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Crooked: Outwitting the Back Pain Industry and Getting on the Road to Recovery
The acclaimed author of Carved in Sand —a veteran investigative journalist who endured persistent back pain for decades—delivers the definitive book on the an essential examination of all facets of the back pain industry, exploring what works, what doesn't, what may cause harm, and how to get on the road to recovery. In her effort to manage her chronic back pain, investigative reporter Cathryn Jakobson Ramin spent years and a small fortune on a panoply of treatments. But her discomfort only intensified, leaving her feeling frustrated and perplexed. As she searched for better solutions, she exposed a much bigger problem. Costing roughly $100 billion a year, spine medicine—often ineffective and sometimes harmful —exemplified the worst aspects of the U.S. health care system. The result of six years of intensive investigation, Crooked offers a startling look at the poorly identified risks of spine medicine, and provides practical advice and solutions. Ramin interviewed scores of spine surgeons, pain management doctors, physical medicine and rehabilitation physicians, exercise physiologists, physical therapists, chiropractors, specialized bodywork practitioners. She met with many patients whose pain and desperation led them to make life-altering decisions, and with others who triumphed over their limitations. The result is a brilliant and comprehensive book that is not only important but essential to millions of back pain sufferers, and all types of health care professionals. Ramin shatters assumptions about surgery, chiropractic methods, physical therapy, spinal injections and painkillers, and addresses evidence-based rehabilitation options—showing, in detail, how to avoid therapeutic dead ends, while saving money, time, and considerable anguish. With Crooked, she reveals what it takes to outwit the back pain industry and get on the road to recovery.
432 pages, Paperback
First published May 9, 2017
410 people are currently reading
1378 people want to read
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Displaying 1 - 30 of 147 reviews
June 5, 2017
I liked this book a lot, however, something was missing. Ramin does a fine job critiquing the spine surgeon and Chiropractic industry but when it comes to the therapists and other service forms of healing she comes across more as a devotee and loses her critical edge. She also does a poor job providing context. For example, over and over she meets with specialists in the field with rock-star personas. In passing she says that you have to watch out for people who tout specialties but are really poorly trained. Sound advice no doubt. However, 99% of us are not journalists who have money or means to access these top-notch specialists. So how is this helpful? After a while she gets more self-obsessed about her own treatments and fails to talk about what the typical sufferer of back pain has access to. What about ex-coal miners in small valleys in West Virginia. What do they do? She does a fine job reporting on the opioid crisis but it was merely a passing chapter. Overall, it would have been a much more solid book if she could have given a better structural analysis of how people in fly-over states with no major assets get their back treatment. Many of the treatments she covers involve going to gyms or other places to receive much physical therapy. Who has time for that? Most working parents are lucky if they can break away for a jog. And speaking of jogging, she just uncritically quotes trainers who say that most exercising done by most people is a waste because it does not target the muscles they think should be targeted. And then they say that when most people do target those muscles they do it all wrong and it is a waste again. Over and over she quotes these people who basically make it sound like their program is the right one and that everyone else is bad. Ramin does not analyze these statements are seem critical at all. She just says that after SHE did the treatment she felt good. Hello placebo affect! One gets the feeling that Ramin is a treatment junkie and that if I had a reputation for healing by having you lay in peanut butter for an hour each day that she would try it and feel good afterword. Also, she has no statistics for those treatments. She is all over the statistics for back surgery. But when it comes to the other programs she is brief and uncritical with the stats.
I know I sound like a downer on this book. But as a newcomer to the subject I did find it eye-opening. It's a good overview of the industry but I would certainly not take anything in this book as a recommendation even though she sound positive about many of the treatments. She loses the ability to be remotely objective and comes across as all to star-struck because she gets access to specialists whom the average person could never get access to much less afford. If you are wealthy, that's great. This book will be a helpful guide in helping you get rid of your surplus wealth. If you are a recovering trucker living on social-security and medicare this book will certainly inspire you to seek out different treatments but you may end up like Ramin bouncing around from program to program because they all just sound so nice.
I know I sound like a downer on this book. But as a newcomer to the subject I did find it eye-opening. It's a good overview of the industry but I would certainly not take anything in this book as a recommendation even though she sound positive about many of the treatments. She loses the ability to be remotely objective and comes across as all to star-struck because she gets access to specialists whom the average person could never get access to much less afford. If you are wealthy, that's great. This book will be a helpful guide in helping you get rid of your surplus wealth. If you are a recovering trucker living on social-security and medicare this book will certainly inspire you to seek out different treatments but you may end up like Ramin bouncing around from program to program because they all just sound so nice.
March 5, 2018
6 things I learned from this book
1. Two people can have the same MRI. One will have back pain the other won't.
2. Don't have back surgery
3. Don't have epidural spinal injections.
4.Don't take opioids.
5. Sitting for hour after hour is bad. Get up and move.
6. Find a good physical therapist who works with you to have a good workout/ stretch program.
1. Two people can have the same MRI. One will have back pain the other won't.
2. Don't have back surgery
3. Don't have epidural spinal injections.
4.Don't take opioids.
5. Sitting for hour after hour is bad. Get up and move.
6. Find a good physical therapist who works with you to have a good workout/ stretch program.
May 27, 2018
This is a good take-down of the back surgeons and others who are exploiting back-pain sufferers.
Overall, the book is quite good as an expose of what is wrong with the entire American for-profit fee-for-service medical-industrial complex. Its morally hazardous incentive system cannot function without strict regulation. Unfortunately, self-regulation is not happening in the current culture of corruption and incompetence.
For people with a bad back, the problem is that the author's recommendations for what to do are mostly based on low-quality evidence. She admits this, and so we wind up with anecdotal impressions from her field trips to various healers. This is perhaps reasonable, because at least what she recommends is probably harmless. Nevertheless, it's disappointing after she devotes so many pages to critiquing things for not being evidence-based.
I wish I could recommend a better book about back pain.
Overall, the book is quite good as an expose of what is wrong with the entire American for-profit fee-for-service medical-industrial complex. Its morally hazardous incentive system cannot function without strict regulation. Unfortunately, self-regulation is not happening in the current culture of corruption and incompetence.
For people with a bad back, the problem is that the author's recommendations for what to do are mostly based on low-quality evidence. She admits this, and so we wind up with anecdotal impressions from her field trips to various healers. This is perhaps reasonable, because at least what she recommends is probably harmless. Nevertheless, it's disappointing after she devotes so many pages to critiquing things for not being evidence-based.
I wish I could recommend a better book about back pain.
October 11, 2023
I was 35 and half in January of 2004, past the age when men get to change the world. My back had never been fantastic. I had rowed crew, was swimming or lifting daily (often both) and regularly playing squash. After an unsuccessful first attempt at entrepreneurship I was getting back into trading bonds for a Wall Street house. This entailed a daily commute by car to and from Canary Wharf. By then I was already visiting my osteopath Kris, mainly to deal with a “psoas’ bursitis,” whatever that means, but the back was not entirely playing ball.
I can remember precisely when it all took a turn for the worse: my friend Kaspar was in town from Hong Kong and the only time he had to share was in the gym, so we did the treadmill side-by-side, talking and running for a half hour. Driving home I felt this massive discomfort in my back. When I got home, I found it very hard to climb out of my car, not some low-slung thing, but an entirely mundane VW Golf. But I thought nothing of it. Three days later, I suffered all the way on my flight to Salonika for a good friend’s wedding, attempted my customary party trick of Cossack dancing and then bang! (or, rather, crack!!) The most intense pain ever hit my lower back, like I had not experienced before.
“All sharp pain is muscular,” my dad (a pioneering heart surgeon) asserted, adding that God did not give me my back to row crew and play squash. This was a sign to get a normal life --of the kind I will never have again, but little did I know that then! All the way back from Salonica to London (via Athens, which is the wrong way) I stood. I only sat down for takeoff and landing, a figurative ice pick firmly lodged in my lower back.
A week later things were a bit better, but not loads. And then I locked myself in the spare bathroom of my grand but shoddily-kept apartment opposite the Brompton Oratory. The door was of the kind that opens inwards, so breaking it took me three hours and entailed hitting it hard off-center, in order to break its frame. By the time I was done, my fists and forearms were purple, my voice was gone from shouting for help and the police were just about arriving to tell me they had had me covered all along. I actually appreciated that enormously. Was fantastic to know. First time in my life I’d had warm feelings for the boys (and girl!) in blue.
My back, on the other hand, was now totally gone. Kaput.
Twelve years later, boy do I wish somebody had given me a copy of “Crooked” there and then. Needless to say, it had not been written yet. But when I saw it I ordered it immediately.
My first reaction when it arrived through the post was “WHAT???”
“Crooked: Outwitting the Back Pain Industry and Getting on the Road to Recovery” weighs 600 grams. That’s one-and-a-quarter pounds in imperial. WHAT ON EARTH? From my angle, the author’s credibility was destroyed.
I read in the Tube these days (driving to work is a total “no no” for me, obviously). I make a point of always standing, so I can keep my back busy. I cannot afford to hang on to 600 (count’em) grams of book. But the damage was done. I was now in possession of “Crooked,” so I resolved to read it.
