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August 2021

JFK’s Back Pain and Physiatry

A Story of Camelot, Heroes, a Villain, and How the Father of Sports Medicine Helped to Pave the Way for a New Generation of Non- and Minimally Invasive Back Pain Treatments

 

Here is a back pain medical case that you will find of interest.

Doctors believe this patient’s back problems started when he was playing football around the age of 20. However, the exact nature of that actual back injury is not known. Three years later, he tried to enlist in the Army but was rejected because of his bad back. He then applied to join the Navy but failed that physical too.

His father however had significant political influence. With his father’s help, he was able to gain acceptance into the US Navy.

During his military service, he experienced a harrowing combat incident. Two of his fellow crew members were killed and he saved a fellow sailor – an exploit that probably further injured his back. For the rest of his life, although he displayed a public image of health and vigor, he was a man in constant pain.

President John F. Kennedy

Unfortunately, this patient – John F. Kennedy, our 35th President (commonly referred to as JFK) – lived in an era where the surgical options available were often experimental and extreme. Given his prominent status, he had the benefit of the best hospitals and physicians. The four spine surgeries that he underwent before becoming President were considered modern for their time. But given what we know now, some of them probably contributed to worsening his medical condition.

Medication Mismanagement

Further complicating Kennedy’s treatment was the inclusion of Dr. Max Jacobson on his medical team. Dr. Jacobson was a New York physician who treated many high-profile clients across the United States. He also came to be known by the nicknames “Dr. Feelgood” and “Miracle Max.”

Dr. Jacobson was used by President Kennedy for injections to combat his most severe bouts of back pain. Historical records show that by May 1962, Jacobson had visited the White House to treat the president thirty-four times. However, Kennedy’s White House physicians ended up stopping the treatments after realizing the inappropriateness and serious side effects of the amphetamines and steroids that Jacobson was administering.

According to a detailed analysis published in the Journal of Neurosurgery,

The poor state of his back and its effect on JFK’s overall well-being may have had a considerable and negative impact on the President’s performance at the crucial Vienna summit with Soviet Premier Nikita Khrushchev in June 1961. In fact, on the 1st day of the tense summit, the president received at least 3 of the methamphetamine-containing shots. Reeling from the nerve-wracking summit, his aching back, and the likely side effects of Jacobson’s methamphetamine shots, the “very gloomy” Kennedy admitted immediately after it ended that the summit did not go well — reflecting that Khrushchev “just beat the hell out of me.”

After a 1972 New York Times investigative exposé, things did not end well for the doctor. In 1973 he was charged with unprofessional conduct and fraud, and he lost his medical license two years later.

Function Restoration and Pain Relief from Physical Medicine

It wasn’t until 1961 that Dr. Hans Kraus, a Physiatrist, was sent to the White House to evaluate Kennedy that things began to change. Dr. Kraus was a specialist in Physical Medicine and Rehabilitation. He has been called the father of sports medicine in the United States.

JFK’s Secret Doctor (Susan E. B. Schwartz)

Dr. Kraus developed a now widely used approach for treating lower back pain. He used it to ease President Kennedy’s problems as well as those of other well-known patients.

When Dr. Kraus initially examined Kennedy, he made a diagnosis of weakness and stiffness in key postural muscles. His believed that trigger point injections should only be performed selectively to the entire affected muscle after a thorough evaluation. He emphasized that the injections were only one component of a comprehensive rehabilitation program. Post-injection therapeutic exercise followed –  focused on gentle motion for restoring flexibility and local circulation. And carefully designed strength exercises were essential to rebuild muscle.

He also dealt with the actions of other doctors treating the President at the same time which were not coordinated with his approach. He insisted that no other physicians be involved in the President’s musculoskeletal care. Today, a major role of Physiatrists is to coordinate musculoskeletal care across a team of the many providers who may be focused on an individual patient.

According to the Journal of Neurosurgery article on John F. Kennedy’s Back, Kraus’ rehabilitation program for Kennedy “… paid immediate dividends. Within months, the improvement was dramatic.”

Dr. Kraus’ personal medical records at the JFK library show that by the time of Kennedy’s death in Dallas, Kraus’s Physiatry-focused therapy had nearly cured Kennedy of his lifelong back pain.

Dr. Kraus’ Campaign to Improve Fitness in the United States

In 1955, a special White House luncheon was organized by Philadelphia’s own John B. Kelly Sr. For those few readers who may be unfamiliar with “Jack Kelly,” he was a triple Olympic champion in rowing. Over the 1920 and 1924 Olympics, Kelly was the first rower to win three Olympic gold medals. He was one of the most successful and famous athletes of his generation.

