The Practical Treatment of Backache and Sciatica

Backache is one of the most common ailments of the human race. Although a distressing condition and a frequent cause of absence from work - it is said that eighteen million working days are lost per year because of back pain - it is amazing how neglected has been the study of its cause and treatment, at least until relatively recent years. This may be reflected in the rarity of photographs of the posterior view of Venus de Milo, as compared with the well-known view from the front! (Figure 1). Undergraduate teaching of backache is scanty, partly because backache is not considered very important as it is rarely due to 'serious' disease and recovery is often spontaneous. However, this is not always the case and a significant number of patients have recur­ rences and fail to respond to conventional treatment. There are many possible causes of backache and physicians and orthopaedic surgeons continue to disagree as to which are the most Figure 1 The Venus de Milo vii THE PRACTICAL TREATMENT OF BACKACHE AND SCIATICA important factors and hence the best treatment. Proper scientific treatment must await deeper knowledge of the aetiology and pathology; meanwhile, management will have to be empirical, at least to some extent. Nevertheless, there is a strong case for establishing guidelines for treatment. Many physicians feel helpless about the best way to handle an individual patient with backache.