Outwitting the Back Pain Industry and Getting on the Road to Recovery

This book is very informative about the back pain industry and alternative ways of helping your back. However, the people involved in the alternative ways differ greatly in philosophy and approach. It is quite confusing out there if you're trying to diminish or heal your back pain. The author was much more critical and analytical about the back pain industry regarding medicine (doctors, medications, surgeries) but not critical or analytical about alternative methods discussed in her book such as Rolfing, Feldenkries, etc. She does mention some potential problems with yoga and pilates though. I think the author regards alternative methods and popular people involved in them a little bit too much. I felt confused after reading this book because there are so many different philosophies and approaches/treatments regarding back pain. However, I know that everyone is different and so different things will work for different people. I guess we just have to shop around and try different things. It's interesting how toning our muscles can make such a big difference with actual spinal/disk problems.

Recently, an exercise client of mine related the following: Years ago, he and three friends travelled to The Greenbrier, a luxury resort in White Sulphur Springs, West Virginia to participate in a three-day charity golf event. On the final day, as they stood on the sixteenth tee, they were approached by a single gentleman in a golf cart. “Mind if I join y’all a few holes?” How could they resist? The man wore a familiar straw hat. At the end of their stay they were greeted by another surprise. The final item on the bill read, “Playing lesson with Sam Snead . . . $150.00.”
Many elements of his tale parallel those found in the book, CROOKED – a few tips and surprises; high price tags and outrage.
I commend author, Cathryn Jakobson Ramin for taking on an entity that has wrapped itself in a shroud of mystery - the “big-business” side of health-care as it relates to the treatment of chronic back pain. Because medical practitioners are among the most highly educated members of society, we have been led to trust their advice as it relates to our health and well-being. Prepare for a shock. The first half of this book is a rude awakening likely to change the way you view the medical community; and likely to “make you mad.”
Five years ago, I spent three days in a local hospital for what was diagnosed as an “acute stroke.” The bill from the hospital totaled $29,770 (apart from the independent bills of the practitioners involved). The medical community helped save a life (something with no price tag), but the experience left a few unanswered questions. Why does a Band-aid cost $50, or a 20-yard walk with a physical therapist $450 in a hospital setting? In the case of low-back care, why do many prescribed treatments not work? Why does the medical community prescribe solutions that are not adequately supported by research, or worse, knowingly prescribe things that don’t work. Are the doctors at fault? Is the system at fault? The author’s investigation allows readers to come to their own conclusion. According to innuendos in CROOKED, my case could have been worse. Had my hospital stay been low-back related, I would have left the hospital, not only “hosed,” but ‘fused and hosed’, with a bill about triple the size. So, I am grateful for a happy ending, and thankful for the author’s investigation of everything related to the treatment of chronic back pain - a quest that, like mine, unveiled more questions than answers. Who’s in bed with whom? Is there any medical approach that shows promise? Answers to these questions may shake you to the core. Fortunately, the second half of the book brightens the picture by dealing with things that might work, steps in the right direction - and most are exercise-oriented.
My participation in exercise (essentially, lifting weights and running) began at the age of 14 and led to an eight-year stint as a physical education teacher, and later, a career in the exercise business (1980). It also led to a taste of the medical side – two lumbar interventions before the age of thirty-two, and two major crises shortly thereafter, the supposed consequences of an “active lifestyle.” I have experienced many of the medical solutions suggested in the first half of the book - acupuncture, chiropractic treatments, surgery, physical therapy and pain management – all with limited success, if any at all. I have also experienced potential exercise solutions put forth in the second half of the book, with limited success in most cases. Along that journey, like the author, I have been exposed to the worst of medicine - and the best, represented by surgeons who turned their backs on their learned profession (due to failure rates they witnessed) and who now use proper exercise as their “go-to” treatment for chronic back pain. The outstanding success of this minority attracted me to the field of rehabilitation, where I eventually owned and operated two low-back facilities, and wrote my own success story. The solution: The “much maligned machine” in Chapter 11 of CROOKED.
