Back Management (Hand Made History) (Report‪)‬

Controversy over the pathology and treatment of low-back strain continues. Strong and diverse views are put forward by different sections of the medical community. From the conflict one fact emerges. No concept of pathology and no treatment routine has gained the authority of universal acceptance. There is, however, one aspect of the treatment of low-back strain on which there is general agreement. It is frequently mentioned, but rarely carried out with the thoroughness it warrants. This aspect concerns the management of the back by the patient himself. It is virtually axiomatic that forward flexion of the spine causes pain and deterioration in either acute or chronic back strain. The stress of lifting or other strain falling on the lumbar spine in this position is notorious for its potential damage effect. Plaster jackets and lumbo-sacral corsets are used in recognition of the need to avoid flexion. In cases where they are not prescribed the need to maintain a lumbar lordosis still exists and this can only be achieved by the patient's voluntary effort. The constant maintenance of this posture under all circumstances for any length of time may seem at first glance an impossible demand to make of any patient. Admittedly there are patients to whom it is impossible. There are, however, a surprising number of people who will observe the routine if they fully understand its necessity, and are helped and encouraged over a period of a few weeks.