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 AN EXPERIMENTAL STUDY OF CERTAIN PHASES OF CHRONIC BACKACHE

A COMBINED GYNECOLOGIC AND ORTHOPEDIC INVESTIGATION

EDWARD REYNOLDS, M.D. AND ROBERT W. LOVETT, M.D. BOSTON

DEFINITION OF CLASS OF CASES UNDER INVESTIGATION

For an indefinite time the medical profession has been confronted with a very common and perplexing class of cases, mostly in women, but occasionally in men, in which persistent backache is the chief subjective symptom. These cases present the following symptomatic pic­ture: The pain, generally dull in character, is as a rule referred to the sacral or lumbar region and is frequently felt in one or both sacro-iliac joints; rarely it is complained of in the dorsal region. It also frequently shoots down one or both legs, in which case it is gen­erally classed as "sciatica" and is aggravated by forward bending or flexion of the thigh with the knee extended. The pain in the back and leg are aggravated by stand­ing, and especially by prolonged standing, such as is involved in the fitting of women's dresses. It is sometimes relieved by the recumbent position, but at times is at its worst when the patient rises in the morning. The pressure of the hand in the small of the back while sitting, or the use of a cushion in the same region in sitting or lying, are instinctive means of relief which every practitioner has seen these patients use. The pain is most often aggravated during menstruation and in general is either unilateral or bilateral, but in the latter case on close questioning is usually found to be worse on one side than on the other. Local tenderness may or may not be present. If the back is exposed and the finger-tips are placed over the erector spinæ muscles, perceptible spasm may be excited in these muscles by voluntary forward or lateral bending at the waist, and perfectly normal spinal mobility is unusual in the more marked cases. Bending is frequently better performed to one side than to the other. The nervous element in these cases may be slight, or so severe as to dominate the whole picture. The condition sometimes originates from accidents, such as falls; it begins at other times as the result of overuse or strain, as in prolonged piano-playing, after heavy lifting, or after surgical operations. At other times it is found without assignable cause. The affec­tion is exceedingly persistent and seldom very severe, and its most striking characteristic feature is the patient's insistence on a habitual pain for which no ade­quate cause is apparent. A search for that cause was the purpose of this investigation.

The causes of this condition have been variously assigned by specialists and the general practitioner to the pelvic organs, to the muscles and joints, and to the nervous system. The uncertainty concerning its true