I was richly rewarded.
First of all, I learned tons.
1. I’ve had two MRI’s: one back in the summer of 2004 and one more recently, in 2013, probably the all-time peak of my pain. The results were 100% consistent: the disc between my 4th and 5th lumbar vertebrae is herniated / prolapsed and the bits that stick out press hard on my nerves.
Consistent, for sure, but totally irrelevant, it turns out. Allow me to quote from page 46: “in 1990, in a study of sixty-seven patients who did not suffer from back pain, orthopedic surgeon and spine researcher Scott Boden showed that more than 90 percent had degenerated or bulging discs, while a third had herniated discs and a fifth showed evidence of spinal stenosis.”
I was beyond shocked to read this. But it’s true. As author Cathryn Jakobson Ramin explains in Chapter 3 (“Hazardous Images”) just because your spine looks bad in a picture, it does not mean you should have debilitating back pain. Ergo, fixing what’s wrong in the picture may not fix your back pain either! I NEVER KNEW THAT. Indeed, when my father took me to a neurosurgeon friend of his, the verdict I was given was “this is a matter of physiology; if we do not intervene, your pain is not going anywhere!” Perhaps and perhaps not, basically.
2. Here in the UK, meantime, I followed all the steps my hyper-generous employer was happy to pay for. I started with infinite amounts of non-steroidal anti-inflammatories. The little red pills of Voltarol were rhomboid in shape and I took them by the ton, as prescribed. They actually did not give me any relief, but what the heck, I would not dream of risking the counterfactual. Then, on July 14, we forced our boss Stan to take us to the Zuma private room to celebrate the decimation of his ancestors (Stan is noble) over copious amounts of Chassagne Montrachet and some even more expensive red, also from Burgundy. The morning of the 15th I somehow navigated the Golf to Canary Wharf, where I had a French linker auction to handle, only to wake up at noon, face-down, in a pool of my own drool. That was the last time I tried the Voltarol. And quitting it did not leave me in any less pain. Cathryn Jakobson Ramin claims that Vioxx and its cousins might briefly have given me more relief while they were still legal, and may even have shepherded me through the bond auction my colleagues had to cover, but this is the one bit in the book I’d liked her to have covered a bit more. Still, you get a decent tour of the anti-inflammatories.
3. Apart for Voltarol, BUPA sorted me out with twice-weekly manipulation of my spine by a physical therapist. This entailed the two of us wearing the same wide leather belt, me leaning over at various angles and him (an older, unprofessionally effeminate, bald man with semifocals) messing with my lower back, and pressing his finger against different places near my spine while I was leaning, for fifteen to twenty minutes at a time.
After some twenty sessions of this charade, he told me that we were done trying this “manipulation” and the next thing he had in store for me was an injection of steroids into a hollow part of my spine. I was given the leaflets, we made the appointment and…
…well, I did not go. Don’t want to dwell too much on why I didn’t, but the thought of this fellow sticking a needle up my, erm coccyx, did not appeal.
Well, who woulda thunk, but Cathryn Jakobson Ramin has him covered too: Chapter 4 is all about jockeys, it’s called “Needle Jockeys” and it explains in gory detail that these injections do absolutely nothing at all in the medium term, let alone the long term. Oh, and if the injection goes wrong, you could be paralyzed for life, or you could die. For all the wrong reasons, it looks like I dodged a bullet there. Just imagine my therapist had been some type of female bombshell…
4. So I gave up on handling my back myself and left it to my father and brother. My father is, as mentioned above, one of the world’s pioneers in heart surgery. My brother may never become a household name, but he teaches heart surgery at Harvard, so he also knows a thing or two about cutting people up. Daddy accompanied me to my visit with my future surgeon (a friend and colleague of his), booked my appointment, told me how to prepare, the whole nine yards.
A week before my operation, daddy called: “Now listen, Athan, son: as your father I must tell you that you should not be operated on. Ninety times out of a hundred, you’ll get your life back. Nine, you’ll do another five operations and live in and out of hospitals for the rest of your life. And one, they’ll snap the wrong wire. I strongly advise you to get accustomed to the pain.”
An hour later, in what was clearly a coordinated effort, the phone rang again. This time it was my brother George: “Ela, Athan. You’re getting operated in a week’s time, right? I’ve called to say good luck, but in reality you just shouldn’t do it. Doctors never have them. I’ve worked at MGH, at Yale New Haven, at Mt. Sinai, at Cornell and at St. Elizabeth’s and I’ve never met a doctor who had one of these. So I asked around a bit. These things are for patients only. Do as you like, but you’re making a mistake. It’s your bad luck. You have a bad back. Don’t make it worse.”
So the whole thing had been a setup, basically. They had played me. Maybe the neurosurgeon had been in it too, I’ll never find out. But I cancelled.
Cathryn Jakobson Ramin has both my father and my brother covered, though. In chapter 5, “The Gold Standard,” she provides the full detail on the statistical results of lumbar spinal fusion surgery. If only they were as rosy as the stats my father gave me! In practice, the operation simply DOES NOT WORK.
The book moves on to discredit three more approaches, on which I do not have any personal angles, but I found her description of the path I nearly took so accurate and so convincing, that Chapter 6 “Google your Spine Surgery” on minimally invasive keyhole spinal surgery and Chapter 7 “Replacement Parts” on vertebral implants are also a total must-read.
Chapter 8 on “Opioid Wars” is the best chapter of the book and worth the price of purchase alone. It’s probably the chapter my friend Jonathan Cohn would like you to read first. (Oh, yeah, that’s why I bought the book, btw. I saw Jon’s endorsement and I thought “what the heck, it must be worth reading.”) Until I read this, I always thought the Sacklers were patrons of the arts. I can still hear the tour guides at Harvard telling the impressionable tourists that the tiling of the Sackler Museum picks up the hues of the roof of Memorial Hall. Now I just think of them as the white collar drug dealers that they are. Start with chapter 8!
From there onward the book goes all crunchy for my macho taste. But that’s just my taste, and if you want to hear about fifteen different types of “back whisperers” and “posture mavens,” if you think your options are limited to pilates and yoga (Pilates was originally Greek, btw, not German, tsk tsk!) then you’re in for a treat: Cathryn Jakobson Ramin gives you the full Grand Tour of all the exercise regimes ever invented for people to deal with their back. It really is all here and if it’s not here, then it’s on her website, which you must visit.
So there you have it: this is not my kind of book at all, but it’s one of the best books I’ve read. If you have a bad back, you can’t afford not to read it.
I can remember precisely when it all took a turn for the worse: my friend Kaspar was in town from Hong Kong and the only time he had to share was in the gym, so we did the treadmill side-by-side, talking and running for a half hour. Driving home I felt this massive discomfort in my back. When I got home, I found it very hard to climb out of my car, not some low-slung thing, but an entirely mundane VW Golf. But I thought nothing of it. Three days later, I suffered all the way on my flight to Salonika for a good friend’s wedding, attempted my customary party trick of Cossack dancing and then bang! (or, rather, crack!!) The most intense pain ever hit my lower back, like I had not experienced before.
“All sharp pain is muscular,” my dad (a pioneering heart surgeon) asserted, adding that God did not give me my back to row crew and play squash. This was a sign to get a normal life --of the kind I will never have again, but little did I know that then! All the way back from Salonica to London (via Athens, which is the wrong way) I stood. I only sat down for takeoff and landing, a figurative ice pick firmly lodged in my lower back.
A week later things were a bit better, but not loads. And then I locked myself in the spare bathroom of my grand but shoddily-kept apartment opposite the Brompton Oratory. The door was of the kind that opens inwards, so breaking it took me three hours and entailed hitting it hard off-center, in order to break its frame. By the time I was done, my fists and forearms were purple, my voice was gone from shouting for help and the police were just about arriving to tell me they had had me covered all along. I actually appreciated that enormously. Was fantastic to know. First time in my life I’d had warm feelings for the boys (and girl!) in blue.
My back, on the other hand, was now totally gone. Kaput.
Twelve years later, boy do I wish somebody had given me a copy of “Crooked” there and then. Needless to say, it had not been written yet. But when I saw it I ordered it immediately.
My first reaction when it arrived through the post was “WHAT???”
“Crooked: Outwitting the Back Pain Industry and Getting on the Road to Recovery” weighs 600 grams. That’s one-and-a-quarter pounds in imperial. WHAT ON EARTH? From my angle, the author’s credibility was destroyed.
I read in the Tube these days (driving to work is a total “no no” for me, obviously). I make a point of always standing, so I can keep my back busy. I cannot afford to hang on to 600 (count’em) grams of book. But the damage was done. I was now in possession of “Crooked,” so I resolved to read it.
I was richly rewarded.
First of all, I learned tons.
1. I’ve had two MRI’s: one back in the summer of 2004 and one more recently, in 2013, probably the all-time peak of my pain. The results were 100% consistent: the disc between my 4th and 5th lumbar vertebrae is herniated / prolapsed and the bits that stick out press hard on my nerves.
