventional and Alternative Guide to Treating Back Pain. Readers Digest.

2. Richard Deyo. 1998.”Low-Back Pain”. Scientific American. August. Pages. 48-53.

EvoWiki than claimed that “There is no magic formula for relieving back pain, or any other type of orthopedic pain.” I am not claiming that a magical formula exists, only that Darwinism has mislead researchers and therapists to rely on treatments, such as bed rest and pain relievers, that often do not help in the long run and can interfere with healing, and that the conclusion that abusing ones back by not using it in ways that it is designed to be used is a major cause of back problems.“Paul Williams is quoted (by AiG, actually) as saying ‘Man, in forcing his body to stand erect, severely deforms his spine.’ This is medically absurd.” This claim may be absurd, but it was taught by some Darwinists and logically follows from Darwinism.

The claim that “Robin McKenzie has no education in medicine at all, and makes his money today selling the modern equivalent of snake oil-- self-help books” is also irresponsible. I will rely on an expert to respond to this charge. The McKenzie Institute International for Back Pain and Neck Pain was formed in 1982 by trained professional licensed physical therapists in New Zealand who were using the McKenzie approach to treat patients. The International headquarters is in New Zealand. The organization has branches in 26 countries throughout the world. Each branch provides courses to teach practitioners… The founder, Robin McKenzie, has written a number of books on the self-help approach to treatment of back and neck pain…. If you decide to pursue this approach, most spine specialists will suggest that you visit a physical therapist that is trained in this approach. The McKenzie Institute International has a program of certification and a diploma program, and has an online listing of credentialed and diploma practitioners around the world (Vert Mooney MD ).

Dr. Mooney is an orthopedic spine surgeon and Clinical Professor of Orthopedics at the University of California at San Diego. Convinced of the effectiveness of the McKanzie system, which he now supports, Dr Mooney uses it to help his back pain patients. Dr. Mooney is an active member of The North American Spine Society, The American Academy of Orthopedic Surgeons, The American Orthopedic Association, The International Society for the Study of the Lumbar Spine, and The California Orthopedic Association.

Case Histories

The simple fact is the system I discussed in my paper often works. Among the case histories that I have in my files, I will review two. The first is my own, and this is how I became interested in this topic. I had severe back problems beginning about 20 years ago. I first used pain relievers including Excedrin and Tylenol. I eventually ended up with an ulcer from taking too much Aspirin, and then began taking Tylenol, which also soon bothered me. When the pain developed into sciatica, I consulted several physicians. I was told that our spine evolved from lower quadrupedal primates and that there was very little I could do to permanently cure the problem. He prescribed drugs including VIOXX® (rofecoxib) and Bextra® for about 6 years, and bed rest, though, to relive the pain. The pain continued to worsen. I was prescribed a tens unit, was given injections of cortisol in my back and after an x-ray, then a CT and, last, a MRI, back surgery was recommended to deal with a herniated disc. The negative experience of friends with surgery discouraged the latter option.

Finally, I was referred to a creationist doctor. He explained that the problem was not due to evolution, but that the human back was designed to walk, and not sit at a desk for hours on end correcting student papers as my job required. I was told to walk 20 minutes a day, and to do a set of back exercises without fail daily. It took several months, but I was finally weaned off of pain medicine The pain medicine I was on then was taken off of the worldwide market on September 30, 2004 by Merck, and dozens of lawsuits are now threatening to bankrupt the makers of both VIOXX® and Bextra.® (Bextra is a COX-2 selective non-steroidal anti-inflammatory drug that was widely believed to be safer than aspirin). I now rarely have any back pain (less than once a month) and, when I do, it is mild and can usually be relieved by a nonprescription drug. When hospitalization forced me to stop my exercises the back pain returned with a vengeance, and was fully relieved by resumption of the exercises. The second case is as follows: I have had lower back problems for the last 28 years, due to having lifted a heavy object improperly. I had many doctors tell me that I should walk with my shoulders forward as though I were walking uphill. I had three operations in the L5 area, including the injection of chymopapain. I was told to stay in bed for six weeks; I did it but it only made my back worse. I was given a list of exercises to do, based on the premise that my problem was due to evolution. Many years later, I went to a young neurologist who advised me to throw out all of those exercises and substitute a set that involved strengthening the lower back muscles and also to take long walks. I followed his suggestions and have had very little back trouble since that time (Case of Lillo, 2001).

I am aware of numerous other similar cases, but these two illustrate the point. I also realize that case histories are of limited use in drawing conclusions, but the empirical research supports these conclusions.

Conclusions

Evidently, the author of the EvoWiki article feels that the solution to back problems is to take strong pain relievers, spend thousands of dollars on X-ray, CT and MRI scans, get injections in one's back, and have a surgeon cut open one’s posterior to try to repair what simple exercises can, in many cases, effectively deal with. All I can say is I am glad I finally found a solution to my severe back problems. I was also informed by several doctors that the treatment I received is now the standard medical responses at some of the leading hospitals in the world, including at the University of Michigan in Ann Arbor, MI.

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