05/26/09 9:30 AM ET
Players dealing with back pain
Must make tough choice between surgery and rehab
By Gary Gillis / MLB.com
What?! The last I heard, Chavez had a sore forearm and was on the 15-day DL, and now his career is in crisis? Well, that made me sit up straight in my chair. And it turns out that's kind of what got the A's six-time Gold Glove third baseman into his current predicament. His back went out when he stood up from a chair. Now he's on the 60-day DL and won't be back with the ballclub any time soon.
"He's actually part of a bigger club" says Dr. Kevin McGuire, co-director of the Spine Center at Beth Israel Deaconess Medical Center. "Eighty-five percent of us will have at least one acute episode of back pain in our lifetime. Low back pain is the number one cause of lost work in the U.S."
Chavez has had lower back problems before, having undergone a microdiscectomy in October of 2007. Material from a lower bulging disc (L4 - L5) was removed in order to alleviate nerve irritation. That procedure was sandwiched in between surgeries on each of his shoulders. In fact, since the notoriously thrifty A's broke their bank to sign Chavez to a six-year, $66 million extension before the '04 season, he's broken down and missed over 300 games.
"I do believe that there's a genetic factor for a significant number of people who suffer from herniated discs," says Dr. McGuire. "Think of it this way. The guy who operates a jackhammer for 30 years with no problem was born with steel belted radials. The 26 year-old who walks into my office with a bulging or herniated disc got the retreads."
Chavez says he is determined to avoid surgery this time around and not, as some articles have suggested, because it would mean the end of his career, but rather because he prefers the option of rehab. Dr. McGuire says that's not an unreasonable approach.
"There may be a fair number of doctor's who would take a look at his MRI's and recommend surgery. Personally I don't operate based on MRI's. I operate based on a patient's story," explains Dr. McGuire. "If they come to see me with a bulging disc and no symptoms, no pain, I wave goodbye to them. I obviously don't know the particulars of Chavez's injury, but based on the symptoms he's described, I don't think surgery is absolutely necessary."
Which is not to say that the rehab approach will guarantee success. Given the abnormal stresses that baseball can put on a body, especially the twisting and torquing of the lower back, even a well-strengthened back may fail again. His money can't buy health, but it can cushion any setbacks. What about that person who can't afford another blow to either their physical or financial backbone?
"In my practice, I have treated heavy laborers. I suggest to them that they might want to move to a supervisory or management role," says Dr. McGuire. "That's not always possible and it's not always what they want. Sometimes they want to go back to doing exactly they did before. When I tell them I can't guarantee that will happen, they walk away rather than explore a surgical option."
And they simply live with the pain?
"You'd be amazed what you can tolerate when you are living paycheck to paycheck and have to put food on the table."
Chavez says he's resigned to the fact that he'll have to have spinal fusion at some point down the road. There are artificial discs that have been approved by the FDA but they don't come close to allowing a patient to recreate normal motion the way an artificial knee or hip does, according to Dr. McGuire. Still, a fusion doesn't mean your days of bending are over.
"Microdiscectomies and spinal fusion are effective treatments for lower back pain and you don't have to limit activities in most cases," he says. "I tell my fusion patients they can jump out of an airplane, ski, base jump and their spine will be stable. It may be sore but it will be stable."
I don't think Chavez is interested in base jumping. He'd prefer base hits, but, like thousands of folks who share his suffering, he'd probably settle for a pain-free walk.
Gary Gillis is a contributor to MLB.com. The BID Injury Report is a regular column on redsox.com. Beth Israel Deaconess Medical Center is the official hospital of The Boston Red Sox. This story was not subject to the approval of Major League Baseball or its clubs.