Consistent, for sure, but totally irrelevant, it turns out. Allow me to quote from page 46: “in 1990, in a study of sixty-seven patients who did not suffer from back pain, orthopedic surgeon and spine researcher Scott Boden showed that more than 90 percent had degenerated or bulging discs, while a third had herniated discs and a fifth showed evidence of spinal stenosis.”
I was beyond shocked to read this. But it’s true. As author Cathryn Jakobson Ramin explains in Chapter 3 (“Hazardous Images”) just because your spine looks bad in a picture, it does not mean you should have debilitating back pain. Ergo, fixing what’s wrong in the picture may not fix your back pain either! I NEVER KNEW THAT. Indeed, when my father took me to a neurosurgeon friend of his, the verdict I was given was “this is a matter of physiology; if we do not intervene, your pain is not going anywhere!” Perhaps and perhaps not, basically.
2. Here in the UK, meantime, I followed all the steps my hyper-generous employer was happy to pay for. I started with infinite amounts of non-steroidal anti-inflammatories. The little red pills of Voltarol were rhomboid in shape and I took them by the ton, as prescribed. They actually did not give me any relief, but what the heck, I would not dream of risking the counterfactual. Then, on July 14, we forced our boss Stan to take us to the Zuma private room to celebrate the decimation of his ancestors (Stan is noble) over copious amounts of Chassagne Montrachet and some even more expensive red, also from Burgundy. The morning of the 15th I somehow navigated the Golf to Canary Wharf, where I had a French linker auction to handle, only to wake up at noon, face-down, in a pool of my own drool. That was the last time I tried the Voltarol. And quitting it did not leave me in any less pain. Cathryn Jakobson Ramin claims that Vioxx and its cousins might briefly have given me more relief while they were still legal, and may even have shepherded me through the bond auction my colleagues had to cover, but this is the one bit in the book I’d liked her to have covered a bit more. Still, you get a decent tour of the anti-inflammatories.
3. Apart for Voltarol, BUPA sorted me out with twice-weekly manipulation of my spine by a physical therapist. This entailed the two of us wearing the same wide leather belt, me leaning over at various angles and him (an older, unprofessionally effeminate, bald man with semifocals) messing with my lower back, and pressing his finger against different places near my spine while I was leaning, for fifteen to twenty minutes at a time.
After some twenty sessions of this charade, he told me that we were done trying this “manipulation” and the next thing he had in store for me was an injection of steroids into a hollow part of my spine. I was given the leaflets, we made the appointment and…
…well, I did not go. Don’t want to dwell too much on why I didn’t, but the thought of this fellow sticking a needle up my, erm coccyx, did not appeal.
Well, who woulda thunk, but Cathryn Jakobson Ramin has him covered too: Chapter 4 is all about jockeys, it’s called “Needle Jockeys” and it explains in gory detail that these injections do absolutely nothing at all in the medium term, let alone the long term. Oh, and if the injection goes wrong, you could be paralyzed for life, or you could die. For all the wrong reasons, it looks like I dodged a bullet there. Just imagine my therapist had been some type of female bombshell…
4. So I gave up on handling my back myself and left it to my father and brother. My father is, as mentioned above, one of the world’s pioneers in heart surgery. My brother may never become a household name, but he teaches heart surgery at Harvard, so he also knows a thing or two about cutting people up. Daddy accompanied me to my visit with my future surgeon (a friend and colleague of his), booked my appointment, told me how to prepare, the whole nine yards.
A week before my operation, daddy called: “Now listen, Athan, son: as your father I must tell you that you should not be operated on. Ninety times out of a hundred, you’ll get your life back. Nine, you’ll do another five operations and live in and out of hospitals for the rest of your life. And one, they’ll snap the wrong wire. I strongly advise you to get accustomed to the pain.”
An hour later, in what was clearly a coordinated effort, the phone rang again. This time it was my brother George: “Ela, Athan. You’re getting operated in a week’s time, right? I’ve called to say good luck, but in reality you just shouldn’t do it. Doctors never have them. I’ve worked at MGH, at Yale New Haven, at Mt. Sinai, at Cornell and at St. Elizabeth’s and I’ve never met a doctor who had one of these. So I asked around a bit. These things are for patients only. Do as you like, but you’re making a mistake. It’s your bad luck. You have a bad back. Don’t make it worse.”
So the whole thing had been a setup, basically. They had played me. Maybe the neurosurgeon had been in it too, I’ll never find out. But I cancelled.
Cathryn Jakobson Ramin has both my father and my brother covered, though. In chapter 5, “The Gold Standard,” she provides the full detail on the statistical results of lumbar spinal fusion surgery. If only they were as rosy as the stats my father gave me! In practice, the operation simply DOES NOT WORK.
The book moves on to discredit three more approaches, on which I do not have any personal angles, but I found her description of the path I nearly took so accurate and so convincing, that Chapter 6 “Google your Spine Surgery” on minimally invasive keyhole spinal surgery and Chapter 7 “Replacement Parts” on vertebral implants are also a total must-read.
Chapter 8 on “Opioid Wars” is the best chapter of the book and worth the price of purchase alone. It’s probably the chapter my friend Jonathan Cohn would like you to read first. (Oh, yeah, that’s why I bought the book, btw. I saw Jon’s endorsement and I thought “what the heck, it must be worth reading.”) Until I read this, I always thought the Sacklers were patrons of the arts. I can still hear the tour guides at Harvard telling the impressionable tourists that the tiling of the Sackler Museum picks up the hues of the roof of Memorial Hall. Now I just think of them as the white collar drug dealers that they are. Start with chapter 8!
From there onward the book goes all crunchy for my macho taste. But that’s just my taste, and if you want to hear about fifteen different types of “back whisperers” and “posture mavens,” if you think your options are limited to pilates and yoga (Pilates was originally Greek, btw, not German, tsk tsk!) then you’re in for a treat: Cathryn Jakobson Ramin gives you the full Grand Tour of all the exercise regimes ever invented for people to deal with their back. It really is all here and if it’s not here, then it’s on her website, which you must visit.
So there you have it: this is not my kind of book at all, but it’s one of the best books I’ve read. If you have a bad back, you can’t afford not to read it.
March 20, 2019
All the ways capitalism has fucked up how we treat back pain, basically. Ought to be accompanied by a separate book about all the ways capitalism has fucked up our backs to begin with. Learned a lot.
January 13, 2019
This is a difficult book for me to review. I felt like I was reading two different books. The first half debunks the traditional back relief approaches from steroid shots, back surgery, chiropractic help, etc. The author is adamant that back surgery for the most part doesn't work. Also, all of the pain medications are also negative. They are addictive and they don't solve anything. Actually, it was quite discouraging. She did emphasize the extremes and all of the things that can go wrong. However, with this said, I doubt that many people in excruciating pain really question the side affects etc. of how they are advised.
The second half is the weak section. What do you do about it? Too many anecdotal stories and too many example of following celebrities, etc. What is the average Jo supposed to do? She advocates for movement, but it is difficult to find the right places to provide a back boot camp. There are so many people suffering with debilitating back issues. Sad. She never addressed acupuncture for example. I felt that the book wasn't complete hence the score. I just noticed that I have reviewed an ebook edition. I read this hard copy.
The second half is the weak section. What do you do about it? Too many anecdotal stories and too many example of following celebrities, etc. What is the average Jo supposed to do? She advocates for movement, but it is difficult to find the right places to provide a back boot camp. There are so many people suffering with debilitating back issues. Sad. She never addressed acupuncture for example. I felt that the book wasn't complete hence the score. I just noticed that I have reviewed an ebook edition. I read this hard copy.
March 29, 2020
Back pain is complex and so is human body. Our knowledge of human physiology is at its infancy. When man become erect spine bears all the brunt and is bound to degenerate. Why to some it causes pain is still unknown. The biopsychosocial approach is our best bet as of now. Pain has a biology, a social and psychological factors. The author cherry picks few cases and conveniently forgets thousands who might have improved. Complications happen with all procedures, like driving. The book is like interviewing all who had had a driving accident and researching car mechanical faults and deterring driving all together.
If modern medicine doesn't work, NONE does.
We can find millions of people who had alternate treatments and physical therapy and they promptly have relapse once the treatment is stopped. How many can afford life long treatment.
I had a transforaminal epidural way back in 2010 and helped me a lot to start physical exercises, which otherwise was not at all possible due to severe pain.
Books like this infuse paranoia,encourage patients not to trust modern medicine (and vaccines).
If you do not have a solution and talk about problems it's just complaining. Can the author definitely say "this treatment works for all everytime" for any chronic painful condition?
Pain is a chronic illness which can be controlled seldom cured, and it's always about risk benefit ratio. The mentioned complications of long term medications, injections and surgery are very real though, but the alternative is life long suffering.
Only thing that works is avoidance - by proper posture, weight reduction and physical activities, not to mention a resilient mind. I wonder if the author would venture investigating why she had a back pain in the first place.
If modern medicine doesn't work, NONE does.
We can find millions of people who had alternate treatments and physical therapy and they promptly have relapse once the treatment is stopped. How many can afford life long treatment.
I had a transforaminal epidural way back in 2010 and helped me a lot to start physical exercises, which otherwise was not at all possible due to severe pain.