According to medical estimates, 80% of back problems are soft-tissue or muscular in nature. Yet, the common diagnoses spewed by medical practitioners - herniated discs, scoliosis, degenerative disc disease – have little or nothing to do with the condition of soft tissue. I was never told that a “weak back” might be my problem - perhaps because there was no way to determine the extent of that weakness, or where within the range of motion it existed. More likely, there was no money down that road.
In 1972, Nautilus inventor Arthur Jones set out to discover “a thing or two” about the muscles that extend the spine. He spent 14 years, $88 million and 3,000 prototypes developing a tool that isolated the muscles in question. “When I say something about a muscle,” he stated, “it will be 100% of that muscle.” The introduction of his final product in 1987, the MedX Lumbar Extension machine, prompted a nomination for a Nobel Prize in medicine. Jones began by testing the isolated low-back strength of approximately 10,000 subjects and declared that “99.99% were in a state of chronic disuse atrophy” – they had never used those muscles, despite the fact that many tested subjects had performed traditional low-back exercise for years, including use of Jones’ original Nautilus Lower Back machine (introduced in 1982). Something became stronger through traditional exercise, but it was clearly not the muscles that extend the spine.
At the time of my first low-back operation (a laminectomy/discectomy for three herniated discs), common advice concerning rehabilitative exercise for the back revolved around strengthening the abdomen. More current advice to “strengthen the core” has changed the narrative without significantly changing the result. We are now encouraged (through printed handouts) to perform either Williams’ flexion exercises (a series of movements designed to strengthen the abdomen) or McKenzie’s extension exercises (movements designed to strengthen low-back muscles). Jones’ work gravitated toward the latter. “Abdominal strength,” he often touted to a medical audience, “has nothing to do with low-back pain.” Injury to soft tissue occurs when a joint system is exposed to a force that exceeds the structural strength of the system. In the case of the lumbar spine, his solution was to strengthen the muscles that extend the spine – the real weak link (confirmed by research at the University of Florida). And logically so. If you sought medical advice for a biceps problem and the physician’s knee-jerk response was to “strengthen your triceps,” you would likely leave. Apparently, we don’t leave in the case of the lumbar spine.
Following years of traditional exercise for the low back (use of both Williams’ and McKenzie’s movements; and seven years on a Nautilus Lower Back machine), my initial test on the MedX Lumbar Extension device revealed below-normal levels of strength (for men my age and weight), especially in angles near full extension (a typical response of first-timers). I eventually purchased the tool, transported it to Venezuela (the site of my back operations) and performed a 12-week protocol – sixteen exercise sessions of approximately two minutes each, a total exercise time of 32 minutes in three months. Days before the machine’s arrival, I had completed six months of physical therapy for a common by-product of spinal intervention, “drop-foot” - a condition that totally disappeared before I completed the MedX protocol. Since that time, I have used the “much maligned machine” for thirty years according to the strength maintenance protocol established by research at the University of Florida: one set of ten repetitions; approximately ninety seconds of exercise; once a month. And, true to form, I performed NO abdominal exercise during that time - still haven’t.
My result was typical. Eighty percent of chronic back-pain patients who completed the 12-week MedX protocol had a reduction in pain perception; 33% became pain-free, almost regardless of diagnosis. I was fortunate to be among the latter. The MedX machine was so successful, as reported by the author, that it threatened an influential segment of the medical community, who - through the political process - shut it down (Medicare payments for MedX treatments were suspended). Fortunately, there were enough doctors who believed in the power of specific exercise for the treatment of chronic back pain to keep the work of Arthur Jones alive.
The author’s investigation makes it clear that not only does the medical community NOT have a solution; it acts as a roadblock to those who do. “Crooked?” You bet.
