Pharmacological basis of treatment

keeping their backs posturally upright. They need help with tights, but shoes, socks, and stockings may be put on by pulling the foot backwards. Hot baths help as the patients will float out into a good posture and the heat will soothe, but to get out of the bath they must turn over and kneel in the bath and not pull themselves out forwards. To avoid a recurrence patients are told to take a forward strain on their backs by bending their knees and hips but not their backs before lifting, and if they cannot reach the object to be lifted they must get on one knee and still keep their backs posturally upright. They must also treat all objects to be lifted as if they were heavy-that is, they must not lift a weight carelessly off the floor but face the weight and lift as instructed. Patients visited at home and found immobile in bed usually have a lumbar strain. A pillow is put under the lumbar region. While they hold the head of the bed traction is applied to their legs until their muscle spasm relaxes and the pain goes. They are then rolled out of bed and shown how they can manage if they stay upright. Many of these patients, lying across a pillow, will turn and manipulate their own backs, usually at night, but the more courageous are hung on a door and manipulated. This treatment could have been deduced by realising how strong a leverage action is exerted to slip back one vertebra over the one below if the muscles do not hold during a forward strain. This is not easily noted, because x-ray films of the vertebral column are notoriously unreliable and such movements that the vertebrae sustain, although enough to irritate the spinal nerve, are readily passed as "within normal limits." Having manipulated well over 2000 backs in this way (patients with unstable backs come back for each relapse) and as only a few are off work for more than a week (some go straight back to work), I would like to recommend this technique for the treatment of backache.