Books like this infuse paranoia,encourage patients not to trust modern medicine (and vaccines).
If you do not have a solution and talk about problems it's just complaining. Can the author definitely say "this treatment works for all everytime" for any chronic painful condition?
Pain is a chronic illness which can be controlled seldom cured, and it's always about risk benefit ratio. The mentioned complications of long term medications, injections and surgery are very real though, but the alternative is life long suffering.
Only thing that works is avoidance - by proper posture, weight reduction and physical activities, not to mention a resilient mind. I wonder if the author would venture investigating why she had a back pain in the first place.
June 23, 2017
If you have chronic back pain you need to read this. Hard to know where to start. Author is a decades-long investigative reporter. She suffered back pain and got into the back-pain-industrial - complex.
About 3 years ago I developed excruciating lower back pain when I stand or walk more than about 10 minutes. It is caused by arthritis and "natural age-related deterioration." There is no operative solution for this.
I saw many doctors, including a pain clinic, and have had several bouts of months of physical therapy, including deep ultrasound heat massage, epidural steroid injections in the sacro-illiac joints (the source of pain), aqua therapy, more injections into the hips when they became painful because of hip bursitis (this wakes me up every night about 3 am) and more. For my low back chronic pain I have had radio frequency ablation (which severs nerve ends) which helped a little temporarily, and many locations of steroid epidural injections. Sometimes the steroids helped the local areas but NOTHING has touched the back pain. I have a Rx for Percocet (opioid pain medication) and try not to take more than one a day. That doesn't touch my back pain. Nothing. Nada. I can take two, but that makes me sleepy and I can't drive. So can't take these during the day.
The author says, "It's amazing the gigantic difference a pain patient can feel when he's had a couple of nights when he doesn't wake up five times. " I don't know what this means. I can't remember the last time I haven't awoken 4-5 times at least.
Also from this book "there are still physicians who tell their low back pain patients to do sit-ups to strengthen their abdominal muscles." And "not only will abdominal exercises strengthen your bones and the muscles of the back but they will also strengthen your entire midsection."
"Not one of these recommendations," said McGill "should be considered safe or effective." Her website is cathrynjakobsonramin.com. She also counsels against doing back stretching exercises when you first wake up and spine is swollen with fluid.
I will probably have to buy this book and re-read it in sections. It was just too much to take in. Depressing but knowledge anyone with chronic back pain should know.
About 3 years ago I developed excruciating lower back pain when I stand or walk more than about 10 minutes. It is caused by arthritis and "natural age-related deterioration." There is no operative solution for this.
I saw many doctors, including a pain clinic, and have had several bouts of months of physical therapy, including deep ultrasound heat massage, epidural steroid injections in the sacro-illiac joints (the source of pain), aqua therapy, more injections into the hips when they became painful because of hip bursitis (this wakes me up every night about 3 am) and more. For my low back chronic pain I have had radio frequency ablation (which severs nerve ends) which helped a little temporarily, and many locations of steroid epidural injections. Sometimes the steroids helped the local areas but NOTHING has touched the back pain. I have a Rx for Percocet (opioid pain medication) and try not to take more than one a day. That doesn't touch my back pain. Nothing. Nada. I can take two, but that makes me sleepy and I can't drive. So can't take these during the day.
The author says, "It's amazing the gigantic difference a pain patient can feel when he's had a couple of nights when he doesn't wake up five times. " I don't know what this means. I can't remember the last time I haven't awoken 4-5 times at least.
Also from this book "there are still physicians who tell their low back pain patients to do sit-ups to strengthen their abdominal muscles." And "not only will abdominal exercises strengthen your bones and the muscles of the back but they will also strengthen your entire midsection."
"Not one of these recommendations," said McGill "should be considered safe or effective." Her website is cathrynjakobsonramin.com. She also counsels against doing back stretching exercises when you first wake up and spine is swollen with fluid.
I will probably have to buy this book and re-read it in sections. It was just too much to take in. Depressing but knowledge anyone with chronic back pain should know.
June 21, 2017
I think this is essential reading for anyone with consistent spinal difficulties/pain. Having had spinal surgery last year that did nothing for the pain, I related to much of what Ramin had to say. I would give this a "5" except that many of the recommendations are not available to everyone, and this is a glaring omission. However, I still think it's a fantastic book!
August 1, 2017
With a spine that's been plaguing me since I was eighteen--let's see, that's fifty-two years now--and nurturing a rock-solid refusal to allow anyone holding a sharp implement to get within a mile of my spinal cord, I decided to take a look at what Ms. Ramin might suggest. There's hope to be found in this book and some of her advice seems to have helped me in the pain vs. mobility department. What's demoralizing to me, though, is her confirmation of something I've suspected since medicine first became a corporate thing with hospitals being bought up by conglomerates; there's a bottom line to this stuff, and you and I are considered a bumper crop of financial opportunity. So the doctor who, twenty-five years ago, said I definitely needed to go under the knife wasn't necessarily motivated by a Hippocratic need to fix my problem. His purpose may well have been to make a down payment on a Bentley.
What I came away with was confirmation that I was probably right in telling that doctor where to put his scalpel, but also that if things ever got bad to the point of my back being in constant pain and having feet I could see but couldn't feel, there would be a good chance I'd end up in a wheelchair if I gave in to the pressure and allowed a surgeon to "fix" me. But forget my woes. What Ms. Ramin presents is documentation of one huge reason why your insurance costs have gone up, and will probably continue to do so as doctors beat the drum for performing unnecessary procedures, and raping insurance companies in the process. I took a star away only in response to bad news and clinical language that tends to inspire sleep--but there was no way the author could help that aspect of things. It's a clinical subject, so you might consider that I'm being petty with that star. Ms. Ramin worked like a demon on this thing. It deserves better than critiques from me. Read the book.
What I came away with was confirmation that I was probably right in telling that doctor where to put his scalpel, but also that if things ever got bad to the point of my back being in constant pain and having feet I could see but couldn't feel, there would be a good chance I'd end up in a wheelchair if I gave in to the pressure and allowed a surgeon to "fix" me. But forget my woes. What Ms. Ramin presents is documentation of one huge reason why your insurance costs have gone up, and will probably continue to do so as doctors beat the drum for performing unnecessary procedures, and raping insurance companies in the process. I took a star away only in response to bad news and clinical language that tends to inspire sleep--but there was no way the author could help that aspect of things. It's a clinical subject, so you might consider that I'm being petty with that star. Ms. Ramin worked like a demon on this thing. It deserves better than critiques from me. Read the book.
February 18, 2018
First half of the book is one depressing chapter after another about medical interventions (procedures & drugs) that were hailed over the past 10 years as miracle cures for back pain, and all failed -- most noticeably the opioid epidemic. Last half, or third, is about the author's exploration of mostly non-intervention practices to assist with back pain, everything from intensive 3-week programs to rolfing, Tai Chi, etc. Lessons learned are... for general back pain and degeneration, don't do anything invasive, don't get hooked on painkillers (duh). Try preventative things, like the methods she mentions towards the end of the book, e.g. Feldrinkais Method. Realize that if you have severe but non-specific back pain you main need a more substantial treatment (like a sort of physical therapy boot camp) that teaches your nerves and brain how to recognize sensations from the spine as NOT being pain, meaning the sensations might not feel good but they don't mean that there is something wrong. Keep moving! Rest is not the best way to improve back pain. And finally, you can't "bank" good exercises for your back. That is, if you have chronic pain, you can't do all this non-invasive work, have the pain subside, and then expect it to never come back. Maintenance is lifelong. The author equates it with brushing your teeth. She highly recommends Stuart McGill's "Big Three" exercises to strengthen endurance of the spine (a modified crunch, a side plank, and a bird-dog). I'm doing bird-dog right now as I type this. Not really...
November 20, 2018
I am certain that future generations will view our present-day methods of treating chronic pain (e.g., slicing people open and using power tools to carve out their spinal discs, etc.) the same way we view bloodletting — as an inefficacious and dangerous practice fed by arrogance, ignorance, and greed.
I’ve had my doubts about the pain treatment industry some time now, but this book pulled the pieces together into a solid narrative that really left me fuming, particularly at the spine surgery industry. Or maybe it should be called the “$pine $urgery” industry.
Anyone who is considering surgery for chronic pain (1) should read this book and (2) should not get the surgery. There are so many alternatives that for various reasons are not readily offered or suggested in the health care setting. The author explores some of these methods, and there are many others that she didn’t have room to discuss.
The reason I didn’t give this book more stars is because the author didn’t approach all of the treatments entirely objectively. For instance, she basically says that chiropractic treatment is invalid because cavitations don’t show up on x-rays. Then in the second half of the book she suggests all kinds of alternative treatments where the benefits most definitely would not show up on x-rays. I believe these alternative treatments work, and I’m no particular fan of chiropractic treatment, but using one yardstick for treatments she doesn’t like and another for treatments she does like suggests she brings some heavy biases into her reporting, which undermines objectivity.