The scope of her efforts in the second half of the book - her investigation of non-medical approaches that claim to be of benefit to back-pain sufferers reveals one constant – the passion of practitioners as it relates to their product. But, is passion enough? Most practitioners fail, in my opinion, in their final efforts to significantly strengthen the muscles that extend the spine. Their approach, in many cases, focuses on preparing the body (or lumbar area) for strengthening (through proper posture, alignment or by other means), all of which appears to make sense, and may be necessary. But, when they get down to the actual process of muscle strengthening, they fall flat on their face.
With equal passion, I add this opinion. Any exercise will not suffice. You must strengthen the right muscles, and use a proper tool. Many exercise proposals in CROOKED - Pilates, functional training or the “Big Three” of Stuart McGill – prove inadequate for one or more of the following reasons:
• They fail to target the lumbar extensor muscles. Free rotation of the pelvis during traditional torso extension exercise allows the large muscles of the hip to engage and reap the benefit.
• They involve exercises that are limited in their effect, quantitatively and qualitatively, by failing to provide direct, progressive or variable resistance.
• They generally fail to provide the intensity necessary to stimulate change.
Combined, these reasons explain why - when isolated and tested for strength - the large majority of spinal erector muscles (those that extend the torso) are in a state of “chronic disuse atrophy.” Traditional exercise cannot do the job. At best, it may provide symptomatic relief which, if you suffer back pain, may be “good enough.” Hope springs eternal, which helps support the approaches (in the book) that represent the psychology of back pain.
Just as a section of the medical community opposed the introduction of - and were threatened by the success of - the MedX machine, many exercise advocates mentioned in the second half of the book are either anti-machine, anti-extension or anti-seated exercise, if not all of the above - a fact not identified by the author. Are they, too, threatened by the MedX tool? To compare the quality of resistance provided by the MedX Lumbar Extension machine to that provided by the “bird dog” of Stuart McGill (as one example) is like comparing the Concord to an Ox Cart. How many bird dogs would it take to equal one repetition on a MedX machine? No one can count that high.
It is equally obvious that the approach holding the most promise for low-back pain, according to the author’s analysis (and my bias) is treatment using the MedX machine, which addresses the root cause of eighty percent of back problems – weak lumbar muscles.
If that is the case - and it is - I ask, “Why fool around?” As the MedX inventor once stated, “If and when the government ever takes any meaningful steps in the direction of sanity, which I doubt, it could come to pass that all cases of lower-back pain will be treated first with MedX machines, that any other treatment will be prohibited until and unless MedX treatment has been tried and has failed. A simple federal law to that effect would save the people in this country a minimum of $80,000,000,000.00 a year; that being B for billion, not M for million. Who else did you ever hear of that has invented or discovered anything of equal value?” Arthur Jones (from My First Half-Century in the Iron Game, Testing Strength: Part Six, 1993)
Arrogant? Perhaps. But Jones offered much more: sincerity, intelligence, passion and intensity. He was not a fan of BS.
MedX treatment first: If it doesn’t work, then try something else.
I applaud the author’s diligent investigation of potential solutions, and find her analysis of MedX treatments (from a neutral outsider’s perspective) thorough and interesting. She did however miss the mark on a few things. First, she should have interviewed Dr. Michael Fulton, orthopedic representative for Nautilus and MedX, and Arthur Jones’ right hand man for 30 years. Fulton was there from day one with both companies, and had specific input into the design and development of the medical tools. He deserves honorable mention - if not top billing - among the MedX devotees mentioned in Chapter 11 (Drs. Dressinger, Mooney and Nelson). Fulton currently operates a state-of-the-art “exercise only” rehabilitation facility in Daytona Beach, Florida. Second, the author may have interviewed the principle executives of Pure HealthyBack prematurely. To those in the know, what remains of the MedX Corporation is poorly managed, unable to meet the needs of the marketplace, and not headed in the right direction, if any direction at all. Fortunately, there are a few clinics around the nation that can handle some of the needs of chronic back patients, despite continued resistance from both orthopedic and physical therapy communities.
Cathryn Jakobson Ramin does a masterful job of exposing the back-pain industry – what works and what doesn’t – and leaves it to the reader to make his or her own decisions concerning their search for a solution. The purpose of her book – getting people on the road to recovery - is well served.
I’d love her to next take on the field of exercise.

