Fighting Back

Have you ever noticed that when all your body parts are working properly you have no real thought about how any one of them feels? Why think about your feet, for example, when they feel fine? I can walk 36 holes and while my feet have performed admirably it certainly doesn’t occur to me to commend them for a job well done. But get a blister, or stubbed toe, a stone bruise or a planter’s wart and right away you can barely take a step without being forced to focus directly on your feet, and more specifically, the pain that emanates from them. The same can be said about any part of the body that is somehow out of whack. We don’t take the time to appreciate how well we feel and how amazing it is that our bodies function so well under the stresses we apply until something hurts.

Pain. Right up there with “love”, it is one of the most challenging subjects that humans deal with. Unless you are a doctor or are involved with someone suffering from pain, if we aren’t experiencing it, we never think about it, or at least we try not to think about it. Why would we, when there is nothing less desirable. Myself, I hate pain. I would do anything to get rid of it, and I know instinctively that the pain that I feel is almost inconsequential to the pain that some people suffer.

There are different types of pain. The type I will address is the physical kind, as opposed to the mental kind. I can’t imagine what it would be like to lose a child to illness or tragic accident. I have had brushes with such loss, and the sensations produced can only be described as horrific and debilitating, even when the loss is not so direct. Almost any physical pain pales in comparison with such heart-wrenching circumstances as the death of family or friend. As I deal with my own pain I try to remember that not only are many people in worse physical pain, many more are dealing with pain that cannot be dealt with by surgery, physical therapy, or exercise.

Nevertheless, this column is about golf and my experiences in the game, and the one thread that winds through my career, or at least the last 25 years out of 35, is my back and the problems it has caused me. I haven’t written about this subject directly in the past for many reasons, but the main reason is that I never wanted to use my back as an excuse for not working hard toward becoming the best player and teacher that I was capable of. I have always had the attitude that when one is presented with a situation it is always best to approach it with a positive attitude. In the case of physical handicaps or injuries, my choice would be to ask myself how I can get better, or how can I work with or around the problem and still be successful. I only want to know what steps I can take to move in a positive direction, and then it is up to me to have the will and desire to do everything I can to improve my position.

I have always used this attitude to my advantage on the golf course. I am somewhat of a volatile player, and when I hit a shot that gets me in trouble, either through poor decision, poor execution, or sheer bad luck, I may express my displeasure vocally or physically, but soon thereafter I am concentrating on what to do next. The question every player needs to ask is “what is the best score I can make from here and how am I going to do it?” Letting a bad shot lead you to another bad shot or poor decision is a recipe for failure. The same can be said of injury or illness. There is nothing to be gained by feeling sorry for yourself or asking “why me?” The only productive thought process is to come up with every way possible to try to get better.

With this in mind I thought it might be helpful to my readers to hear the story of my back problems in more detail, touching on the various treatments I have tried, and , most importantly, focusing on what can be done to prevent a bad back from happening in the first place.

A “disc” is a cushion, or shock absorber, that lies between the bony vertebrae that make up the structure of the spine. The discs allow the spine to move in varying directions without the vertebral bones rubbing together. Running through the middle of the spine is the Spinal cord, essentially a bundle of nerves that extrude out from cord at various spots in the spine, running quite close to the discs as they exit. When a disc deteriorates it generally loses its cushion and begins to flatten, causing the bones to get closer to each other and leaving less space for the nerves to exit out from the spinal cord. The inside of a disc is like the inside of a jelly doughnut, and as the disc flattens this material may be pushed out, resulting in a “bulging” or “herniated” disc. Severe trauma may even rupture the disc, at which point a piece of the disc breaks off. All of this is bad, as nerves need space to run freely without any pressure on them. Pressure on a nerve means pain, and when there is pain the muscles surrounding the area respond by tightening up to restrict movement which would cause more irritation.

For most people who suffer back pain the problem is muscular as opposed to the nerve-related problems I just described. Weak muscles in the stomach, hips, legs and spine can cause overuse of surrounding muscles, which then get weaker and tighter and may even go into spasm, causing bouts of pain which can be excruciating and debilitating. The good news for this type of back problem is that most of the time the episodes are short-lived, and with therapy and exercise the problem can be permanently eliminated. The more serious occurrence is caused by the spinal nerves becoming impinged by disc material or changes in the structure of the bony vertebrae. In this case the pain, instead of being localized in the lower back, radiates down the leg of the affected side, where tingling and numbness are common along with the severe pain. For those who suffer nerve entrapment, the sciatic being the most prevalent, surgery is an option, and all the other possible treatments are designed in the hope that surgery can be avoided.

