Page Four P H Y S I O T H E R A P Y July, 1948 BACK ACHE: From the Physiotherapists' Point of View. B y G . S. S C H E R M B R U C K E R , M .C .S .P . I THINK I AM SAFE in asserting that the I physiotherapist has more to do with pains in the back than with any .other type of injury or disease. This has always been true, but the more doctors take heed of this very prevalent condition, the truer it 'becom es. It is a fact that far too little heed is given to back ache. It does not kill the patient, nor is it an infectious disease, and, therefore, it seems to me that it is to o often looked upon as a neurosis. The patient is given a bottle of medicine, (it doesn’t much matter what it is, but is probably some harmless and not very effective sedative), and a chronic back gradu­ ally develops and causes much distress. It is not my intention to analyse the various causes of back ache, nor do I propose to discuss any aetiological points. Back ache is a highly controversial subject, and I would not presume, as a physiotherapist, to expound any theories of causation. I propose to deal with the ordinary tired back, by far the com m onest form of back ache, and the one in which physiotherapy can play a very im portant role. The muscles of the back are postural, and they are very seldom com pletely at rest. Their tone, therefore, must always be good, and, if it tends to weaken, steps must immediately be taken to produce the neces­ sary strengthening. Overwork and overstrain, both physical and mental, produces spasm of the back muscles, and this, I am firmly convinced, is the m ajor cause of the typical back ache so often encountered in our modern society. The doctor sends the patient to the physiotherapist with the assurance that his examination has revealed no Tuberculosis or other infection— nor has it revealed any bony defects or serious arthritic changes or pro­ lapsed Disc, or any other of the multifarious, but somewhat rare, causes of back ache which require surgical treatment. The physiothera­ pist’s field is now clear. His jo b is to strengthen a weak back and so eliminate the pain, or, at least, reduce it to a minimum, for there are some people w ho will always have back ache, sometimes no matter how hard we may try to cure it. The following method is one which I recommend and which is probably in fairly general use. The patient is put in the prone position on a com fortable plinth, and his back is sub­ jected to therapeutic heat — in this case. I prefer Infra-Red radiation to any other form of heating. The back is gently palpated to establish on which side of the column the spasm is more marked. In almost every case, one side will be found more spastic, and this group should at once be massaged. The massage, under the Infra-Red Lamp, should be deep, but not painful, and the depth of treatment should be progressive. Light Effleurage, becoming heavier, should be follow ed by fairly light kneading which, in turn, becomes very deep, but must not be painful. To hurt a back like this is folly — it exaggerates the spasm because the patient tries to protect himself by tightening his muscles. W hen the spasm has yielded to treat­ ment, (and it does not invariably do so in one session), isolated fibrositic nodules can be treated by friction. It is w rong to imagine that the pain is due, solely, to nodules. In fact, I incline to the opinion that nodules, as such, are seldom the main cause of pain. They' may often cause referred pain, but, in this paper, I do not propose to go into that big and controversial field. Having com pleted the initial massage and heat, and having had a slight “ Nodule Hunt,” the tone of the muscle should be examined. Lightly resisted exercises should be given, and the physiotherapist should compare the strength of contraction of the tw o groups of muscles. Having established which is the weaker group, it should be given gentle surging faradism. I strongly deplore an overdose of this type of treatment, but, as strongly, recommend a mild dose. Not more than ten contractions, at the first sitting, to each muscle. The faradic current, stimulating the muscle through its nerve fibre, as it does, can cause muscle fatigue, and, for that very good reason, R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) July, 1948 P H Y S I O T H E R A P Y Page Five I deplore the use of mechanical surging. It is bad, very bad indeed, to leave a patient with one of these contraptions on his muscles while the physiotherapist attends to some other case. Faradism must be graduated surging or it is harmful and painful. Exercises, actively performed, are neces- £ind very good indeed far better, in fact, than any mechanical stimulations, such as the faradic current produces. But it is a fact that very very few patients actually perform exercises. Y ou can tell them to do so and stress their importance, but, unless they are supervised, they just do not co­ operate. Many doctors ask us to teach patients exercises. W e do so, but only the very few really co-operate. Those who do, respond well and their recovery is expedited. Exercises must be made pleasant. Tell a patient to go swimming. He will, and, in doing so, will probably have the best possible exercise for his back muscles. Tabulated exercises exist in profusion, and m ost of them are very good, but as the tired back is generally experienced by older patients, they seldom do exercises. It is my opinion, there­ fore, that we must try to get the back muscles stronger by mechanical means, first, by Massage and heat, and faradism. Then we introduce exercises, simple active movements, at each treatment. The back pain will diminish, if it does n ot' disappear altogether. The patient is then shown a few simple tabulated exercises, and he is told that if he does these simple movements, regularly, he is less likely to have a recurrence of his back - ache. He will probably be m ore likely, then, to do some exercises, than he would have been had he been required to learn a whole lot of involved physical jerks before he got rid of his pain. The human being revolts at doing a jo b for himself, when he expects someone else to do it for him. Thus, with the suggestion that exercises should follow a course of treatment for back-ache, I end m y paper and await, with interest, the views of the school of thought to whom exercises form the basis of all back treatments. I N T E R N A T I O N A L C O N G R E S S The President has received a notification from England stating that the Chartered Society of Physiotherapists is organising an International Physiotherapy Congress in London from 23rd to 25th September next. A cordial invitation is extended to members of the South Africa Society to attend this function. Lectures and demonstrations will be given by eminent members of the Medical profes­ sion and by Chartered Physiotherapists. Visits have been arranged to various London hospitals. Of particular interest to S.A. members will be the Symposium by overseas visitors on “ The Treatment of Anterior Poliom yelitis.” A number of interesting social functions has been arranged. These include a reception of overseas visitors by the Council for Physio­ therapy in the Apothecaries Hall on the eve of the Congress; a reception by the London County Council at the County Hall, W est­ minster and a reception at the Guildhall at which the Lord M ayor of London will receive the guests. On the Sunday follow ing the Congress, there will be a special service in W estminster Abbey. A period has been set aside on the pro­ gramme for considering ways and means of prom oting closer relationship and collabora­ tion between physiotherapists in different parts of the world. H otel accom m odation will be reserved if the C.S.P. receive previous notification. Should any member know that h e /sh e will be in England during this period, they are asked to write to the General Secretary (Miss Oosthuizen) who will notify the C.S.P. R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. )