Gary Bannister, BA, MEd.

As a chronic back pain sufferer, I inhaled this book in just a couple of days. God I wish I would have been able to read this five years ago before starting down the path of injections, chiropractors, spinal surgeons and the like. This book pointed me to Sarno's Healing Back Pain - also a very helpful book. Between the advice of these two books I am almost pain free after four years of misery. Thank you Cathyn!

I have been a physical therapist for 36 years. For the past 30, I have focused on orthopedics and spinal rehabilitation. I have seen many of the issues that Cathryn writes about: failed surgeries, drug dependence, failed interventions such as IDET's, and disc replacement and reliance on passive forms of treatment to manage pain. I am highly trained as a manual therapist but I know that nothing that I do passively will restore a patient to normal function. Good rehabilitation includes progressive strength training with a focus on motor control and muscle balance. We also now know that the central nervous system changes in response to pain, becoming more sensitive with time. Some people are more prone to this process than others. Our thoughts and beliefs about pain and pathology have a powerful influence on our ability to get better and restore an appropriate pain response. Cathryn is absolutely correct that treatment of chronic pain requires a commitment to addressing all of these issues. Read this book, then find a practitioner who understands this.
Caroline Taylor, DPT, PT, OCS, FAAOMPT

Important information for back pain sufferers and those who love them.
Ramin is an excellent writer and makes the first half of the book (about the epidemic of back pain and the industry of medical professionals) easy to read, although terribly sad. The second half of the book is about solutions; Ramin tells us her personal journey while researching.
I'm surprised that none of the previous reviewers have mentioned the posture/movement chapter, which as an Alexander Technique teacher who has helped many students out of pain, is to me as important, if not more important, than the exercise chapter.
Many people exercise with postural imbalances and movement patterns that contribute to their pain, so ideally one starts with awareness of these issues. Then finds exercise that works for their particular conditions, preferences, etc.
I particularly appreciated that Ramin was clear that a journey of self discovery is part of the process of relieving and/or managing pain. People who have chronic back pain need to discover how we have contributed to our back pain (unwittingly) and what we can do to change our habits, patterns, stresses, and paradigms to get better.

Well researched but way too many words on things that don't matter - self-absorbed extraneous prose. It was painful to get through at times. I don't care if the extended stay had a kitchenette or if a patient had an aquiline nose, or if the lobby was marble clad. How many times she had to reschedule an appointment tells me nothing I care to know. Just get to the point.

The book presents many one-sided cases - all back surgery bad - and gives less attention to successful outcomes. I have suffered significant back injuries. Just give me the skinny so I can help myself and move on.

In Crooked: Outwitting the Back Pain Industry ... Cathryn Jakobson Ramin has written the best book I have ever read on back pain and the millions of people who live with and frequently seek the holy grail of the treatment that will be the cure.

As a traveler along this path, I can relate. While my back pain was correctly diagnosed by my physical therapy as stemming from a hypermobile sacroiliac joint, the bottom line, for me, is my extremely flat feet and the multiple fusions I've had in each one after each posterior tibial tendon, which holds up the arch, ruptured. But this is not a whine about poor me, it's an introduction about why I found this book so intriguing. In the book, Ms. Ramin describes in detail the multiple potential causes for back pain and the industry that has been spawned as people go from practioner to practioner, test to test, procedure to procedure, and drug to drug, usually to no avail. This is not a book about back pain from serious pathology such as tumor or traumatic injury, it's a book about people who, for whatever reason, suffer from low back pain and the huge, profitable, industry that the quest for the cure creates.

After describing in detail the agony of this mysterious pain and it's potential for incapacitation and loss of function, the author describes the multiple tests and procedures that people resort to in order to try to feel better, essentially debunking the myths around MRI scans, opiates, injections, and chiropractic care, concluding, correctly, that while intervention can result in temporary pain relief, nothing will really work without exercises to strengthen the core, hips, and glutes - exercise that must be done in order to literally gird one's loins against future problems.

The research and thorough description and analysis in this book is astounding. Even more astounding is the author's ability to convey this in laymen's terms without dumbing down the information, and her ability to turn a lot of medical information into an extremely readable book. She achieves this by a lot of case studies and interviews, and because she traveled this road not just as a journalist but as a human being with back pain.

I think I am one of the lucky ones. Yes, I see a chiropractor who uses a very gentle approach to manipulation and is a highly trained acupuncturist. Yes, I've had x-rays and an MRI to be sure my pain was not coming from anywhere other than my SI joint, and I have had injections from a physiatrist, not a surgeon, and exercise instruction and monitoring from a physical therapy. I am extraordinarily lucky that my physiatrist, having seen my images, did not try to horrify me with the fact that I, like about 75% of the people in my age group, have collapsed (but asymptomatic) collapsed discs in my lumbar spine. The treatments I've had have all been undertaken knowing that I sought symptomatic relief so that I could continue to do the exercises I need to do to remain relatively pain free. And that, I believe, is the bottom line message of this book. Back pain is not something that can, in most cases, be relieved by drastic measures or by remaining passive. Relief can be obtained so that one can actively exercise. Maintaining a pain-free back is like maintaining cardiac health after a heart attack or surgery - one has to commit to an exercise program and stick to it.