THE EVOLUTION OF MY BAD BACK

First indications: Trouble shoveling snow as a kid. Lower back feels weak. Not just trying to get out of work.

Huge mistake without having a clue what I was doing: Every kid wants to copy the swing of his favorite player, and swing the way all the magazines say you should. In the 1970’s there was Nicklaus and Watson, and the teaching said that the “reverse C” finish was the way to go. Well, it was the way to go, all right, right to the operating table. Just watching my old swing on video now is enough to give me back spasms. I look like I’m doing limbo after every swing. I should sue Bob Toski and anyone else who championed the idea of keeping your head behind the ball until your back explodes.

First episode: A week’s worth of pain while in college at Wake Forest in 1976. Saw a trainer, got some ice and heat, didn’t think much of it.

Next problem which eventually fueled the bad back: Tore my sternum lifting weights the year I transferred to LSU. Couldn’t play for 6 months. Saw trainer, went on Butazolidin (“bute”), an anti-inflammatory later known for causing the disqualification of the Kentucky Derby winner. No wonder it lowered my blood cell count and almost damaged my kidneys. Pain finally recedes and I go back to playing. Best thing to result was my grade average skyrocketed to a 3.75. Made Dean’s List. Problem would recur in a year and become chronic. Still trying to play golf, I would stop exercising in order to protect the area. Eventually would undergo sternum fusion in 1982 which would fix the problem. After that I thought surgery was the answer to everything.

All-time stupid decision which would make everything worse: Decided to go roller-skating with my roommate and our girlfriends while under the influence. Demonstrated no balance and no skating ability and fall backward on my tailbone 3 times, extremely hard each time. Once wasn’t enough. 3 days later I trip walking down the stairs of my apartment and land awkwardly on my right foot. Feel something odd, then next day wake up and can’t move. Probably the first herniation of the disc. Pain for a week, then OK again. No problem rest of college. No more roller skating for rest of life.

More trouble: Trying to play mini-tour in Florida. Back begins to hurt more often. See Orthopedic, who diagnoses herniated disc and recommends fusion. Seek second opinion. Another Orthopedic recommends 4 months of physical therapy and strengthening exercises before deciding what to do. Seems like it helps. Pain comes back.

First surgery: Single disc laminectomy in 1983. Neurosurgeon removes part of disc and bone around nerve root. The surgery works wonderfully and within two months I am back hitting balls with no pain. Instead of taking it slow and strengthening the area around the surgery I pound balls and start doing aerobics. I am well-intentioned but entirely ignorant of the consequences of my stupidity. I stay relatively healthy the next year and a half, and I play in Asia, win a Space Coast mini-tour tournament (after four years of trying), and qualify for the finals of Tour School.

Pile on DeFrancesco! Practicing for Tour School finals blows out the back. Nerve pain is so great I cannot even swing 4 days before I am supposed to leave. I end up in the hospital in traction for 3 days. Not your optimum preparation. I shoot right around 80 for four rounds, miss the cut, and head home to an apartment that has been burglarized and a wife who informs me that she wants a divorce. Thanks.

Get out of town: I move to Atlanta to room with my old college roommate, get a job at a frozen drink bar, and have some fun for a year before my back blows up completely and I have to undergo surgery number two.

The fusion: This operation was no fun at all. With two discs now herniated the doctors want to take bone from my hip and stuff it in between the vertebrae in my lower back. They do laminectomies on both discs, fuse the bottom two vertebrae, and put metal rods in to stabilize the area while the soft bone hardens. I won’t be able to put my own socks on for 4 months. It’s painful and frustrating, and every day sees a mood swing from optimism to despair. It will be a year before I can play 18 holes of golf.

Might as well teach: As soon as I can put my socks and shoes on I realize that since I’m running out of money I had better think about getting a job. An old mini-tour friend tells me about a job opening at a club on Long Island where there should be a lot of teaching, so I write the pro a letter explaining my backgound and my situation and asking for the job. Incredibly, he hires me without an interview. I am now officially a golf instructor.

Surgery number 3: I teach for two seasons and start playing again, and in the fall of 1988 I decide to try to play some mini-tour golf in the winter. I head to Florida, get an apartment, and never play a round of competitive golf because my back starts to hurt again. I call my doctor in Atlanta who did the fusion, and he agrees to go in and take out the rods and check for any other problems. He finds that the fusion bone has grown in too much and is blocking the nerves in both levels of the fusion, so he has to do laminectomies on both sites again. At this point I’ve had it with golf, but I decide to teach one last season in New York before quitting altogether.

