Refresher course for general practitioners: the treatment of lumbar disk lesions

Reprinted with permission from British Medical Journal, 2:1434-1438, 1950. Much confusion exists on this subject. Some years ago the main difficulty was to appear credible when attributing such well-known conditions as lumbago, fibrositis, and sciatica to so recent a discovery as a disk lesion. Now that the diagnosis has become widely accepted, medical men have found themselves in a therapeutic quandary. Traditional measures such as drugs (apart from analgesics), radiant heat, diathermy, massage, exercises, injecting nodules, and "taking the waters" have suddenly lost their last vestige of theoretical justification. Little has so far come forward to replace these abandoned types of "treatment", and the distress of doctors and patients is heightened when they find out that the only radical treatment is an operation - by no means always successful - warranted only in extreme cases. This therapeutic nihilism is quite unjustified, for there are a number of simple treatments, none a panacea, each with its due proportion of successes. Few patients prove unrelievable if conservative means are intelligently employed, and it is only for some of these few that surgery need to be contemplated at all. J Orthop Sports Phys Ther 1990;12(4):163-169.