I received this book as an ARC from the publisher.

there was little there that had not been heard on npr i purchased book hoping to find the particular exercises explained yet was dissapointed apparently you need to buy the doctors back book or find a gym with a 75000 machine. not much use for me. if you have long standing back pain you probably know what the first part of the book tells you medicine has nothing to offer.

I purchased this from an indy bookseller, and I'm reviewing it as a former healthcare professional and a current long term chronic pain patient. Ramin covers a wide variety of treatments for back pain, and she hits on some of the more notable scams. However, in reading the portion of the book where she purports to report what works, her evidence is almost all limited to testimonials and her personal experience. As an aside, I've been treated by a few of the people she claims do great work and wonderful things, and I was left unimpressed, with no pain relief, no increase in function and no actionable self management plan to work effectively toward those. She also assumes that people trying to get on top of chronic pain have unlimited personal funds to pursue all of the non-hospital or physician based programs and interventions that she describes.

At the end of the read I was pretty much where I started: despairing of every being able to sleep well again, engage in any activity other than the most pressing for personal survival and writhing the days and nights away in what is now unendurable pain. Do not read this with any idea of coming away with an actionable, effective plan for reducing pain and increasing function. It's simply not there. What you might get a handle on are some of the warning signs to steer you away from the most harmful of treatments and the sleaziest of scammers, and for that, the book has value.

Ramin doesn't spend much time in addressing prevention. Adequate worker protections, safe workplaces, better time away from work programs and real time for adequate recovery are not available for most US adults.

First like many others I did not find this helpful. No one mentions that you can't even follow her story, she jumps around. It is hard to gather all the information and process it because of she goes from one story to the next then spiderwebs back to the first story. It is so bad I can't even finish reading this negative jargon babbling mess. One thing is for sure while she is talking bad about how the Dr.s and specialists are lining their pockets, so isn't she with this awful book that like most of us have purchased to help find some form of relief. I was hoping for the book to help me with maybe an exercise routine or something. Also I never thought that the book would only focus on low back issues. I have neck issues. So with that this book bashes almost every type of help out there. I say do your own research find a Dr., a chiropractor, PT or exercise routine that works for you and no doubt add a positive attitude in the mix. That is half the battle. Think better = feel better! But avoid this book!

In a world of fake news and subsidized research, Crooked stands straight. It provides exhaustive information about the science and the treatment of back pain. The first half chronicles the mistakes and scams--and shows the reader who benefits from misinformation and mistreatment. It sure isn't the patient. The second half is a thoughtful journey through the regimens and behaviors that can actually help.
The fact that the author tells her own story throughout makes this book, so carefully researched, come to life.
I had to finish it quickly because people seeing it in my arms wanted to grab it.
Good science, good sense, and good advice.

Nicely constructed book that explains the terrible pitfalls of back procedures and then offers sound advice on how to deal with pain management and recovery. The book is well-written and researched. Both an industry expose and a resource for best solutions.

I never thought I would deeply enjoy reading a book about back pain, but this book kept me engaged from start to finish. I have recommended it to many people, including doctors, back pain sufferers, and people who are dealing with other types of pain. The author has a very engaging writing style, and her own struggles with back pain add a personal touch to the narrative, since she ends up trying many of the treatments. The thesis of the book is that surgery is seldom the answer for treating back pain, and in fact many people are in worse shape after getting spinal surgery. In contrast, intense exercise programs (supervised by appropriately educated professionals) can make a huge positive difference, and this has been verified by research. The psychological aspects of back pain are also explored, and I found the details fascinating. In short, this is a well-written and highly informative book that will change the way readers look at back pain, and perhaps pain treatment in general.

After a long flight to Taiwan where I watched too many movies and did not move around enough, I began a long painful back problem as yet still unresolved. I've tried so many remedies as discussed in book including chiropractors, acupuncture, endless PT, muscle relaxants, yoga, pilates, epidural steroid injections, MRI's (degenerative disc disease/bulging discs), podiatrist, heating pads, home back traction devices, expensive work chairs, special ergonomic items for car and the desk etc. And I have been lured by the ads for the laser spine ads with "minimally invasive procedures". It was heart breaking to read about the chronic opioid addiction issues that began with lower back pain and shocking to learn about the overuse of spine surgery and the negative outcomes associated with surgery. Or the reliance on MRIs to diagnose back problems when back abnormalities are very commonplace even with people who have no pain. Over the years, my lower back has actually gotten much weaker from fear of tweaking it further. I look forward to experimenting with many of Cathryn's suggestions for exercise and pain management and also basic posture improvement. Thanks for this most excellently researched book!