Trying to quit: I move back to Virginia, get my real estate license, get married, and quickly go broke. The only way I can make any money is teaching golf. I even try waiting tables, but I last 2 days, realizing that I am working harder to make 40 dollars in 6 hours than I do to make the same amount in a half hour. Plus, I don’t have to wipe down the salad bar. So it’s back to teaching, this time at Woodholme.

The next 9 years: From 1991 to 2000 I teach and I play, and while I need no more operations (indeed, doctor I see in 1992 tells me that I have what is called a “failed back” and that I should simply do what I can do until it hurts too much, then slow down until I can do more again. He explains that there is little more surgery can do except create more scar tissue, and that I will have to learn to live with and cope with my back the way it is). Many good things happen over this period: I have two wonderful daughters, I play well at times and build a decent resume’ of accomplishments, while at the same time my teaching career builds to where it is both successful and fulfilling. Still, at any point in time my back is a threat to flare up and knock me out of whatever competition I am in. I have to closely monitor my practice time, as too much will knock me out of action. I have to be careful with my exercise, and stretching and sit-ups are about all I can handle. I try to stay away from orthopedics, chiropractors, physical therapists, trainers, and anyone else well-intentioned people suggest may help me. I feel as though I am on the cusp of being a great player, but physically I just cannot withstand the rigors of practice that it would take to reach the next level.

Dr. Rose and Advantage Golf: For years I had no interest in letting anyone change my daily routine. It always seemed that any new thing I put into my program in an effort to get stronger or more flexible or gain more endurance just ended up hurting me. In the fall of 2000 my friend and fellow teacher at Woodholme, Bernie Najar, attended a 2-day seminar given by Dr. Rose regarding exercise and fitness for golfers. The emphasis was on learning to assess the physical limitations of a student, and then devising an exercise program to help them overcome their limitations. I had no interest until Bernie gave it a rave review, so I went in December. There I learned that there were ways to exercise my back, legs, and midsection that I had not previously known about. I started on a program of my own under Greg’s guidance, and by June of 2001 I was feeling as good as I had felt in 20 years. I proceeded to win the National Club Pro Championship, the Section Assistant’s Championship, and the Section Championship, eventually earning Player of the Year for the Section for the 4th time. I was 44 years old and seemingly losing ground as far as my health was going, and this was a complete turnaround. I was doing a lot of balance and stability work using an exercise ball and various other unstable surfaces, with the focus on creating stability in my back and pelvis. I continued my work into 2002, and felt good enough to even start running. By winning the 2001 CPC I had 8 exemptions to Tour events to look forward to, and I felt ready to do something special.

One more time: In late May 2002 I play in the Holden Cup, an 18 hole tournament, and during the round my back and leg begin to throb and go numb. I am hopeful that the feelings will go away, as they have done for the last few years, but alas, this time it will not go away. I take a week off, then play in the Kemper, but it flares up again and I have to withdraw from U.S. Open Sectional Qualifying in New York and from the Westchester Classic. For the rest of the summer I take time off between tournaments to rest before going to play, but my ability to practice is completely cut off and my game is in a holding pattern. I finish 2nd in the Maryland Open, 7th in the National CPC, and play in the PGA at Hazeltine, but things are getting worse instead of better. By the time September rolls around I play in one more tour event where I withdraw after the first round, and I am done for the year. I leave 4 Tour exemptions unused, and my back resists any efforts to make it better. I am despondent, and by November afraid that my playing career may be over.

Ready to try anything: First I try epidural injections. The doctors shoot steroids directly into the spine, and it hurts. In many cases people get complete relief: I get none. Next, I see the acupuncturist, two of them actually. The first one talks to me for an hour then puts a million needles in me. It doesn’t hurt at all and it seems relaxing, but I get no relief. The next guy is from Korea, and he tells me he is going to do “high stimulus” acupuncture. Accustabbing is more like it. It is so painful that I have to lie down for a few minutes after he finishes so that I won’t pass out. To top it off, he tells me not to drink or have sex for two weeks. I actually went back one more time, but that is all that I can take. Next I see the orthopedic back specialist, and he orders an EMG, which is a nerve stimulus test. It shows that there is something causing the nerve to be irritated, but the MRI results are negative. When I ask him what I can do, he shrugs his shoulders. Next I see the chiropractor. Dr. Rose has done some adjustments to me in the past, but he is too far away to see on a regular basis, so I go to Dr. Kalkstein in Towson. I had avoided chiropractic for a long while since I was operated on, but I have mellowed on the idea and now it seems to be helping.

