Acknowledgements

I would like to thank Isabel Atherton, my wonderful agent at Creative Authors who seems to know just when a particular book is needed. Thanks also to Quincy Rabot for kindly agreeing to write a foreword, to Jennifer Barclay, who commissioned this title, and to Chris Turton and Abbie Headon for the helpful editorial input.

It has been a pleasure to work on this book, since the writing process helps to clarify one’s clinical knowledge. I hope that it will be useful to anyone with back pain.

Author’s Note

When I was a medical student we were taught a list of causes of back pain. Knowing about them was enough to get through the degree course, yet when one first ventured out into the casualty departments and saw real people with real back pain they were not all that helpful. The surprising thing was that very few of the patients I met were actually affected by any of the causes that we had been taught about. Then, years later in general practice, it was obvious that the undergraduate training about back pain that I had been given was woefully inadequate to deal with the spectrum of back pain that I was seeing, virtually on a daily basis.

About twenty years ago a close relative had a prolapsed intervertebral disc, or as it is commonly (yet incorrectly) known, a slipped disc. He tried all sorts of things to help it before it was finally diagnosed and treated surgically. A talented sportsman, it effectively curtailed his sporting life. Another more distant relative coped with a chronic back condition by doing yoga and regularly visiting a chiropractor. Both of them from time to time asked me for advice and I simply gave them the best advice that I could, although my own understanding of back pain still had a long way to develop.

Then one year I strained my back while bending to pick strawberries. I felt an instant stabbing pain in the small of my back, as if I had been struck from behind by an invisible assailant. I could not move for several minutes and the pain was excruciating. It was as I struggled to get back to normality over the next couple of weeks that I decided to become more knowledgeable about back pain so that I could protect myself against another episode, as well as becoming more effective as a doctor.

I found it to be a difficult task, because people experience back pain in different ways, with differing pain thresholds, different body builds, different occupations and very varied life styles. Yet over the years I built up a range of strategies, looking at first aid measures, lifestyle changes, and different therapies including acupuncture and manipulation. I have found that there is almost always something that you can advise people to do in order to manage their back pain. And I have included the top fifty things in this book for you to start doing today.

Dr Keith Souter

Foreword

by Quincy Rabot, Osteomyologist and specialist in back pain and sports medicine

If you are reading this the chances are that you suffer from back pain, or have suffered from a bad back in the past.

Next to stress, back pain is the second most common cause of sickness in the UK. Reading this whole book might be one of the best things you can do.

I have noticed that in 30 years of treating back problems the outstanding belief among patients is that the cause of their pain was an event; they lifted something badly, they slipped, they twisted awkwardly or they slept on a bad mattress, and so forth. This is a common misconception. The event was, most likely, only the trigger. The real cause was a complex pattern of musculoskeletal imbalance and dysfunction that had established itself over a period of many years. In such instances, it is only a matter of time before it results in muscle spasm and pain, or worse still, torn ligaments and ruptured or prolapsed discs.

What is most important to understand is that such imbalances in your neuromuscular system can be caused by many aspects of your lifestyle: your mental attitude, your emotional responses to events in your life, your posture and working habits, the sports and exercise you either do or don’t do, and even the food you eat.

As I tell my patients, having your episode of back pain treated by a good osteomyologist, chiropractor, osteopath or physiotherapist is like cutting the top off an iceberg. Just because you are out of pain does not mean that the problem has gone away. You need to make some changes to your neuromuscular patterns and work towards regaining good functional patterns to remain pain free.

This calls for some education on how your back works and on what you need to do in order to make the necessary changes. What Dr Keith Souter has done in this clear, splendidly informative and well-thought-out book is to provide you with all the information you need in your journey towards a good, healthy and functional back. All you need to provide is some measure of application and effort!

It is well worth it.

Introduction

Back pain is extremely common. In the UK today more than 2.5 million people regularly experience back pain. Eighty per cent of people will experience at least one episode of back pain at some stage in their life. Surveys published in the British Medical Journal in 2000 suggested that in the preceding year up to half of the adult population in the UK had experienced back pain lasting 24 hours. It is the second most common reason for absence from work and currently results in about 9.3 million lost working days per year. No one is immune to it and it can have a dramatic effect on family life, relationships, work and general well-being.

Research from other countries suggests that these figures are not static, but imply that the prevalence of chronic low back pain is steadily rising. A comparison of figures in Colorado, USA, reported in the Archives of Internal Medicine in 2009, found that in a 14-year period the prevalence of chronic low back pain rose from 3.9 per cent of adults to 10.2 per cent. Why this should be the case is not clear, yet it is tempting to suppose that it could be related to rising obesity levels in the population, for as we shall see later, this is a significant risk factor.

In terms of cost, the NHS spends over £1 billion a year on back pain treatments. This includes over £500 million on hospital treatment, around £150 million for GP consultations and another £150 million for physiotherapy treatment. In addition to this, it is estimated that over £500 million is also being spent in the private sector for various treatments, both orthodox and complementary.

You would think that with all the money that is being spent we would have all the answers to the problem of back pain. The simple truth, however, is that we do not. Indeed, according to the Royal College of General Practitioners only 15 per cent of cases of back pain are accurately diagnosed.