He has just conferred with the patient, and now he is taking the man's physical therapist to task. "I know it goes against your training," he tells his abashed employee. "But pain doesn't matter. Pain doesn't matter! A bad back is like a rusty hinge. You won't get the hinge to move unless you force it. You get resistance—crackles, creaks and squeals. With a patient, the patient is the squealer." The patient is the squealer!?! Did this guy study at the Steve Martin Little Shop of Horrors Dental and Surgeons' College?
Hardly. In fact, the alleviation of pain matters a great deal to the good doctor; he just goes about it differently. Rosomoff is a pioneer in a new type of back treatment that relies not on surgery but on vigorous muscular therapy to cure the condition. For some 6,000 patients, who have paid $16,000 to $20,000 for four weeks in his center over the last 11 years, he is akin to God. The loving, nurturing kind, that is, not Job's.
Rosomoff bases his therapy on the premise that many operations for back pain are "addressing the wrong problem." The source of most agony, he believes, is not the injury to a vertebra or disk but to the muscles surrounding it. These muscles are sending the urgent messages to the brain that result in pain—and it is the proper realignment of the body after an accident or other trauma that will make the pain go away. At first, the therapy itself may hurt. "But that's unavoidable," he says. "The muscles have to be restored to the proper length to move with proper efficiency." Thus there is no cutting; instead, there is stretching, massaging and body positioning—all quite capable of drawing moans from a back patient.
Hacks and charlatans have traditionally cashed in on the backache, which afflicts about 75 million people at some point in their lives. It is the second most common reason for visiting a doctor (after upper-respiratory ailments) and is the claim on 25 percent of all disability payments. But Rosomoff is impeccably credentialed—and particularly so in the area he has chosen to abandon: back surgery.
As head of the departments of neurological surgery at three Miami-area hospitals, Rosomoff has long been on the forefront of vertebral and spinal-cord surgery. He co-invented the percutaneous cordotomy, in which electric current, replacing the scalpel, burns out a section of the spinal cord. He also pioneered the neural-arch resection, a radical surgery for those who still have pain after repeated operations. The back sections of afflicted vertebrae are removed, allowing the spinal nerves to move freely without being pinched or compressed.
But in time, surgery became less important. When Rosomoff prescribed preoperational muscle therapy to prepare for postsurgery rehabilitation, he gradually discovered that his patients were getting better without going under the knife. He had long been dubious about the benefits of back surgery. "We had the full records of 2,000 GI's from World War II with herniated disks," he says. "We found that there was no difference in recovery between those operated on and those not operated on." Around 1978 he declared a moratorium on low-back surgery, increased muscular therapy and found he was doing more good than he ever had done before. "We began seeing what we call the 'positive lipstick sign,' " he says. "As women patients began to feel less pain, they took more pride in their appearance and started putting on makeup again."
Those were the first stages of the Comprehensive Pain and Rehabilitation Center, which now employs more than 100 and has facilities for treating about 50 sufferers. After patients arrive, their body movements and job related motions are often recorded on videotape. Among those reviewing the tapes is Renée Steele Rosomoff, a respected rehabilitation specialist who serves as the program director at her husband's center. "Observing patients' work habits," she says, "tells us what therapy they need."
Once admitted, sufferers give up whatever drugs they have been using and then submit to a 12-hour-a-day, six-day-a-week schedule of therapy. The regimen combines physical treatment with psychological, vocational and even sex counseling. Then it's back home, with occasional observation by center personnel.
The Rosomoffs are proud that several pro golfers have solved their profession's occupational hazards at the center; sometimes, after observing them, all Rosomoff needs to do is recommend a different club length. Another patient was Colombian soccer star Willington Ortiz. Already operated on once for a herniated disk, he had re-injured his back, but with Rosomoffs program he was able to make a second recovery without surgery. Also cured was a TV anchorman who had been considering suicide because of his pain and the changes it had wrought in his life. His outpatient progress is easier to monitor than most. Renée just turns on the TV news. "We can tell by his posture and his eyes how he's coming along," she says.
The Rosomoffs have some general advice for those with everyday problems: A simple way to solve sciatic pressure, Renée says, is for men to remove wallets from their back pockets before they drive. Those who use the telephone a lot should get headsets or speakerphones—leaning sideways to hold the receiver can be harmful. Secretaries and others at desk jobs should get up frequently. And it would be better for people who do dishes to place one foot on the shelf under the sink.
That may sound unconventional, but then so did Hubert Rosomoffs original nonoperating concept—and the majority of his former patients swear by it. The center takes its share of criticism, some from surgeons ("The ego of surgeons is a formidable thing," says Rosomoff with a sigh), and there are patients who, after studying the program, still choose surgery. "People psychologically want a quick fix," he says. "The magic operation is attractive."
He stops there, but you can almost hear him thinking the hackneyed but sometimes useful cliché of the '80s: No pain, no gain.
- Laurel Tielis.
Hubert L. Rosomoff, head of the University of Miami's Comprehensive Pain and Rehabilitation Center at Miami Beach's South Shore Hospital, is not happy. It seems one of his patients is having insufficient pain.