Back pain has existed for many generations in Gloucester, Gloucestershire and indeed the rest of the world as far back as the Bronze Age!
The father of medicine Hippocrates (460 BC) was the one of the earliest scholars to attempt to describe an injury to the spine involving pain in the sciatic nerve and more broadly the term ‘low back pain’. Hippocrates first coined the phrase ‘sciatica’, meaning ischios or hip. Sciatica followed on to mean pain in the leg as a result of problems with the hip. Hippocrates also noticed that sciatica symptoms often had seasonal differences in how common people suffered its pain. Treatment of sciatica and back pain in those days often involved warm water, fasting, boiled milk consumption and so on. Hippocrates concluded that back pain and sciatica would take far longer in those that were old, whereas the young recovered far quicker. Galen almost a century later noted strange repeated patterns of posture amongst back pain sufferers and normal people alike. This is where the phrases ‘lordosis, kyphosis and scoliosis’ come from and we still use these terms today. However, in those early days, back pain was treated by bleeding a patient to remove the pain by ridding the body of toxicity!
In the 5th century AD the Romans now started to use modalities to treat back pain that, believe it or not are still in use today. Traction of the back and spine to relieve sciatica was then implemented as a successful way of improving symptoms of back pain and sciatica. The Greeks and Romans also during this time made clear and specific references to the presence of symptoms that were attributed to sciatic nerve irritation. Buttock, leg, thigh, knee and back pain were now closer associated with irritation of the nerves as they exit the back. Other symptoms included muscle wasting, sensation disturbances, antalgic postures and even constipation. Traction is still a very popular and accepted form of treatment for back pain and sciatica alike.
In the 6th century, the Greeks were more specific about the origins of back pain and sciatic nerve irritation. It was now much clearer that back pain that involved the nerves as they exit the spine were able to cause leg pain and even foot irritation. Greek and Roman doctors often made reference to pain of the sciatic region of the body and back pain in many documented examples. However, there was confusion and there was often disagreement about their understanding of back pain and that it may emanate from the hip joint and in fact not the spine.
Surgical approaches towards back pain have also been variable through time, where at the end of the 10th century surgeons and doctors preferred not to attempt surgical intervention but to actually wait and observe what happens over time. In many cases people with back pain actually improved without any major intervention. Many people during medieval times also attributed low back pain to bad or evil spirits and the treating of this cause of back pain might help! In the 1700’s a scientist known as Cotugno concluded that there was a fundamental difference between back pain caused by nerve problems versus back pain caused by joint arthritis.
As history moved on to beyond the 1900’s, doctors now believed that back pain was a result of nerve aggravation and damage. This so created more irritation to surrounding tissues and hence caused back pain. Gradually this simplistic understanding of low back pain started to dwindle and was overtaken by more modern day thinking behind the mechanics of back pain. Harvey Williams Cushing was a Neurosurgeon in America and started to spread the notion that surgical intervention had its benefits in the treating of back pain, spine pain and sciatica.
In 1901 the first successful operation was completed on the back to remove part of a disc that encroached upon a nerve. In 1934 it was proposed that the contents of a disc squeezing out was a big common cause of back pain. In 1927 it was discovered that the hole that the spinal nerve root exits in the spine causes back pain and so irritate the sciatic nerve and 2 years later in 1929, it was discovered that the bits of the disc that squeeze out of the main body of the disc can float around the nerve and cause irritation and eventual back pain. These findings are not too distant from the modern day understanding of what happens to the spine over time as it degenerates and gives a great insight as to what causes back pain….and perhaps its treatment thereof.
The ability to investigate back pain further, in a objective manner arrived with the dawn of x-rays and radiology. X-rays gave the doctor the ability to look closer into the spine, into the disc space and health of the facet joints. These structures for the first time rose as possible contributors towards back pain and spine pain in general, perhaps all the way up to the neck and neck pain. The disc of the spine being the foundation to all injuries to the spines of all sufferers of back pain was popularised by someone called Dr JS Barr who successfully operated on disc injuries and reported significant results in reduced back pain, sciatica, and back aches. The disc as a big cause of back pain then seemed to flourish with great popularity and acceptance amongst the medical community worldwide right up through to the 1980’s when the dawn of better, more efficient methods of back pain analysis came about through MRI scans and CT scans. By this point in time the western world was now heavily impacted upon by back pain and it had risen to become one of the most common reasons people visited their doctor for help! Back pain is also the most common reason why people miss days at work. This means that businesses productivity is hit as well as a greater strain on the public health services. With this greater technology came the understanding that the disc of the spine was not necessarily the sole problem and that back pain was indeed far more complex in its cause and management.
In the last 20 years back pain has gone from strength to strength in terms of how many people suffer it, but also how many people who treat it. Back pain has a huge impact on home life as well as work life. Many employers now have much improved appreciation of back injuries and laws in the UK now protect the employee much better in the last 15 years or so. Businesses must allow sufficient time for rest and recuperation, plus also amend working conditions so that a sufferer of back pain or sciatica can work with as minimal chance of relapse as possible. For example, height adjustable desk, back pain stools, regular breaks and even rooms set aside for employees to stretch and ease their back pain are now common place.