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| Keywords: ChronicBackache1042.png CHRONIC BACKACHE--REYNOLDS AND LOVETT Journal of the American Medical Association Chicago Ill 1910 REYNOLDS Edwards AND LOVETT Robert W PD Image ChronicBackache1041 png PD-old conclusions governing the treatment of these cases It is evirlent that a determination whether the original cause of the hack ache is primarily intra-abdominal or originÂally static is a necessary preliminary to intelligent or effective treatment In practice in the comparatively limited field selected by us for discussion here the eases wonld seem to fall schematically into thrce c1a es The gyneCQlogic of intrapelvic origin The orthopedic of mechanical or static origin The borderland cases 'in which both elements are pr ent or in which the differentiation hetween the two is at first impossible The recognition of a borderland class is necessary on account of the frequency oI it appearance in clinical work but thc line between this and the other c1 sses is so indefinite that it can be described only by implication under the other headings <center>1 Treatment of Cases of 1 ntrapeh'ic Origin</center> Static backache is frequently a promineut symptom oI the intrapelvic ncoplasms It is then due to an alteraÂtion of attitude caused either by an instinctive effort to lessen pathologic pressure ithin the pelvis or by dis4 turhance of balance fTom the actual weight of the laTger growth In the'e cases no improvcment in the static condition can be expected until after the removal of the nE'oplaRm and here an immediate opel'atiye removal should be promptly followed by propcr orthopedic tTeatÂment if necessaTY On the other hand many of the pto es are merely secondary results of static abncnnalitie In these cuscs especially gynecologi ts should be careful not to adopt treatment without first making a stuely of the static causes which so often haye produced or are perpetuating them since some previously nmnanageable retroverted uteri prolapse-d oVHl'ies etc call be promptly relieved by minor intrapelvic treatment after the static fault which caused them have been correct 1 Ptoses of the kidneys and other upper abdominal v; cera are equally important and shonld be considered Under these conÂditions also those cases which still demand major measÂurcs will more surely become symptomatic as well as anatomic snccesses nnd many anatomic failures will be aided ¢ In the inflammatory ffcdion of the peh-ic organ the instincti'-e efforts of the patient to protect the tenelcr ~trndnl'es from the pres~t1re~ and jars which are alw lYS incirlent to locomotion in the crect posture lead usually' to so persistent a maintenance of a constrained attitude that the prominence or tatic bac-k~chc in these cases is easily understood in thc light of 'hat has becn said in onr experimental section Thc relative value of static 01' intrapelvic treatmcnt 8 an initial step in the management of these caBCS depend largely on the sta e of acutene ' at the time at which treatment is undcrtakcn Jt is enerally conceded that during toc preseuce of an acutc symptomatology thc infhtOlmatory affections of the peh-ie organs should have dcplcti c nd soothing rathcr than radical treatment In the more cute cascs the musclcs of the back arc almost invariably in a ~tate of irritation anLl Sp 1Sffi and no part of the initial palliatory trcatment is more imporÂtant or more promptly grateful to the patient than rcst in bed support to thc il'l'itated muscles hot packs the loca electric light bath ctc for thcir relief On the othcr hanel even ill thc chronic cases too earlv attempts at mechanical correction of the faulty posture· are apt to do harm rather than good so long as the pel ic tenderÂnr ~ cs arc unrclicrcu since if successful they agnin expose the tender organs to the prc sures from which the faulty attitnde has partially relicved them The complication of ptoses with inflammatory condi_ tions demands evidently thc weighing of rel lti\'c indica tions in the individual case It is manifestlv impossible to cover within the lenath of snch a paper as this evcn in outline the wholc fi~ld of gynecologic practice in its relation to static backache even without the equally important lesions of general abdominal surgery but we hope that what has bcen here said may serve to illustrate the principles involvcd The gynecologist may of conrse Teadily examine the backs of bis paticnts and may with practice acqnire Some facility in the differential diagnosis of back-strains into thosc of primarily intra-abdominal OT primarily static origin bnt he should never forget that in the static ca;e the abnormality which is the original cause of the sympÂtom may often be found in a distant part of the skeleton e g the feet and that its detection may reqnire special knowledge Throughout the field of gynecologic practicc thc csti mation of static conditions is of importance whcn er backache is a symptom <center>2 Treatment of Cases of Mechanical or Static Origin</center> The orthopedic surgeon will be wise to rcfer to the gynecologist for a preliminary examination uud opinion by which to gnide treatment thosc ca cs in hieh the hi~tory 01' the replies to the usuill questions are suggc54 tive of utcrine disease This is especially important when the symptoms snggest the possib le presencc of inflammatory di~ea3e of the intrapclric organs ¢ incc in these cases as has been ~aicl aboyC' altcHltioo of attitmlc sneh as would hc indicatcd by thc bark· hain aionc mav be distinctly harmful The accepted orthopedic trcatment of back-strain a ' it exists to-day has been already spoken of in the beginning of the paper It is a matter of common information that it is on the whole unsatisfactory Thc treatment which from onr point of iew should be in theory the most satisfactory and which in practice in our hands has proved the most successfnl is as follOws A defect of balance cxists which in the cnd must be curcd by remedying that defect of balance a matter only to be brought about by substituting a corrcet for an inrorrect attitude Massage and gYll mflstic cxcr 'i~ 3 to induce this correct attitUllc would seem to be the ob\'ions method to follow But practically this alonc at the outÂ~et is gcncrnll - unsatisfadory for the following rra~nn5 Onc is dealin~ in most instances not with ath-letcs wit1 wcn-developccl muscles but with men or more ofbn women of les 3 than average physique as a wholc~ \\ ho~c back muscles in particular are overstrained weak and irritatcd These patients are recumbcnt not ol'cr tCll oot of thc twenty-foUl' hours s a rule and for thc rc t of the time arc generally sitting ~tanding~ 01' walking To begin by gymnastics on mu~cular l \'cloplllcnt lIIHIrl' thcse conditions is to exerti e still furtber IOI' pcl'i 'Jl' Iwlf an houl' rlail ' muscles alrcady ovcruscd am for the remaining fourteen lOurs of the twenty·folll' the irritaÂtion induced by the malposition goes on fol' a correct po~'ition cannot at once he suhstifnted for nn illcol'rr rt position It is a frequent experiencc to find thc backache made immediately wor~c by such treatment eren when gil'cn by skilled pcrson It is as if thc oculist OJ' lcrcr1 1Ji~ patients suffering from eyc-stmin due to flfo tiglllati~lJl to usc the eye a little more each day to strengthen thcrn heforc he correct cd the isual errol' The bc t resolts in back·strain are to be obtained not by attcmpting to Permanent corset treatment Reynolds and Lovett - Chronic Backache | ||||
