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The spine is not so simple

Back pain, often associated with leg pain, is common. Rapid conclusions as to the cause are often made, and the unfortunate victim is told with authority by friends that “this is obviously a ‘disc'”. Even the profession was beguiled at one stage into believing in the “dynasty of the disc” for nearly half a centuary. However back pain originating is the disc is relatively rare.

The compendium of potential caused of back pain is large, and often originates from causes external to the vertebral column such as inequality of leg length and restricted (but unrecognised) limitations of hip movement. Even changes in the feet, by disturbing the fine and specific axis of balance of the vertebral colum can produce back pain. [This will be the subject of a dedicated page in the future].

Events near the vertebral column can produce back pain, such as gynaecological or bowel disease. Others include disease of the min arteries or ulceration of stomach or duodenum.

The ligaments, particularly the ilio lumbar ligament and fascia can produce intractable back pain. [Entrapment of the sciatic nerve by the piriformis muscle will be considered in a later post].

The problem is that the vertebral colum is an exceedingly complex anatomy of fine dimension, and is hidden deeply within the body. It is frequently assumed that one or other type of “scan” will be all-revelatory. Unfortunately even the most sophisticated investigatory equipment is too crude to give precise answers. Instead this equipment might show an abnormality which is no more than a “red herring”, with the regrettable outcome that  patient and therapist  alike begin to pursue this misleading cue even to the extent of attacking it surgically. Another problem is the cavalier surgeon who is determined to “explore”. Pain, however, is never found with a knife.

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