I’ve had my doubts about the pain treatment industry some time now, but this book pulled the pieces together into a solid narrative that really left me fuming, particularly at the spine surgery industry. Or maybe it should be called the “$pine $urgery” industry.
Anyone who is considering surgery for chronic pain (1) should read this book and (2) should not get the surgery. There are so many alternatives that for various reasons are not readily offered or suggested in the health care setting. The author explores some of these methods, and there are many others that she didn’t have room to discuss.
The reason I didn’t give this book more stars is because the author didn’t approach all of the treatments entirely objectively. For instance, she basically says that chiropractic treatment is invalid because cavitations don’t show up on x-rays. Then in the second half of the book she suggests all kinds of alternative treatments where the benefits most definitely would not show up on x-rays. I believe these alternative treatments work, and I’m no particular fan of chiropractic treatment, but using one yardstick for treatments she doesn’t like and another for treatments she does like suggests she brings some heavy biases into her reporting, which undermines objectivity.
August 13, 2017
This is not the kind of book you typically find on my nightstand, but...spoiler alert...I have back pain. I read an interview with the author and bought it immediately. Let me first say that this book is extremely well-written--it's like one of those great New Yorker articles you find yourself reading aloud to anyone who will listen. If Atul Guwande and Mary Roach collaborated on a book about back pain, this would be it.
The author's an investigative reporter (with, you guessed it, back pain) who spends the first half of the book exploring the history & current reality of back pain treatment, and the many ways the medical system has failed to address this incredibly common condition. There's greed, corruption, and malpractice, as you might expect.
In the second half, she takes us on a firsthand journey of the treatments that actually do work, as demonstrated through rigorous studies and plenty of interviews with people who've been successfully treated.
If you or anyone you know has back pain, this is the book! Seriously--check it out. (Oh, and in case you're wondering--you probably aren't, but I'll tell you anyway--after I read this book, I changed a bunch of things about how I deal with my own back, and it's all WORKING!)
The author's an investigative reporter (with, you guessed it, back pain) who spends the first half of the book exploring the history & current reality of back pain treatment, and the many ways the medical system has failed to address this incredibly common condition. There's greed, corruption, and malpractice, as you might expect.
In the second half, she takes us on a firsthand journey of the treatments that actually do work, as demonstrated through rigorous studies and plenty of interviews with people who've been successfully treated.
If you or anyone you know has back pain, this is the book! Seriously--check it out. (Oh, and in case you're wondering--you probably aren't, but I'll tell you anyway--after I read this book, I changed a bunch of things about how I deal with my own back, and it's all WORKING!)
September 20, 2017
I am a physical medicine and rehabilitation chiropractor. I found Crooked to be factual, entertaining, enlightening and pretty thorough. Her conclusion- that most back pain sufferers are mis-treated due to ignorance is spot on. She rightly includes all professions that may be involved in caring for this patient population and points to the minority successful practitioners and programs for guidance. Lay readers may be left feeling hopeless due to physical, financial or other inability to enjoy cutting edge, evidence-based approaches to treating low back pain, as these resources are few and far between. What IS clear is that these same frustrated patients best be wary of surgeons, physical therapists, chiropractors and others who have gotten lax and not kept up with the evidence and/or have convinced themselves that they are providing more benefit and less harm than they actually do.
My advice if you are not so lucky as to have access to one of the experts (there are many PT's, chiropractors and others who are qualified to help you. But it can be difficult to find them in the mass of zombie practitioners) is to read, re-read and follow Dr. Stuart McGill's (one of the author's "spine whisperers") book BACK MECHANIC. Dr. McGill's work will fill in the gaps found in Crooked.
My advice if you are not so lucky as to have access to one of the experts (there are many PT's, chiropractors and others who are qualified to help you. But it can be difficult to find them in the mass of zombie practitioners) is to read, re-read and follow Dr. Stuart McGill's (one of the author's "spine whisperers") book BACK MECHANIC. Dr. McGill's work will fill in the gaps found in Crooked.
August 12, 2018
I was close to giving this a 3 star as there are some things I have issues with in this book. However, she provides such a wealth of important information on this subject that is SO important to any of us with back issues that I am willing to give it 4 stars! I had a single level cervical fusion 2 years ago that just made things worse. Reading the first half of this book just made me so angry that doctors are prescribing interventions that have low effectiveness rate. One issue I had with this book is that she only talks about the lumbar spine issues and interventions. It made me wonder if the interventions she talks about are as ineffective for cervical issues.(I am sure they are) And on the other hand, if the ‘good’ interventions and exercise programs are good for cervical issues as well. One thing that is discouraging is that many of us can’t afford all the things she talks about in the second half and insurance won’t cover them. Very frustrating. Now I am off to research some lower cost options to implement her suggestions. One side note is that I am surprised that she didn’t investigate or mention acupuncture as it has also been effective in back pain relief. Excellent book in many ways but a bit meandering at times, just like this review!
June 15, 2017
Cathryn Jakobson Ramin endured back pain for decades and in a quest to find relief spent 6 years looking into to back pain remedies. As an investigative journalist, she was the perfect candidate to delve into this growing problem in the U.S. Over $100 billion a year is spent in our country on relief from back pain. Unfortunately, many of the commonly prescribed procedures offer no relief for pain or are actually harmful, leaving the patient worse off than before the procedure. After reading this informative book, I came to understand the best remedy for an aching back is walking and light exercise. The worse things one can do for an aching back are to have surgery, spinal injections, strong pain relief medication, and/or chiropractic care. Many individuals who walked and exercised eventually were free from pain and able to move on with their lives. However, in the U.S., things probably will not change anytime soon because of big Pharma and the large amount of doctors who make their money from spine surgeries. If you suffer from back pain, this book is a must read. It's very eye opening!
July 15, 2017
This book does an excellent job of chronicling why you should not get back surgery and the problems with going to a chiropractor and Ramin backs it up with research. Like another reviewer said though, the value of the book comes apart a bit during the treatment section during the last half. I absolutely agree with her that exercise based therapy which is tailored to the patient's individual needs is the only workable response to most back pain. But, the therapies she endorses are not available to most of us. I've had significant back problems for 35 years, but carefully selected physical therapists and well-trained pilates instructors have become those "back whisperers" that she recommends.
I intend to recommend this book to others with back pain but, when I do, I will warn them not to take the therapy section as the ultimate truth. One other note, Ramin has an excellent website that is a good source of information on this topic. As with the book though, you need to evaluate it critically and not take everything as gospel.
I intend to recommend this book to others with back pain but, when I do, I will warn them not to take the therapy section as the ultimate truth. One other note, Ramin has an excellent website that is a good source of information on this topic. As with the book though, you need to evaluate it critically and not take everything as gospel.
March 9, 2020
A rough book to get through. Good (or at least a lot of) data on all the bad things the medical profession does to your back, which relatively little, if any, helps (most seem to actually be damaging). But so, so long and very repetitive. And the second half of the book, where Ramin goes through remedies, are not very thorough, no real direction except there might be something out there (other than surgery of course). This is one of those times where the author reading her own work is tough to listen to. Even at 3x.
July 7, 2018
If you have chronic back pain, don't miss out on this book. The first half can be depressing, as the journalist author investigates the surgical side of back treatment. The second half, though, explores the many non-surgical, non-medicated treatments.
July 11, 2019
Ramin takes a critical look at chiropractors, physical therapists who don't actually teach people any exercises, doctors, and spinal surgeons, and extolls the virtues of exercise rehabilitation specialists, posture therapists, etc.
I'm so incredibly biased on this subject that I'm going to review this book from the perspective of my own experience, not to analyze the author's organization and research.
Reading this book was an affirmation to me as I found it to be largely spot-on when compared to my own healing process.
I herniated my L4/L5 disc in early 2017. It was the most excruciating pain I'd ever felt, running from my back all the way down to my left foot. I could barely walk for two months after it happened, and at first I even had trouble sleeping at all since the touch of the softest blanket felt like it was burning me.
My chiropractor at the time got me in for an MRI and declared that I needed surgery. Luckily, the neurosurgeon he wanted to refer me to was scheduled two months out, so I couldn't see him right away. While I waited, I looked up everything I could get my hands on about herniated discs, and, crazy with pain, became increasingly convinced that my life as I knew it was over and I was going to be like this until I died.
However, my chiro referred me to chiro #2, who had a decompression table that might serve as a last-ditch effort to avoid surgery. Chiro 2 put me on this table that played me like an accordion and he encouraged me to keep moving, gently, and as much as possible.
At the time, I thought the decompression treatments saved me, but now I think it was the encouragement to keep moving, plus a woman I knew who helped me focus on a belief that I would get through this.
Using hiking poles, I walked as much as possible and I went swimming at least once a week even though it was painful. Gradually, I started to get better, to the point that by the time I met with the neurosurgeon, he said that I didn't need surgery. That summer, I challenged myself with an 8-mile hike on Mount St. Helens.
Now, two years out from the injury, I still have to take as many walks as I can, plus swimming and Pilates, but I have zero pain or numbness from my injury. I also haven't felt the need to see a chiropractor since I was released from Chiro 2's treatment.
