BECAUSE low back pain is so commonly encountered, the physician must learn to recognize accurately the various causes of backache and to institute the proper treatment himself or direct the patient to another physician who is capable of carrying out the necessary treatment. The physician’s lack of interest in this important problem accounts for the prevalence of various medical cults which specialize in the treatment of back pain.
To maintain the erect position, one must have good body balance. This balance may be upset by the presence of certain mechanical factors such as faulty posture, obesity, relaxed abdominal musculature, weak back musculature, and inequality of length of the lower extremities. When backache is caused by some disturbance in the normal body balance through the action of one or more of these mechanical factors, the condition is called a “mechanical backache.” The same mechanical factors often play a significant role in producing at least a portion of the low back pain associated with fibrositis, hypertrophic arthritis, rheumatoid spondylitis, spondylolisthesis and other causes of backache. Nevertheless the term “mechanical backache” should be reserved for the case in which there is no demonstrable pathologic condition to account for the pain within the back or pelvis other than mechanical factors.
Good posture is essential to good body balance. When a person stands correctly, a perpendicular line dropped from the ear should pass through the shoulders, hips and ankle joints (fig. 1a). With good posture, the head is high, chin up and in, chest up,. . .