Some of you may know that I have been away from the practice for most of the last nine months. I have been pursuing my interest in the history and philosophy of medicine and science by doing an MPhil at Cambridge. One of the consequences of this was an investigation I conducted into how mechanical back problems, which until the early twentieth century were largely treated at home or by folk remedies, became absorbed into mainstream medicine. This assimilation increased enormously from the late 1940s right up to the 1990s. Despite, however, the expansion of medical intervention with its use of various new technologies and investigations, the rise in the prevalence of back problems continued unchecked. Modern medicine contributed little to its demise. This raises the obvious question, why? The answer it would seem is that the majority of back complaints are not a medical problem at all, in the sense of them being a disease or a correctable deformity. They are simply part of the human condition. We all have our unique posture. Although we share the same anatomy, we are all different. Most back issues relate to how our individual body deals with the everyday pressures we put upon it. They are the reaction of the back to such things as sustaining relatively static positions, such as sitting or standing. Muscle strength, weight and flexibility all have their effects, both positive and negative. Some people have a natural propensity to be excessively stiff or hypermobile. Additionally how people cope psychologically also affects the longevity of a back complaint.
It should come as no surprise therefore to realise that much modern technology, MRI for example, has little part to play in most mechanical back problems. It will tell us little that can’t be gleaned from a good clinical examination and will not alter the treatment plan. The important thing is to be aware of each back’s specific shortcomings and receive appropriate advice about suitable exercises and activities to be able to manage it for the long term.
History shows that backs became over medicalised for no good reason. Current work suggests a more autonomous, ‘patient centred’ approach is the way forward. Physiotherapy provides the knowledge needed to achieve this.
Clare Roche