A Century Of Treating Back Pain
Back pain in the early 20th century was commonly attributed to ‘rheumatism’, with little explanation provided in clear biomechanical terms. However, given the World War and the subsequent devastation wrought by the Spanish flu, it is clear that there were more pressing matters on people’s minds at that time.
Over the course of the 20th century, the treatment of back pain underwent a transition from traditional healing methods such as Bone Setting to the modern medical model and emerged on the other side of this transformation. Along the way, there were also some interesting subplots that are worth exploring.
Although we will need to criticise mainstream medicine to some extent, this will be done with great respect for the many ways in which medicine has helped us in other areas. It is worth noting that the author of this blog owes his life to the skill and care of his doctors.
Medically Prescribed Bed Rest
The practice of prescribing bed rest for back pain was a common treatment during the 20th century but ultimately proved to be detrimental to patients. This approach was promoted by orthopedists, who were relatively new to the medical field at the time. The idea of using “healing rest” to alleviate spinal tissue irritation may have seemed promising, but in reality, extended periods of lying flat on one’s back can cause increased stiffness, muscle atrophy, and clinical depression, all of which can exacerbate back pain. As a result, more severe cases of back pain emerged, as opposed to the milder, occasional episodes.
Medically Prescribed Bed Rest
The practice of prescribing bed rest for back pain was a common treatment during the 20th century but ultimately proved to be detrimental to patients. This approach was promoted by orthopedists, who were relatively new to the medical field at the time. The idea of using “healing rest” to alleviate spinal tissue irritation may have seemed promising, but in reality, extended periods of lying flat on one’s back can cause increased stiffness, muscle atrophy, and clinical depression, all of which can exacerbate back pain. As a result, more severe cases of back pain emerged, as opposed to the milder, occasional episodes.
Surgery
During the second phase of attempts to alleviate back pain, medical professionals resorted to surgical disc repair and spinal fusions. However, this approach treated back pain as a medical condition rather than a biomechanical and overall well-being concern. The common practice of diagnosing back pain by focusing on spinal abnormalities and imperfections, despite the fact that most of these do not cause pain, was a significant misinterpretation affecting the vast majority of sufferers. Research has now revealed that only a tiny fraction of individuals with back pain require surgery. Nevertheless, spinal surgery was once widely employed as a primary treatment in the mid-20th century. Fortunately, through research, this approach was exposed as a mistake, leading to a reduction in the number of people receiving surgery for back pain today.
**If you have a major disc prolapse and severe leg pain, surgery can definitely be an excellent short-term solution, especially with modern procedures that have become less invasive.
Surgery
During the second phase of attempts to alleviate back pain, medical professionals resorted to surgical disc repair and spinal fusions. However, this approach treated back pain as a medical condition rather than a biomechanical and overall well-being concern. The common practice of diagnosing back pain by focusing on spinal abnormalities and imperfections, despite the fact that most of these do not cause pain, was a significant misinterpretation affecting the vast majority of sufferers. Research has now revealed that only a tiny fraction of individuals with back pain require surgery. Nevertheless, spinal surgery was once widely employed as a primary treatment in the mid-20th century. Fortunately, through research, this approach was exposed as a mistake, leading to a reduction in the number of people receiving surgery for back pain today.
**If you have a major disc prolapse and severe leg pain, surgery can definitely be an excellent short-term solution, especially with modern procedures that have become less invasive.
Pharmaceuticals
The third phase of medical treatment for back pain in the 20th century involved the use of drug therapies, which continues to be a prevalent practice today. However, the problem of back pain in our society is multifaceted and extends beyond the use of drugs. While painkillers provide short-term relief, their long-term use can have adverse physical effects and often replaces legitimate scientific rehabilitation efforts.
While drug therapies have their place in managing back pain, they cannot be considered a long-term solution, much like how they are not a solution for tooth decay. It is worth questioning if medicine has turned to drug therapies as a last resort, given that medical training does not typically cover accountable and updated pain management. Family doctors are spread thin in terms of their scope of practice, while orthopaedic surgeons may have hyper-specialisation that limits their ability to address back pain.
It is important to note that there are three major sub-plots in the story of back pain treatment in the 20th century that have not been addressed.
