We're thrilled to bring another installment of the Flowly Book Review Series. This week, let's join Flowly team member Christine and embark on an exploration of Crooked: Outwitting the Back Pain Industry and Getting on the Road to Recovery by Cathryn Jakobson Ramin.
The views expressed in this blog are solely those of the reviewer and do not necessarily reflect the opinions or position of Flowly.
Why did you choose to read Crooked?
Last week, we reviewed Back Mechanic, a book that Luigi Mangione, currently on trial for the murder of the United Healthcare CEO, read in regard to his chronic back pain. This week, we’re diving into another book he reviewed to see if there was anything that we could share with our Flowly community.
I will have to say that my impressions of both books are flipped when compared to Luigi's. I found Crooked far more helpful and comprehensive, but I fully want to acknowledge that I'm not suffering from chronic back pain. After reading Crooked, I can see how Luigi preferred Back Mechanic since it had an actual plan that one could follow. For those suffering from persistent - and debilitating - back pain, I can see how Crooked wouldn't lend them much hope or relief.
However, as someone working within this realm, I truly appreciated the writer's background as an investigative journalist because of the depth and breadth she goes into when it comes to back pain.
What’s it about?
In Crooked, investigative journalist Cathryn Jakobson Ramin, who endured chronic back pain for years, offers an in-depth exploration of the back pain industry. Drawing from her personal experience and extensive research, Ramin delves into the effectiveness, risks, and drawbacks of various treatments. After spending years and significant money on numerous therapies with little relief, she uncovered troubling truths about the $100 billion spine medicine industry, which often falls short and can even cause harm.
Over six years of research, Ramin interviewed a wide range of experts, including spine surgeons, pain specialists, physical therapists, and chiropractors, as well as patients whose journeys with back pain led them to make difficult choices. Crooked presents a candid and eye-opening critique of treatments like surgery, chiropractic care, spinal injections, and painkillers while emphasizing evidence-based rehabilitation methods. The book provides essential insights for both patients and healthcare professionals, offering guidance on how to navigate the complex landscape of back pain management and find more effective, affordable solutions.
What are the main takeaways?
1. This one may be common sense for anyone living with back pain - or any kind of chronic pain - but the road to recovery never ends. While reading Crooked, I was constantly reminded of something we often say at Flowly: healing doesn't mean that the pain no longer exists; it means it no longer controls our lives.
What Cathryn goes through is often something we hear a lot from our own heroes: they've tried everything, and nothing seems to work. I truly appreciate the fact that she not only looked into every treatment, therapy, and modality that was offered at the time of her writing the book but also did in-depth research to offer more to the readers. From reading her book, I think my empathy for our community increased because I have a much better scope of the breadth and depth that they themselves must've gone through to treat their chronic pain.
2. Back pain is complex, and so are the treatments. This was something that Dr McGill also wrote about in Back Mechanic, but I felt Crooked did a much better job at painting a fuller picture. What works for someone may not work for someone else. Additionally, Crooked opened my eyes to the myriad of conflicting information out there, even from experts who've helped hundreds of people with back pain. For example, Dr McGill and his methods are mentioned heavily in Cathryn's books, and she credits his Big 3 exercise to helping her. However, she also mentions other experts who believe in movement as a back pain treatment who offer conflicting advice from Dr. McGill.
"For instance, although some back whisperers put great stock in stretching, human biomechanist Stuart McGill, a professor of kinesiology at University of Waterloo in Ontario, Canada, is not a fan. In fact, he’s against the practice, calling it a waste of time and observing that it can make recovery harder. In contrast, Massachusetts physiatrist James Rainville, renowned for his esteemed back pain rehab program at New England Baptist Hospital in suburban Boston, integrates stretching exercises into every patient’s protocol."
Unlike Back Mechanic, where this point was made to showcase the McGill Method as the best treatment for back pain, I liked how Cathryn used it to make the point that treating back pain must be an interdisciplinary, multi-modality effort to ensure that one keeps making progress in their healing journey. This is something that I feel applies to chronic pain management as a whole too.