I never got the sense that either of my chiropractors were just out to take my money--they are both really great guys. However, I'm now pretty convinced that chiropractic care just isn't necessary for people who are able to stay fit and find other ways to release tension.
I'm also very grateful that the neurosurgeon I saw was one who was very conservative with treatments and was not at all eager to cut me open willy-nilly. The stories I read online of how a failed microdiscectomy led to a spinal fusion which led to another spinal fusion terrified me. Never. Never ever doing it. I had to wait a long time to be out of pain, but it was worth it not to be cut open, and I'm thankful to this author for looking at the lack of effectiveness of spinal surgery.
I found the musings about exercise to jive with my own experience, although I don't think it's necessary to go out and find the best of the best like Ramin did. Her advice about which credentials to look for is probably good, though.
Ramin admires John Sarno's work. Sarno's books are about how all back pain is emotional, not physical. I don't believe that's true for everyone, so I think Sarno sounds a bit quacky. However, I could see how emotions could contribute to back pain by creating muscle tension, and I could believe that some people might be able to cure their pain by dealing with their emotional state.
I also don't think rolfing should be looked upon as a universal good for back pain. When I was looking for info about the psoas muscle, because I believed that a psoas strain had caused my herniated disc, I found info about deep tissue massage to release the psoas. However, the psoas is behind a lot of important stuff and near the abdominal aorta, so if you get someone who's not experienced at finding it, they could really damage you if they press too hard on the wrong thing.
Ramin touts posture awareness, which I did find to be a good tool in my back-healing toolbox. The book 8 Steps to a Pain-Free Back: Natural Posture Solutions for Pain in the Back, Neck, Shoulder, Hip, Knee, and Foot was very helpful. I spent a lot of time with it re-learning how to sit, stand, walk, and sleep so that my whole body would be in better alignment. I don't think Ramin mentions the author of this book in hers, but I noticed that the book was in her bibliography.
Overall, this book made me so thankful that I had my back injury in 2017 and not before. The book came out that same year, and it sounds like best practices for conservative treatment of back pain had already begun changing by then. I am so happy that they did.
I do notice that I remain reluctant, psychologically, to do anything too strenuous. I've found that lifting too much does set off some numbness in my toe or my foot, so I think I'll keep avoiding that. Ramin's book made me think that maybe it's okay to push myself a little bit in other areas, though, like maybe some jogging instead of walking, going to a more difficult Pilates class, or maybe starting some weight training.
I spent most of my life as a sedentary nerd, but Ramin's got me convinced that maybe a life-sentence to exercising isn't actually so bad.
I'm so incredibly biased on this subject that I'm going to review this book from the perspective of my own experience, not to analyze the author's organization and research.
Reading this book was an affirmation to me as I found it to be largely spot-on when compared to my own healing process.
I herniated my L4/L5 disc in early 2017. It was the most excruciating pain I'd ever felt, running from my back all the way down to my left foot. I could barely walk for two months after it happened, and at first I even had trouble sleeping at all since the touch of the softest blanket felt like it was burning me.
My chiropractor at the time got me in for an MRI and declared that I needed surgery. Luckily, the neurosurgeon he wanted to refer me to was scheduled two months out, so I couldn't see him right away. While I waited, I looked up everything I could get my hands on about herniated discs, and, crazy with pain, became increasingly convinced that my life as I knew it was over and I was going to be like this until I died.
However, my chiro referred me to chiro #2, who had a decompression table that might serve as a last-ditch effort to avoid surgery. Chiro 2 put me on this table that played me like an accordion and he encouraged me to keep moving, gently, and as much as possible.
At the time, I thought the decompression treatments saved me, but now I think it was the encouragement to keep moving, plus a woman I knew who helped me focus on a belief that I would get through this.
Using hiking poles, I walked as much as possible and I went swimming at least once a week even though it was painful. Gradually, I started to get better, to the point that by the time I met with the neurosurgeon, he said that I didn't need surgery. That summer, I challenged myself with an 8-mile hike on Mount St. Helens.
Now, two years out from the injury, I still have to take as many walks as I can, plus swimming and Pilates, but I have zero pain or numbness from my injury. I also haven't felt the need to see a chiropractor since I was released from Chiro 2's treatment.
I never got the sense that either of my chiropractors were just out to take my money--they are both really great guys. However, I'm now pretty convinced that chiropractic care just isn't necessary for people who are able to stay fit and find other ways to release tension.
I'm also very grateful that the neurosurgeon I saw was one who was very conservative with treatments and was not at all eager to cut me open willy-nilly. The stories I read online of how a failed microdiscectomy led to a spinal fusion which led to another spinal fusion terrified me. Never. Never ever doing it. I had to wait a long time to be out of pain, but it was worth it not to be cut open, and I'm thankful to this author for looking at the lack of effectiveness of spinal surgery.
I found the musings about exercise to jive with my own experience, although I don't think it's necessary to go out and find the best of the best like Ramin did. Her advice about which credentials to look for is probably good, though.
Ramin admires John Sarno's work. Sarno's books are about how all back pain is emotional, not physical. I don't believe that's true for everyone, so I think Sarno sounds a bit quacky. However, I could see how emotions could contribute to back pain by creating muscle tension, and I could believe that some people might be able to cure their pain by dealing with their emotional state.
I also don't think rolfing should be looked upon as a universal good for back pain. When I was looking for info about the psoas muscle, because I believed that a psoas strain had caused my herniated disc, I found info about deep tissue massage to release the psoas. However, the psoas is behind a lot of important stuff and near the abdominal aorta, so if you get someone who's not experienced at finding it, they could really damage you if they press too hard on the wrong thing.
Ramin touts posture awareness, which I did find to be a good tool in my back-healing toolbox. The book 8 Steps to a Pain-Free Back: Natural Posture Solutions for Pain in the Back, Neck, Shoulder, Hip, Knee, and Foot was very helpful. I spent a lot of time with it re-learning how to sit, stand, walk, and sleep so that my whole body would be in better alignment. I don't think Ramin mentions the author of this book in hers, but I noticed that the book was in her bibliography.
Overall, this book made me so thankful that I had my back injury in 2017 and not before. The book came out that same year, and it sounds like best practices for conservative treatment of back pain had already begun changing by then. I am so happy that they did.
I do notice that I remain reluctant, psychologically, to do anything too strenuous. I've found that lifting too much does set off some numbness in my toe or my foot, so I think I'll keep avoiding that. Ramin's book made me think that maybe it's okay to push myself a little bit in other areas, though, like maybe some jogging instead of walking, going to a more difficult Pilates class, or maybe starting some weight training.
I spent most of my life as a sedentary nerd, but Ramin's got me convinced that maybe a life-sentence to exercising isn't actually so bad.
March 9, 2025
YILIN KİTABI
öncelikle kitap önerisi için luigi mangione'ye çok teşekkürler.
hayatında 1 kez bile ağrımamış ve beli ağrıyan birini tanımıyor olsanız bile (çok zor) okumanız gereken bir kitap. konu aslında çarpık sağlık sistemi ve tüm katılımcıların insanları iyileştirmekten ziyade 'müşteri' olarak sistemin içinde tüketici olarak kalması için elinden geleni yapmasıyla sadece yanlış teşhis ve tedaviden çooook daha geniş yerlere uzanıyor.
işe yaramayan görüntüleme sistemlerinden, gereksiz operasyonlardan devasa risklere, malpracticeten başka hiçbir şey yapmayanların ceza bile almadıkları dev 1 çukur ve hiçbiri istisna değil. tüm korkunçlukların yanı sıra omurga sağlığı ile ilgili de çok fazla şey öğrendim; fellow oturarak çalışanlar yapacak çok şey var.
yazar ara ara kritik düşünmeye yaptığı vurguyu kendi promote ettiği yaklaşımlarda kaybediyor ve aslında neyin iyi olduğunu kanıtlama çabasında biraz yönünü/ikna ediciğini kaybediyor. ama bu da tedavi yaklaşmının/bireyin ihtiyacına özgü ve bütünsel olmasındadır diyoruz.
sadece amerika özelinde değil tüm dünyadaki sağlık sistemleri ve conflict of interest ilişkileri üzerine yine bizim üzerimize araştırmak-öğrenmek-bilinmeyeni bilmek görevleri yükleniyor. hepimize kolay gelsin.
öncelikle kitap önerisi için luigi mangione'ye çok teşekkürler.
hayatında 1 kez bile ağrımamış ve beli ağrıyan birini tanımıyor olsanız bile (çok zor) okumanız gereken bir kitap. konu aslında çarpık sağlık sistemi ve tüm katılımcıların insanları iyileştirmekten ziyade 'müşteri' olarak sistemin içinde tüketici olarak kalması için elinden geleni yapmasıyla sadece yanlış teşhis ve tedaviden çooook daha geniş yerlere uzanıyor.
işe yaramayan görüntüleme sistemlerinden, gereksiz operasyonlardan devasa risklere, malpracticeten başka hiçbir şey yapmayanların ceza bile almadıkları dev 1 çukur ve hiçbiri istisna değil. tüm korkunçlukların yanı sıra omurga sağlığı ile ilgili de çok fazla şey öğrendim; fellow oturarak çalışanlar yapacak çok şey var.
yazar ara ara kritik düşünmeye yaptığı vurguyu kendi promote ettiği yaklaşımlarda kaybediyor ve aslında neyin iyi olduğunu kanıtlama çabasında biraz yönünü/ikna ediciğini kaybediyor. ama bu da tedavi yaklaşmının/bireyin ihtiyacına özgü ve bütünsel olmasındadır diyoruz.
sadece amerika özelinde değil tüm dünyadaki sağlık sistemleri ve conflict of interest ilişkileri üzerine yine bizim üzerimize araştırmak-öğrenmek-bilinmeyeni bilmek görevleri yükleniyor. hepimize kolay gelsin.