Muscle Activation Therapy: My good friend Richard Kress suggests that I go to see a trainer who is doing something unique and different. I agree, and I end up on the table with Charlie Mcmillen, an intern in the MAT program, or Muscle Activation Therapy. Charlie tests each of my muscles by having me push against his resistance in odd positions, and the results tell him that many of my muscles are shut down and not working at all. He “activates” them by palpitating (pressing really hard with his fingers) the muscle attachments to stimulate the cells in the attachments which awakens them so that they can tell the muscle when to contract or relax. He then reinforces the activation with isometrics, and shows me how to do the isometrics at home. The process is radically different, incredibly painful, and wonderfully effective. One of the most radical concepts of the method is its bias against stretching. In fact, Charlie tells me, I should not stretch at all. Instead of stretching the muscles that feel tight, I should concentrate instead on strengthening the muscles that move you into that position. In most cases muscles are tight because they are overworked to make up for other muscles that are weak or shut down. He did a demonstration with my hamstring muscle, showing that after doing an isometric in the direction I was trying to move in I gained 20% more movement in that direction, without stretching. I was open to this line of thinking as I had injured both of my shoulders my overstretching them over long periods of time. Now I do an hour of isometrics every morning for various parts of my body, and I have started swimming every day as well. Charlie came to my gym to show me how to use the weight machines, and now I am lifting every other day as well. My idea now is to get stronger in all areas, and as long as I keep my muscles activated and work with correct form I should be able to get back to a normal existence, and get into even better shape.

Whew. Sorry about taking you through all that , but I’ve been through so much dealing with my back that I thought all the back sufferers out there might be interested to see how I’ve been able to overcome, for the most part, a debilitating, chronic problem. To finish I’d like to offer some general concepts that I think will help if you are waging a similar battle:

1. Always think in terms of how to make things better. Be relentless when it comes to trying to be positive. Basically, you have two choices; give up, or move forward. Giving up is not an option, so making the best of what you have and doing everything in your power to make it better becomes a way of life.

2. Be ready to sacrifice and work harder than other people. To do this you must find the time. That means learning to live with less sleep. I used to think I needed at least 8 hours of sleep a night. I have trained myself to feel fine with no more than 6. This allows me to wake up every day at 5 AM to take a long, hot shower, then do an hour of isometric exercises. After breakfast I have time to head to the gym to swim, lift weights, or both. These are things that I have found necessary in order to cope with and get ahead of my back problems.

3. Learn proper bending and lifting form, and always be conscious of what you are doing. Don’t lift things that are awkward or too heavy. Don’t be a hero. Get help when you need it, and don’t try to save a few bucks when hiring someone to move things or do a job around the house will save your back.

4. When doing any new exercise, start very slow and pay attention to how your body feels. Patience is a must. Go for the least amount of change possible. Don’t compare yourself with others when working out. Chances are they are using poor form and too much weight anyway, and are on the way to eventually hurting themselves.

5. Eat properly and stay at a low body weight. Find an aerobic exercise you can safely do and work into it slowly. This could be walking outside or on a treadmill, swimming, using an elliptical training machine, a regular or stationary bike, a rowing machine, a stepper, or anything else. Find a way to elevate your heartrate for a period of time.

6. Strengthen yourself. I would recommend going to the website “Muscleactivation.com” and finding a therapist in your area. Start by having your body assessed and work towards having an isometric workout of your own you can do at home.

7. Stop stretching. I know this sounds radical, but the concepts of Muscle Activation make perfect sense to me and I cannot see myself stretching again. Instead, use isometrics to strengthen the muscles that move you into positions you cannot reach.

8. Be open-minded to alternative forms of therapy. Consider any one of therapies I have mentioned, and others I have not. Do your own research and make sure you have references from someone you either know or can talk to personally.

9. Avoid heavy or constant use of painkillers. Painkillers mask the symptoms, but they do not address the root of the problem. At times they can be helpful, but make it a goal to eventually go without. Anti-inflammatories are a different matter, but if you take them on a consistant basis make sure you have your blood tested regularly.

10. Make a list of questions to ask your doctor. Orthopedics are busy and your visit will be over before you know it. I always hated leaving the office with unanswered questions. I learned to have my questions written down so that I would not forget to ask them. Part of having a good attitude while in pain is knowing as much as you can about what the doctors think is going on, and what the prognosis and modes of treatment might be. You need to know what you should and should not be doing on a daily, or hourly, basis. You need to ask in order to get the details.

11. When in doubt, ask for a picture, preferably an MRI. If your problem is bad enough you will end up having one anyway, so why not just get it over with. That’s why you have insurance.