Eight years after back surgery, I picked up this book in a panic. I was being revisited by that most unwelcome burning hurt in my low back and stabs of sciatica down both legs.The prospect of needing to again go under the knife terrified me.This book taught me that I probably could have avoided the knife in the first place. While my surgery had been successful, many are not, and Ramin's meticulous and convincing research highlights the limitations and risks of traditional medical interventions. It also shines a sobering light on a back industry cabal bent on self-enrichment at desperate patients' expense.

But the real value of Ramin's book for me was hearing about her own journey to reclaim her back function. Desperate and long-suffering, she tried and learned about virtually every modality around, drawing on both investigative journalistic skills and personal treatment results. She describes the wizardry of a number of individuals with diverse credentials--physical therapists, trainers, medical professionals and others. What these "back whisperers" share is an interest in how people walk, sit and stand and a "knack of being able to inspire confidence and the desire to work hard in people who might otherwise be disinclined to get off the couch."

Ramin's book inspired me to be proactive and search out what works. Instead of calling the orthopedist, I've consulted a neuro-muscular specialist, and I've adjusted my Pilates routine. My sciatica is virtually gone and the low back pain has abated. Ramin has quelled my panic and helped give me back my back. I am very grateful.

Finally there's hope for back pain sufferers. This impeccably researched book warns of the perils of many common back pain treatments--the author's investigations uncover some alarming cases of medical malfeasance. Then in Part Two she reveals what the back pain industry doesn't want you to know--what it takes to actually rid yourself of back pain. Cathryn Jakobson Ramin takes the reader by the hand and, in her effortless and engaging style, helps you navigate the complex and murky world of back pain treatment in a way that will leave you empowered to do the work it takes to free yourself from back pain. I've already recommended it to everyone I know with back pain.

In a world of fake news and subsidized research, Crooked stands straight. It provides exhaustive information about the science and the treatment of back pain. The first half chronicles the mistakes and scams--and shows the reader who benefits from misinformation and mistreatment. It sure isn't the patient. The second half is a thoughtful journey through the regimens and behaviors that can actually help.
The fact that the author tells her own story throughout makes this book, so carefully researched, come to life.
I had to finish it quickly because people seeing it in my arms wanted to grab it.
Good science, good sense, and good advice.

I never thought I would deeply enjoy reading a book about back pain, but this book kept me engaged from start to finish. I have recommended it to many people, including doctors, back pain sufferers, and people who are dealing with other types of pain. The author has a very engaging writing style, and her own struggles with back pain add a personal touch to the narrative, since she ends up trying many of the treatments. The thesis of the book is that surgery is seldom the answer for treating back pain, and in fact many people are in worse shape after getting spinal surgery. In contrast, intense exercise programs (supervised by appropriately educated professionals) can make a huge positive difference, and this has been verified by research. The psychological aspects of back pain are also explored, and I found the details fascinating. In short, this is a well-written and highly informative book that will change the way readers look at back pain, and perhaps pain treatment in general.

After a long flight to Taiwan where I watched too many movies and did not move around enough, I began a long painful back problem as yet still unresolved. I've tried so many remedies as discussed in book including chiropractors, acupuncture, endless PT, muscle relaxants, yoga, pilates, epidural steroid injections, MRI's (degenerative disc disease/bulging discs), podiatrist, heating pads, home back traction devices, expensive work chairs, special ergonomic items for car and the desk etc. And I have been lured by the ads for the laser spine ads with "minimally invasive procedures". It was heart breaking to read about the chronic opioid addiction issues that began with lower back pain and shocking to learn about the overuse of spine surgery and the negative outcomes associated with surgery. Or the reliance on MRIs to diagnose back problems when back abnormalities are very commonplace even with people who have no pain. Over the years, my lower back has actually gotten much weaker from fear of tweaking it further. I look forward to experimenting with many of Cathryn's suggestions for exercise and pain management and also basic posture improvement. Thanks for this most excellently researched book!