April 12, 2021
5.0 out of 5 stars Very useful in charting a path. Explores a whole range of treatments
Reviewed in the United States on January 8, 2018
Verified Purchase
We found this book after some searching because my wife has non specific back pain. With insurance deductibles as high as what they are these days (thanks to the Patient Protection and Affordable Care Act), I am trying to map a plan for her treatment as judiciously as possible because it only takes a very few missteps to waste a lot of money.
Boy am I glad that I found this book!
There is so much information on this topic, it's amazing that the author got in even as much as she did.
The author breaks the book into two parts: 1. Problems. 2. Solutions.
That is not quite the way that the book comes across to me. It's more like:
1. Scope of the problem
2. What *definitely does not work* (i.e., Chiropractic-- If the initial practitioners of chiropractic knew how much fodder they would have provided for later people to blowtorch them with, they would never have started to ply their trade.)
3. What has a shakier track record (Surgery of various types/ Injections, along with detailing the techniques of each type of surgery)
4. Relationship of mental states to back pain. (It's not psychosomatic, but more of it is in a person's head than they might imagine.)
5. What has the best track record (Different types of exercise and methods to improve movement).
There are also quite a few questions around the edges that have tangential relationships.
'
1. What are the misaligned incentives such that surgeons want to do a whole bunch of extra surgeries, even if they have only marginal benefit. (To a hammer, everything looks like a nail.) Could those incentives be made better?
2. What happens when the state is the single provider of medicine? There are a lot more treatments than they can test and sort through and in their question to do less work, they may exclude some very effective treatments.
3. What happens when insurance companies will not pay for something that is a little bit too much to pay for out of pocket but less than what it would cost to take a surgery?
The book itself appears to be four things at once:
1. Medical history
2. Investigative journalism (the author herself goes through many treatments as well as calls to attention exposes of corrupt doctors)
3. A policy book (that asks questions about outcomes under universal health care as well as insurance based systems)
4. Information on success rates of different types of surgery/ procedures (and there are many of them)
I don't know that this is an exhaustive literature survey-- but there are some things that give the reader directions for further study. So, for example, we might want to get a meta analysis of one particular type of surgery to get an idea if *many* surgeries say that it is no more effective than placebo or just the study that Ramin uotes.
The book is well organized (with a good index) and well sourced.
Verdict: Worth the price and worth the time. Even if you have to read the book a second time or go to the medical library to source some of the citations in this book or do secondary research.
Recommended.
Reviewed in the United States on January 8, 2018
Verified Purchase
We found this book after some searching because my wife has non specific back pain. With insurance deductibles as high as what they are these days (thanks to the Patient Protection and Affordable Care Act), I am trying to map a plan for her treatment as judiciously as possible because it only takes a very few missteps to waste a lot of money.
Boy am I glad that I found this book!
There is so much information on this topic, it's amazing that the author got in even as much as she did.
The author breaks the book into two parts: 1. Problems. 2. Solutions.
That is not quite the way that the book comes across to me. It's more like:
1. Scope of the problem
2. What *definitely does not work* (i.e., Chiropractic-- If the initial practitioners of chiropractic knew how much fodder they would have provided for later people to blowtorch them with, they would never have started to ply their trade.)
3. What has a shakier track record (Surgery of various types/ Injections, along with detailing the techniques of each type of surgery)
4. Relationship of mental states to back pain. (It's not psychosomatic, but more of it is in a person's head than they might imagine.)
5. What has the best track record (Different types of exercise and methods to improve movement).
There are also quite a few questions around the edges that have tangential relationships.
'
1. What are the misaligned incentives such that surgeons want to do a whole bunch of extra surgeries, even if they have only marginal benefit. (To a hammer, everything looks like a nail.) Could those incentives be made better?
2. What happens when the state is the single provider of medicine? There are a lot more treatments than they can test and sort through and in their question to do less work, they may exclude some very effective treatments.
3. What happens when insurance companies will not pay for something that is a little bit too much to pay for out of pocket but less than what it would cost to take a surgery?
The book itself appears to be four things at once:
1. Medical history
2. Investigative journalism (the author herself goes through many treatments as well as calls to attention exposes of corrupt doctors)
3. A policy book (that asks questions about outcomes under universal health care as well as insurance based systems)
4. Information on success rates of different types of surgery/ procedures (and there are many of them)
I don't know that this is an exhaustive literature survey-- but there are some things that give the reader directions for further study. So, for example, we might want to get a meta analysis of one particular type of surgery to get an idea if *many* surgeries say that it is no more effective than placebo or just the study that Ramin uotes.
The book is well organized (with a good index) and well sourced.
Verdict: Worth the price and worth the time. Even if you have to read the book a second time or go to the medical library to source some of the citations in this book or do secondary research.
Recommended.
September 14, 2018
I have had back pain since 2010. Sometimes it doesn't hurt at all. Sometimes it hurts so much the thought of sitting in a movie theater with friends for two hours makes me feel panicked. I've had several of the treatments described in this book, and some of them have helped- for a while. And some of them haven't. And I think that's what I relate to most in this book: so many of the results from back pain treatment are inconclusive and costly.
Like all things, it's complicated. If you're in pain long enough, this book says, your nerves can start behaving like a hot mic, picking up any movement and distorting it into feelings of pain, even if everything is actually fine. Some people suggest that back pain can be linked to emotional states. But also back pain can come from something as simple as not holding yourself correctly over a long period of time. Or, perhaps, as my doctors and many others have said in the past, it could be a disc 'herniation' that requires surgery.
Unless you're lucky, and can find a 'back whisperer' to give you physical therapy that you can accurately replicate on your own time (not something I've always been good at, I admit. Though I am trying to fix that), or find the perfect exercise regime, or a godlike yoga instructor. Not to mention sticking to that exercise regime/PT/whatever for the rest of your life, because - surprise - back pain is often a lifelong Thing To Manage.
Crooked made me think. And question. And worry. And besides the worrying part, I think that's the best thing a person can get from reading this book. When a doctor gives you a diagnosis, ask questions. Do your research. And when it comes to back pain, don't underestimate your ability to recover.
Also don't be afraid to jump back and forth between the Problems and Solutions sections of the book. The Problems section is a valuable (but sickening) list of warning flags and terrifying reports of spinal fusion companies and chiropractors behaving like businesses trying to get the most out of the health care system, and it's okay to get so freaked out about everything that you dip your toes in the Solutions section for a breather.
Like all things, it's complicated. If you're in pain long enough, this book says, your nerves can start behaving like a hot mic, picking up any movement and distorting it into feelings of pain, even if everything is actually fine. Some people suggest that back pain can be linked to emotional states. But also back pain can come from something as simple as not holding yourself correctly over a long period of time. Or, perhaps, as my doctors and many others have said in the past, it could be a disc 'herniation' that requires surgery.
Unless you're lucky, and can find a 'back whisperer' to give you physical therapy that you can accurately replicate on your own time (not something I've always been good at, I admit. Though I am trying to fix that), or find the perfect exercise regime, or a godlike yoga instructor. Not to mention sticking to that exercise regime/PT/whatever for the rest of your life, because - surprise - back pain is often a lifelong Thing To Manage.
Crooked made me think. And question. And worry. And besides the worrying part, I think that's the best thing a person can get from reading this book. When a doctor gives you a diagnosis, ask questions. Do your research. And when it comes to back pain, don't underestimate your ability to recover.
Also don't be afraid to jump back and forth between the Problems and Solutions sections of the book. The Problems section is a valuable (but sickening) list of warning flags and terrifying reports of spinal fusion companies and chiropractors behaving like businesses trying to get the most out of the health care system, and it's okay to get so freaked out about everything that you dip your toes in the Solutions section for a breather.
January 24, 2019
I have been suffering with sciatica and a lumbar disc protrusion for almost a year (after a lifting accident?). This book came up in my feed, I downloaded it, and finishied it within days, due to my obsessive interest in my own condition.
It's strenght is the detailed investigation with which Ramin details conventional treatments for back pain. I learned in more detail about the fiscal motivation of much of hte back pain industry. There were plenty of examples of doctors, surgeons, and vendors willing to sacrifice human suffering in order to make a quick buck. The most horrifying story was regarding a Corona del Mar hospital where doctors used fake spinal fusion screws in order to save money, causing multiple back failures in surgical patients. In addition, Ramin doesnt only go after greedy surgeons, but chriopractors and "natural" interventions as well, many of which are likewise in it for the money.