Chiropractic
The term ‘chiropractic’ has its roots in the Greek words cheir, meaning ‘hand’, and praktos, meaning ‘done by hand’. The founder of chiropractic, Daniel David Palmer, a self-taught healer, chose this name. Palmer’s interest in the relationship between the spine and health was sparked by his own experiences, and he discovered that various forms of spinal manipulation had been used for centuries without a scientific explanation. He developed a hypothesis that became the foundation of the chiropractic profession based on his reasoning ability and extensive knowledge of anatomy and physiology.
Today, chiropractic adjustments have been proven to be an effective treatment for lower back pain, in line with international guidelines. Palmer performed the first official chiropractic adjustment in September 1895 and established the Palmer College of Chiropractic in Davenport, Iowa, in 1897. By 1931, 39 states had granted chiropractors legal recognition as primary healthcare providers, on par with doctors and dentists.
Chiropractic has made a significant contribution to pain management, and millions of people receive chiropractic treatment worldwide each year. However, early theories about the influence of chiropractic adjustments have been found inadequate over time, and researchers are extensively revising them. Nonetheless, spinal manipulation is listed on virtually all scientifically validated international guidelines for the management of back pain.
While traditional chiropractic’s contribution to the management of back pain is somewhat limited due to the complexity of the issue, modern European-style chiropractic training encompasses a wide range of evidence-based perspectives and techniques. Since the early 20th century, chiropractic has been less invasive and less harmful than traditional medicine in managing back pain. While not a competition, this comparison is valuable for those seeking pain relief.
Osteopathy
Andrew Taylor Still, a physician and surgeon, founded osteopathy in Kirksville, Missouri, in the late 1800s. His belief that the body’s parts should work together for optimum health led him to develop a concept of restoring the body to health with minimal surgery and medicine.
Through experimentation and effective treatments, Still gained a reputation, and patients from all over America sought him out for treatment. This led to the establishment of the American School of Osteopathy, which in 1892 enrolled its first wave of 22 osteopathic students. The two-year program included in-depth education in anatomy and physiology, and upon graduation, students were awarded the title of D.O. (Doctors of Osteopathy) with full practice rights.
Osteopathy grew rapidly, and in 1917, the British School of Osteopathy was founded, laying the strong foundations for osteopathy in Europe. However, the integration with medicine was uneasy at times during the 20th century, and it wasn’t until the introduction of the Osteopaths Act in 1993 that osteopathy became a legally regulated profession. This led to the establishment of the General Osteopathic Council and the Register opening in 1998, requiring qualified practitioners to register with GOsC to practice and use the title of ‘osteopath’.
Osteopaths, like chiropractors, have made valuable contributions to the non-invasive, non-toxic, and conservative treatment of back pain since their professional birth just over 100 years ago. They are well-positioned to carry the torch of ‘best practice’ as society learns more about how to collectively manage lower back pain.
The Biopsychosocial Model – The Beginning Of A Happy Ending
The 20th century ended with significant progress in our comprehension of lower back pain. We saw the early stages of healthcare professionals collaborating as a team and developing a consensus on how to manage back pain. Thanks to ample research, we now have international guidelines for handling lower back pain, a crucial milestone. A significant advancement of the late 20th century was the biopsychosocial model of lower back pain, formulated by orthopaedic surgeon Gordon Waddell.
This model is currently the most comprehensive approach to understanding back pain and the chronic disability that often accompanies it. It considers back pain not only from a physical perspective but also from a holistic viewpoint, including the mind, emotions, and societal and cultural factors. The term “biopsychosocial” reflects this integrated approach, with “bio” referring to bodily tissues, “psycho” to the mind, and “social” to society and culture. The biopsychosocial model recognises that back pain, like all chronic pain, is profoundly influenced by emotional well-being, belief systems, and cultural attitudes toward pain and those who suffer from it. Although it is not perfect and may require revision, the biopsychosocial model represents a significant breakthrough in our comprehension of back pain.
Conclusion
In conclusion, the alarming increase in long-term disability caused by back pain makes this conversation not just about back pain treatment but about the freedom to live a happy, normal life. Back pain can restrict individuals from enjoying certain activities, fulfilling their responsibilities to others, and connecting with loved ones. For those with severe cases, simply being able to walk, stand, sit, and sleep without pain can provide a sense of basic freedom. These are the fundamental realities underlying the issue of back pain, while the treatment details are merely the means to achieve these goals.
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