Eight years after back surgery, I picked up this book in a panic. I was being revisited by that most unwelcome burning hurt in my low back and stabs of sciatica down both legs.The prospect of needing to again go under the knife terrified me.This book taught me that I probably could have avoided the knife in the first place. While my surgery had been successful, many are not, and Ramin's meticulous and convincing research highlights the limitations and risks of traditional medical interventions. It also shines a sobering light on a back industry cabal bent on self-enrichment at desperate patients' expense.

But the real value of Ramin's book for me was hearing about her own journey to reclaim her back function. Desperate and long-suffering, she tried and learned about virtually every modality around, drawing on both investigative journalistic skills and personal treatment results. She describes the wizardry of a number of individuals with diverse credentials--physical therapists, trainers, medical professionals and others. What these "back whisperers" share is an interest in how people walk, sit and stand and a "knack of being able to inspire confidence and the desire to work hard in people who might otherwise be disinclined to get off the couch."

Ramin's book inspired me to be proactive and search out what works. Instead of calling the orthopedist, I've consulted a neuro-muscular specialist, and I've adjusted my Pilates routine. My sciatica is virtually gone and the low back pain has abated. Ramin has quelled my panic and helped give me back my back. I am very grateful.

Finally there's hope for back pain sufferers. This impeccably researched book warns of the perils of many common back pain treatments--the author's investigations uncover some alarming cases of medical malfeasance. Then in Part Two she reveals what the back pain industry doesn't want you to know--what it takes to actually rid yourself of back pain. Cathryn Jakobson Ramin takes the reader by the hand and, in her effortless and engaging style, helps you navigate the complex and murky world of back pain treatment in a way that will leave you empowered to do the work it takes to free yourself from back pain. I've already recommended it to everyone I know with back pain.

I find it difficult to palate non-medical people making facts up and writing with a huge bias on their shoulder. Every pain patient is different and every journey is not as clean cut. The world is filled with people who had amazing relief after physical therapy or injections or surgery.

Admittedly, you can get in for a spinal fusion faster than you may be able to read this book, but it’s for good reason. It’s chock full of all the things your spine surgeon is NOT going to tell you.

As someone who has been a yoga teacher and massage therapist, I am no stranger to anatomy but after a year of pain I found myself consulting Dr. Google far too often. After finally seeking an MRI, I was told by two spine specialists that with a herniated disc and spondylolisthesis I require spinal fusion surgery. One doctor, after prodding even stated any other course of action would not work at all and if I requested it he would not send me.

I found this to be fatalistic and frankly a red flag. So, I picked up several books and began to read. Crooked, by far the most informative in the bunch, is essential for creating the questions that you don’t even know you have or need to ask. I’ve learned so much about the options I have, the history behind back pain in our medical/healthcare system.

Most importantly, this book lays a foundation for discovery and the ability to advocate for yourself when you do make the next step, whether that be an exercise regime or surgery.

Great read for people with back issues, those in the fitness industry, and anyone curious about things such as the effect such medical issues have on the opioid epidemic.

This book agrees with the other newer back health books in that surgery, pain shots, bed rest, opioids, and chiropractors aren't the answer to your back pain. In fact, for 2/3 of "Crooked," you may think you have no options at all because Jakobson-Ramin goes into depth on just how many high-dollar quacks and charlatans are lurking out there in the back health industry, willing to take your money despite high risks and low gains. The title is clearly a play on those crooked doctors and our crooked backs. Even if you, like I, have read some of the other books on backs that come to the same conclusions this one does, you will probably find you will want to read something like this every so often just as a reminder to stay with evidence-based results and not quick-fix promises of glitzy TV ads that in the end, often make things worse. For instance, Jakobson Ramin went to Laser Spine Institute so we don't have to.

The book gets fairly technical at points, even though it's basically just following the journalist's own steps toward back health. At times I envied her for getting to try out all the expensive gait-improvement classes, fancy desk set ups, or back rehab programs I've heard about (look at the youtube for Back Boot Camp at the New England Baptist Hospital to get an idea of what can generally help heal the back naturally.)

The conclusions section of the book isn't as complete or miraculous as we would like because there isn't an amazing cure out there. We have to put in the time and effort to keep our backs at an acceptable level of comfort. Human nature is bound to want something faster, something with better guarantees, and something that doesn't have to be done as regularly, but sadly it's just not there yet. It's like when Homer Simpson went to Dr. Hibbert who told him doctors hadn't yet perfected back care because they'd "been too busy on the fronts."

