Over the centuries, victims of back pain have submitted to a vast variety of treatments. The bizarre nature of some of these testifies to the sufferers’ desperation: they were willing to try anything – even, it is said, having a tame bear tread on their back. In spite of great advances in medical science generally, these unorthodox treatments – except, perhaps, the bear – are still in with a chance.
Back pain therapy presents special problems. It is often difficult to diagnose accurately the cause of an attack of back pain. Damage to the structures of the back does not, as a rule, show on the surface, many do not show up on X-ray and even in-depth specialist investigations may not reveal anything obviously amiss.
Moreover, very often back pain is out of proportion to the problem causing it; although the pain is severe and disabling, the structural damage may be minor, and one accepted view is that it will heal, given time, provided movement is restricted to the pain free range. Another school of thought considers this to be short-sighted and holds that correct treatment by a qualified therapist will expedite recovery and may help to reduce scar tissue, the presence of which can produce long-term problems.
If any treatment is given, it is sure to get the credit for the recovery. But the next time it is tried on someone, it may not work, either because it is valueless, or because the problem is not the same.
The information gleaned from each case may be of only limited use in the next one, and the treatment of back pain has had to be largely empirical. The fact that diagnoses are often less than accurate makes the choice of therapy problematic and specific therapies which exist for one condition are sometimes applied erroneously to another. There is no scientific body of knowledge which allows a doctor or any other practitioner to state with certainty that a particular treatment will cure the trouble.
The rationale of advising rest, and particularly bed rest, is based on the clinical observation that lying down may relieve pain. This applies to a diagnosis of disc prolapse: intra discal pressure is lowest in the lying position. However, disc prolapse constitutes only a small percentage of all lower back pain and treatment for disc prolapse cannot necessarily be extrapolated to all lower back pain. However, rest is the first line of treatment for acute attacks of back pain.
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