3. Back pain treatment shouldn't be around the symptoms but around the causes. This is a philosophy shared by Dr McGill in Back Mechanic, but I liked how Cathryn brought in the psychosomatic aspect of back pain as well. I felt her book was truly holistic in that she covered back pain from a physical, psychological, and social aspect since that reflects our thinking at Flowly about chronic pain being biopsychosocial.
4. [Bonus] To truly see success with back pain management (and even chronic pain management), you need agency. The best results come from those who not only seek and demand the best treatment for their pain but also have the grit to follow through on the exercises and the actions they have to do on their end to facilitate the healing. On the healing journey, the experts can only guide you for so long, and it'll be up to the patients to carry themselves forward.
5. [Bonus] I found it SHOCKING that even spine surgeons wouldn't want to go under the knife if they had back pain. The fact that these medical professionals won't go through the procedures and see it as a last measure should be emphasized for those who clamor for surgery to try every other modality and treatment out there.
"At an American Academy of Orthopaedic Surgeons conference in the summer of 2010, a hundred surgeons were polled as to whether they’d personally have lumbar spinal fusion surgery for unspecific low back pain. The answer—from all but one—was “absolutely not.” The risk-reward ratio just wasn’t good enough."
How did Crooked affect you?
This book took me longer to read than Back Mechanic because of how often I needed to take a break after reading each chapter (especially during the first part). It made me truly appreciate my back health and opened my eyes to how I've taken it for granted.
I can 1000% say that I am fully dedicated to back pain prevention so that I don't have to go through what Cathryn went through for her back pain.
Who should read Crooked?
Honestly, everyone, but especially those who work long hours in front of the computer. Our back is something that we take for granted when we're young, but it's something that can cause lots of agony, and I feel like we're seeing an uptick in people with chronic back pain because of the sedentary lifestyle many of us have.
Because of her journalism background, the way Cathryn writes is very visceral and engrossing, so I think this book could be triggering to those in our community who have gone through pretty much everything they could think of for their pain. However, for those curious about the history of each modality and who have the mental bandwidth to do so, this book would add more context to all the treatments they've probably tried or considered.
There are several quotes from the book that I think could help reassure our community that we are always doing what we can at Flowly to ensure that we bring them the best of pain management:
1. "A psychologist who is not specially trained in cognitive behavioral therapy for chronic pain may actually make things worse, by encouraging the patient to “talk it through,” and dwell on the pain, rather than to find ways to manage it."
More than CBT, we are employing pain-informed therapies like Pain Reprocessing Therapy (PRT) and Emotional Awareness Expression Therapy (EAET) to ensure that we are specifically targeting and working on chronic pain.
2. "With meditation and biofeedback, you learn how to teach yourself to relax, to remain calm, and that’s really an important component. You learn that if the pain comes back—if you have a relapse—you will not be at sea, floundering and drowning.”
At Flowly, we often talk about our app sessions as a bottoms-up approach to meditation because of the biofeedback component. I hope any hero reading this is reminded to do their Flowly session today!
3. " “When you’ve been in chronic pain for years,” she said, “you’ve spent a long time detaching yourself from your body’s sensations, out of self-preservation. It can take a while to tune in to what your body is doing.” "
During our 12-week Healing from Pain program, we spend a good portion of the time inviting our heroes to re-familiarize themselves with their body and their emotions. While uncomfortable (especially if you've been dissociating for a while), it'll eventually lead to breakthroughs in your healing journey.
4. "Do everything slowly."
It can be easy to want to rush through it all and "complete" the program, but healing is not linear, and there will be ebbs and flows in how well you feel as though you're making progress and improving. Remember, it's a journey, not a sprint.
Have a book you would like to review and share with the Flowly community? Send us an email at contact@flowly.world.