After hearing about solutions for my frequent back pain and sciatica from “welcome to the club” to try these pain killers to back surgery, Crooked finally makes sense of the conflicting, frustrating advice that nearly caused me to abandon hope. I don’t recall when or why my pain started. First, the discomfort ran up and down my left leg on a schedule that stretching seldom eased. Walking our dog I’d start to feel a burning pain in my lower back. Stoic inclination to live with it has kept me off drugs and away from surgery but at what cost? Over compensation and worse injury? I was nervous -- and then I saw this book.

A friendly narrative told partly through the author’s agonizing back pain history exposes risks discovered, all too often, after the fact. Case in point: epidural steroid injections. A bullet often dodged wisely. Other chapters report virtual visits to doctors’ offices where the author asked my questions about therapies and devices and short-lived breakthroughs that end in lawsuits. Or what about a $2,000 work station that moves up and down to assist good posture? Occasionally the science eluded me but always gave me confidence that conclusions reflected it. I would not sell any chapters short because I gleaned something useful in all of them, but I would buy the whole book again for just one chapter: What Your Brain Has to Do With Your Back. Pain in the absence of injury is real, not imaginary -- and it doesn’t have to be my lifelong companion.

Some reviews claim this book doesn't spell out exactly what is helpful and what isn't. Certainly the first 1/2 of the book is an expose of the dangers of various treatments, warning about the profit motive driving much of USA health care, and in this section there isn't much to be happy about.

BUT the second half of the book is packed with helpful information about what options are LIKELY to help the most people. I listened to this part of the book with a notebook in hand and made notes and then asked my physiotherapist about anything I wasn't sure about. Some of the recommendations were hard for me to accept, for instance the assertion that I was unlikely to do more damage to my painful back by tieing my shoes, even though my pain receptors seemed to be telling me a very different story.

By the end of the book I was soberly aware that my own rehab would require more exercise than I wanted, more discernment in doing enough (but not too much) exercise and YET MORE work on myself to address the stress and anxiety underlying my pain.

I found Cathryn Jakobson Ramin to be a trustworthy guide to a very complex area of human experience and I will be continuing my research into some of the ideas and techniques she outlines in the book. I'm particularly interested in Dr. Sarno's approach after going on to watch several video's online such as the "Razag Ballroom" lecture by Dr. Ira Rashbaum. Well worth searching it out.

For those who are suffering I recommend postponing Part One and going immediately to Part Two for practical advice about relief. You will have to access other sources for more information but the leads in Part Two are very helpful. I read Dr. Sarno thirty-five years ago and believe the mind can exacerbate pain but most pain is not psychosomatic in my humble opinion and has a physical root. Stuart McGill's approach has promise for me but he is very stingy with his suggestions unless you buy his books which seem to be very technical and may actually be overkill. As for Part One which I went back and read after Part Two, it contained some very good cautionary advice which gives new emphasis to the phrase FEE for service and patient beware.

Nicely constructed book that explains the terrible pitfalls of back procedures and then offers sound advice on how to deal with pain management and recovery. The book is well-written and researched. Both an industry expose and a resource for best solutions.

Author Cathryn Jakobson Ramin has done a brilliant job of both conducting extensive research of the back industry, and in summarizing the key findings that are important for those who suffer from back pain. The subjects covered include surgical and non-surgical modalities related to the back industry, which are well detailed in order to understand which solutions are most likely to be beneficial.
Equally important, she has identified the surgical procedures and or therapies that one should at a minimum be cautious of, or that are not proven to help back pain at all. I learned about therapies that I had never hear of (e.g. Rolphing among others) which I have subsequently tried. I am finding that some of these therapies have been beneficial in my recovery (previously enduring two back surgeries). The prescription related aspects are well detailed including the down side of these medications, which was a wake up call for me to move me off of opioid consumption. A major leap of faith for me with a positive outcome. The key take away for me was the importance of getting back into the game of life.
It is refreshing to read a book that has been so extensively researched and to have the facts summarized in a way that exposes the myths and pitfalls of the industry, while identifying meaningful solutions that will help those suffering from back pain to optimize their recovery.

Paul McCarthy