Great champion oarsman John B. Kelly, Sr. (1889-1960) appears in a single scull in this bronze monument that sits along Philadelphia’s Schuylkill River.

A bronze monument in Kelly’s likeness sits on the edge of the Schuylkill River where he trained. Jack was also a multimillionaire in the bricklaying and construction industry – as well as the father of actress Grace Kelly, Princess of Monaco.

In addition to President Eisenhower, the luncheon was attended by Kelly, Pennsylvania’s Senator James H. Duff, and about 30 sports celebrities, including Willie Mays, Jack Fleck, and Tony Trabert. They listened in silent shock to a report by the two researchers who had prompted the luncheon.

Dr. Kraus and his research partner, Bonnie Prudden, reviewed their findings for the gathering. Their report detailed how schoolchildren were less physically fit than a comparable group of Italian and Austrian children. The study measured muscle strength and flexibility between children on the two continents.

This crisis in the U.S. did not differ between rural versus urban locations, or by socioeconomic status. American children were uniformly physically “unfit.” As a 1955 Sports Illustrated article summarized, the cause ranged across several factors from “the playpen to the school bus to television – in short, America’s plush standard of living.

One result of this meeting was the initial establishment of the President’s Council on Physical Fitness by Eisenhower administration. However, as another 1957 Sports Illustrated article detailed, at that time, the American Medical Association (AMA) and gym teachers opposed the concept of mandatory exercise programs in school, finding the concept as being too strident.

Needless to say, we’ve come a long way since then in understanding how vital regular exercise is both for our children as well as for ourselves.

The Connection Between Exercise and Orthopedic Health

Dr. Kraus was born in Trieste in 1905 when it was part of the Austro-Hungarian empire. That was before that city became part of the future nation of Italy. From a young age, he always wanted to be a physician.

As a young surgeon at the University of Vienna, Kraus discovered clinical evidence of the benefits of exercise in healing fractures. He developed specific exercises to promote faster recovery, and he found that patients who performed those exercises healed quicker than those who didn’t. Those insights established the foundation of his philosophy of treatment that he followed for the rest of his life – an approach that was far different than how traditional medicine was practiced back in his time.

He was considered a maverick in those early years. Today he is recognized as being an innovative medical pioneer who was ahead of his time.

Physiatrist and Sportsman

Dr. Hans Kraus

Kraus’ focus on sports medicine evolved naturally. In addition to being a doctor, he was a top all-around sportsman, skier, hiker, and mountain climber. He was also proficient in judo, boxing, acrobatics, and fencing. He was internationally known for his mountain climbing first ascents – and he had a deep involvement with skiing’s healthy physical growth in the United States.

For his contributions to U.S. skiing, he was elected to the U.S. Ski and Snowboard Hall of Fame. The U.S. skier Billy Kidd credited Dr. Kraus’ treatments for making it possible for him to win an Olympic medal. As Kidd has detailed, when he first approached Dr. Kraus to help him, Kidd thought, given his back pain, his skiing career was over.

As Kidd recounts, Kraus’ initial trigger point injection treatment for him did not yield immediate overnight results. But Kidd dedicated himself to faithfully exercising, using physical therapy, and following Dr. Kraus’ recommendations on reducing stress. After two years Kidd found, like Kennedy, his pain was gone. And he found himself back on the winner’s podium.

Dr. Kraus was an associate professor of clinical physical medicine and rehabilitation at the New York University School of Medicine until he retired in 1973.  One of his innovations includes the development of trigger-point therapy for the relief of back pain. His contributions to the treatment and prevention of injuries weave their way prominently through the physiatry field of medicine today.

When Main Line Spine doctors work with you to relieve low back pain and restore functionality without surgery, that effort often reflects on the innovative medical path Dr. Kraus started almost a century ago.

 

Further Reading

Pait, T. Glenn, MD & Dowd, Justin T., MD John F. Kennedy’s Back: Chronic Pain, Failed Surgeries, and the Story of Its Effects on His Life and Death, Journal of Neurosurgery, 11 July 2017

Schwartz, Susan E.B. JFK’s Secret Doctor: The Remarkable Life of Medical Pioneer and Legendary Rock Climber Hans Kraus, Skyhorse, June 15, 2012.

Doyle, William PT 109: An American Epic of War, Survival, and the Destiny of John F. Kennedy, William Morrow, October 6, 2015.

Lertzman, Richard A. & Birnes, William J. Dr. Feelgood: The Shocking Story of the Doctor Who May Have Changed History by Treating and Drugging JFK, Marilyn, Elvis, and Other Prominent Figures, Skyhorse, May 1, 2013

What is Physiatry? What is Physical Medicine & Rehabilitation?, Main Line Spine

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