The weakness of the book, however, is that Ramin paints with too broad of a brush, often cherry picking stories, anecdotes, and studies which lead her to imply back interventions are ineffective for all patients and exercise is the cure. Given my independent research I think a more balanced answer lies in the middle. Certainly for non-specific bach ache symptoms, by geriatric patients who are not active, surgery should be a last resort, there seeem to be many instances (for instance symptomatic nerve root compression) for which various endoscopic microdisectomies are highly effective and lead to a healthy prognosis.
It's strenght is the detailed investigation with which Ramin details conventional treatments for back pain. I learned in more detail about the fiscal motivation of much of hte back pain industry. There were plenty of examples of doctors, surgeons, and vendors willing to sacrifice human suffering in order to make a quick buck. The most horrifying story was regarding a Corona del Mar hospital where doctors used fake spinal fusion screws in order to save money, causing multiple back failures in surgical patients. In addition, Ramin doesnt only go after greedy surgeons, but chriopractors and "natural" interventions as well, many of which are likewise in it for the money.
The weakness of the book, however, is that Ramin paints with too broad of a brush, often cherry picking stories, anecdotes, and studies which lead her to imply back interventions are ineffective for all patients and exercise is the cure. Given my independent research I think a more balanced answer lies in the middle. Certainly for non-specific bach ache symptoms, by geriatric patients who are not active, surgery should be a last resort, there seeem to be many instances (for instance symptomatic nerve root compression) for which various endoscopic microdisectomies are highly effective and lead to a healthy prognosis.
June 17, 2017
Ramin does a thorough job revealing the inadequacy and possible dangers of most back pain treatments that are seen as accepted practice these days. Readers will be appropriately warned off of going to chiropractors, having laser treatments, enduring serial spinal injections or giving into fusion surgery. The key to dealing with back pain seems to be a combination of intensive, targeted exercise (best prescribed by a highly skilled and well trained PT) and getting your fear of being debilitated by back pain under control. Unfortunately finding a "back whisperer" is no easy (or affordable) feat. Ramin tried so many different "experts" in the field of back pain rehabilitation, I began to wonder why she didn't stick with the one or two professionals who appeared to work their miracles with her. She was constantly being treated by experts who made time in their overbooked schedules for her and gave her advice and treatment that was comprehensive, but time consuming and VERY expensive. If you are fortunate enough to find a "back whisperer," it's unlikely that person will be able to see you any time soon, and insurance (including Medicare) won't cover it. This is a great book for telling you what not to do for back pain. Her solutions for what you should do seem out of reach financially and time-wise for the average person.
March 15, 2017
Cathryn,
Thank you for the opportunity to read your book, “Crooked, etc etc—title”
I loved your book; it is wonderful, thoroughly and brilliantly researched; a compelling and essential work. And, it is so easy---a beautiful read. You have really accomplished something. Congratulations.
Wow. I believe you have a winner, here.
I can't wait for the book's publication to buy a copy for my daughter Jessica, the Pilates Master who does experience back pain on occasion.
Howard Schatz, MD
Thank you for the opportunity to read your book, “Crooked, etc etc—title”
I loved your book; it is wonderful, thoroughly and brilliantly researched; a compelling and essential work. And, it is so easy---a beautiful read. You have really accomplished something. Congratulations.
Wow. I believe you have a winner, here.
I can't wait for the book's publication to buy a copy for my daughter Jessica, the Pilates Master who does experience back pain on occasion.
Howard Schatz, MD
May 7, 2018
A fairly thorough look at issues around back pain, mostly through the lens of the author's experience. I do have something of a class critique, that I'm not quite sure how to formulate? It feels judgy when she moves outside of her own sphere of upper-middle-class professionals. But there are some specific things in part two that I might actually look into myself. (I've had pretty good results with the McKenzie method, FWIW.)
January 27, 2024
Like a lot of people who have read this book I have some back problems. Honestly nothing compared to some of the horror stories here, but enough that I have a had two x-rays since 2019 both confirming degenerative disc disease (DDD), spinal stenosis and lower lumbar spondylosis. With that diagnosis you naturally get a bit concerned, but one of the first things you learn in 'Crooked' is that those things describe a huge percentage of the human population over say 40 or 50 and I am well beyond that! Anyway this is a really valuable book on many levels. It provides a broad and insightful review of the medical profession response to what is nearly an epidemic in modern America, probably owing to prolonged sitting and sedentary lifestyles, although individual reasons vary. She does a full take down on the various spinal surgery, device and pain intervention industries and anyone considering surgery of any kind really owes it to themselves to at least read this first. Most have become familiar with the pain management catastrophe owing to successful books and series like 'Dopesick' and others that exposed the abuses started by the infamous Sackler family.
Much of the rest of the book focuses on her search for solutions to back pain and she firmly comes down on the side of exercise, something I have had good results with myself. Unfortunately, it gets a little confusing as she consults different practitioners and experts on what combination or theory of exercise is best. Some of the rehab facilities she visits are either prohibitively expensive or confined to big cities. Same for some of the 'alternative' methods such as Feldenkrais, Rolfing and Alexander technique. But the important thing is she comes at each discipline with an open mind and gives the reader enough information to make their own inquiries. I would recommend this book to anyone with back pain, even minor, which can easily become major if ignored. It will provide a world of information and hope! 4.5 stars rounded down for the absence of any diagrams or even photos to help the reader with visualization.
Much of the rest of the book focuses on her search for solutions to back pain and she firmly comes down on the side of exercise, something I have had good results with myself. Unfortunately, it gets a little confusing as she consults different practitioners and experts on what combination or theory of exercise is best. Some of the rehab facilities she visits are either prohibitively expensive or confined to big cities. Same for some of the 'alternative' methods such as Feldenkrais, Rolfing and Alexander technique. But the important thing is she comes at each discipline with an open mind and gives the reader enough information to make their own inquiries. I would recommend this book to anyone with back pain, even minor, which can easily become major if ignored. It will provide a world of information and hope! 4.5 stars rounded down for the absence of any diagrams or even photos to help the reader with visualization.
January 31, 2020
Yes, Crooked reveals the dark side of the (money making) back pain industry and spends a lot of time on what NOT to do. But happily, there's plenty of advice of what one can do and investigate.
Ms. Ramin reinforces that our sedentary lifestyles with too much sitting, heads constantly forward, and a c-curved spine causes deterioration of the spine, muscle loss, and resulting pain. Then I read (and re-read) the best chapter in the book -- The Back Whisperers. Turns out proper reconditioning with exercises and soft tissue work can make such a difference. She talks about how we limit our movements and hold our backs in awkward positions to avoid back pain -- which promotes further back de-conditioning. (I'm automatically straightening up as I write this). She goes into detail on the importance of proper body conditioning with correctly executed exercises and how to reduce the effects of poor posture and body movement.
In the end, I came away with the sobering thought that there is no cure for my chronic back pain (herniated discs). But can it be successfully managed and one can return to a normal life.
Crooked is a result of much hard work and incredible amount of research. I wholeheartedly prescribe this book and a personal thank you goes out to Ms. Ramin.
See full review and more at https://www.bookbarmy.com
Ms. Ramin reinforces that our sedentary lifestyles with too much sitting, heads constantly forward, and a c-curved spine causes deterioration of the spine, muscle loss, and resulting pain. Then I read (and re-read) the best chapter in the book -- The Back Whisperers. Turns out proper reconditioning with exercises and soft tissue work can make such a difference. She talks about how we limit our movements and hold our backs in awkward positions to avoid back pain -- which promotes further back de-conditioning. (I'm automatically straightening up as I write this). She goes into detail on the importance of proper body conditioning with correctly executed exercises and how to reduce the effects of poor posture and body movement.
In the end, I came away with the sobering thought that there is no cure for my chronic back pain (herniated discs). But can it be successfully managed and one can return to a normal life.
Crooked is a result of much hard work and incredible amount of research. I wholeheartedly prescribe this book and a personal thank you goes out to Ms. Ramin.
See full review and more at https://www.bookbarmy.com
July 19, 2017
When an investigative journalist turns her attention toward a malady she's been suffering through, chances are pretty good things will get interesting. This book does not disappoint. The first part of this book is a scathing indictment of various facets of our medical and insurance industries-- chiropractors, opioid pushers, spine surgeons, etc. The second part consists of various chapters devoted to practices that both avoid everything talked about in the first section, and have had some success in treating the problem. I would recommend this book to anyone who may be experiencing lower back pain or (like me) hip and leg pain caused by issues of the lumbar spine.
Pro: Provides researched reasons to avoid or pursue various remedies for lower back and associated maladies
Con: Some parts, especially in the second section, seem more anecdotal than thoroughly and formally analyzed, and in some cases contradict each other. For example, is stretching good or bad? Depends on which practitioner of which xrcise regimen you talk to.
Pro: Provides researched reasons to avoid or pursue various remedies for lower back and associated maladies
Con: Some parts, especially in the second section, seem more anecdotal than thoroughly and formally analyzed, and in some cases contradict each other. For example, is stretching good or bad? Depends on which practitioner of which xrcise regimen you talk to.
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