With the recent Centennial Celebration of the birth of President John F. Kennedy comes renewed interest in his political and personal life. What is sometimes forgotten is that underlying Kennedy’s legacy was his struggle with multiple medical problems, including chronic back pain. The pain at times was so severe that Kennedy underwent multiple spine surgeries, relied on daily use of a back brace (and sometimes crutches), and tried various alternative treatments.
T. Glenn Pait, MD, Director of the Jackson T. Stephens Spine and Neurosciences Institute at the University of Arkansas for Medical Sciences, has researched Kennedy’s history of chronic back pain for several years and spoke to SpineUniverse about his findings.
Dr. Pait: The treatment that John F. Kennedy received was considered modern for its time. Given his prominent status, he had access to the best hospitals and physicians.
Despite being advised by the Mayo Clinic surgeons (Rochester, MN) not to undergo spine surgery, on June 23, 1944 he underwent surgery at the New England Baptist Hospital (Boston, MA) by a Lahey Clinic neurosurgeon. Like many people today, Kennedy had to weigh his options, including, the risks and benefits of surgery. Young Jack Kennedy’s father, Joseph Kennedy Sr, a former U.S. Ambassador to the United Kingdom, told the Lahey Clinic doctors, including Frank Lahey, something had to be done!
Jack Kennedy's pain became intractable, prompting him to undergo surgical intervention. Kennedy underwent an L4-L5 laminotomy and L5-S1 discectomy. Unfortunately, the surgical benefits were short-lived and disappointing. His spine demons continued their mischief.
During Kennedy’s time as a Senator, he required near-constant use of crutches. He sought care at the Hospital for Special Surgery (New York, NY) where he received implantation of a metal plate (called a Wilson plate) that was attached along the spinous processes of his vertebrae (the knob-shaped projections on the back of each bone in the spine) in his low back and down onto his sacrum (the triangular bone at the end of the spine). This is an example of early use of instrumentation and spinal fusion.
Unfortunately, the surgery led to infection and removal of the metal implant. Just as today, infections sometimes happen even in the best of hands. Years later, Kennedy developed another spinal infection requiring surgery.
Later in life, Kennedy was treated by the notable physician Janet Travell, MD, who developed a technique for trigger point injections using procaine (an anesthetic that numbs the area and reduces pain). Dr. Travell became the first female White House physician. These trigger point injections and a muscle-strengthening program led to a period of improvement in Kennedy’s back pain and functioning.
Later in 1960, campaigning for the presidency took its toll on Kennedy. At this time, he met with Max Jacobson, MD, also known as Dr. Feelgood, who injected him on many occasions with a concoction that included amphetamines. In fact, Dr. Jacobson injected Kennedy before the first presidential debate with Richard Nixon. Amphetamines have many side effects, including mood swings and impaired judgement, that some believe may have affected Kennedy’s performance at the debate. However, physically, he looked much better than Nixon, which was important for this first ever televised presidential debate.
Q: How did rehabilitation and physical therapy help improve Kennedy’s back pain?
Dr. Pait: White House physician Rear Admiral George C. Burkley, MD, became concerned about Kennedy’s worsening back pain in 1961 and Dr. Travell’s increasing use of procaine injections. Dr. Burkley sought the help of Hans Kraus, MD, a specialist in physical medicine and rehabilitation who has been called the father of sports medicine.
Notably, Dr. Kraus started Kennedy on water therapy, which brought dramatic improvement, and a pool was built at the White House. Kennedy had been swimming for a long time, including on the Harvard varsity swim team. In addition, Kraus’ rehabilitation program included weight lifting, massage therapy, and heat therapy.
Dr. Kraus tried to wean Kennedy from the canvas corset back brace, made of cloth with metal rods that he had worn for most of his adult life to allow Kennedy to build up his muscles. Kennedy had become dependent upon his brace, but promised that he was going to get rid of it.
Q: What role may Kennedy’s back brace have played in his assassination?
Dr. Pait: During Kraus’ attempts to wean Kennedy from the brace, Kennedy experienced a strain to his left iliopsoas (a group of inner hip muscles that help flex the hip when walking and stair climbing) stemming from the demands of his presidential campaigning. Kennedy was diagnosed with the strain by Preston Wade, at the Hospital for Special Surgery, who advised heat, rest, and use of an Ace bandage. This setback resulted in increased use of the back brace along with an Ace bandage so that Kennedy could keep up with his campaign schedule.
It has been theorized that the tight binding of the brace and Ace bandage may be the reason why Kennedy did not fall forward after the first shot was fired at Dealey Plaza. He may have survived the first gun shot, but the brace and Ace bandage prohibited him from being able to fall forward, maintaining his upright position, which caused him to be in the line of fire for the second fatal shot to the head. In fact, the corset brace and Ace bandage (laced in figure 8 loops around his trunk and thighs) were cut off Kennedy during resuscitation attempts at Parkland Hospital in Dallas.
Q: If Kennedy was your patient today, with the treatment and technological advances now available, what would be a reasonable treatment plan?
Dr Pait: If Kennedy were treated today, he would have undergone conservative therapies, such as physical therapy, interventional nerve injections, and use of medications, including non-steroidal anti-inflammatory medications and gabapentin (an anticonvulsant drug prescribed for nerve pain) before surgery was considered.
Today, an MRI of the lumbosacral spine would have been performed to better determine the source of his pain. Surgery would become an option if he failed all non-surgical options, his pain caused a decline of his ability to move and function, and radiological studies (x-rays) demonstrated a spine condition that correlated with his history and physical examination.
Q: What led you to this research?
Dr. Pait: After learning of President Kennedy’s back surgeries and his struggles with continued pain, I began to research the exact types of surgery the president underwent. I not only examined Kennedy’s medical records, but also read accounts from his close friends and associates, who I think give the greatest insight. While Kennedy always portrayed himself in the best of health, he would tell his close friends about his pain. In fact, some of his early acquaintances and friends commented that Kennedy was constantly complaining about his back pain, even when he was driving around in a car.
As a neurosurgeon with a primary interest in the spine, Kennedy piqued my interest with his long history of spine problems. It is also interesting that, as a child, Kennedy had scarlet fever, measles, whooping cough, chronic sinusitis, and bronchitis. He was plagued by ongoing gastrointestinal problems (colitis and irritable bowel syndrome). In fact, around the time of his first and second spine surgeries, Kennedy was diagnosed with one of the early cases of Addison’s disease possibly secondary to chronic corticosteroid use for treatment of the gastrointestinal problems. Addison’s disease is a condition in which the adrenal glands do not produce enough cortisol that may cause fatigue, weight loss, muscle weakness, and stomach pain among other symptoms.
Despite his lifetime of suffering from chronic pain and other conditions, Kennedy persevered. President Kennedy pursued his dreams despite experiencing challenging, and at times debilitating, medical conditions. On the other hand, perhaps his dreams and his commitments to America allowed him to keep his health demons at bay.