Lumbago And Sciatica

Any affection involving discomfort, pain, ache, or disability of the

large muscles in the lumbar regions is likely to be called lumbago,

not only by patients but by physicians. Any condition that makes it

painful to use the upper part of the lower limb and especially the

group of large posterior leg muscles just below the nates is called

sciatica. These are commonly supposed to be typical "chronic

rheumatisms." Anythin in this region that is the source of discomfort

on rainy days and comes especially to the working man who has been

exposed to the elements, or that follows a wetting or the wearing of

damp clothes, is confidently classified as a chronic rheumatic

condition. Almost needless to say any such conclusion as to the

heterogeneous groups of symptoms that occur in these regions, far from

adding to our knowledge, rather confuses the situation. There is an

assumption that we know something about them when we call these

conditions either lumbago or sciatica, but unless each individual case

is carefully investigated and its conditions studied so as to get at

their true etiology, it is almost impossible to treat them

successfully. While the general practitioner of medicine of the

regular school often fails in his treatment of them, these affections

are among the most fruitful sources of revenue for the irregular

practitioners.



It was particularly for pains and aches in the back that St. John

Long's liniment proved so efficacious about a century ago. So-called

lumbago and sciatica patients were among the most frequent callers on

Perkins in the days of the famous tractors and many of them received

great relief. In our own time these constitute a class of patients who

go from physician to physician and who finally are cured or relieved

by some irregular practice which we know contains nothing especially

remedial, but the advocates of which somehow succeed in persuading

these patients that they must be better than before. Most old people

have some aches and pains in either the lumbar muscles or the large

muscles at the back of the thigh. Many of them are relieved by

massage, but still more of them find relief in the rubbings and

manipulations of the osteopaths, and they are great advertisers of the

relief that has been afforded them and they have helped much in

securing such state recognition as has come to the systems they

thought curative in their cases. Eddyism has been helpful to a certain

number of them. Fads of various kinds catch still others. Evidently

these intractable cases deserve to be studied from the standpoint of

what mental influence can do for them.





Conditions Mistaken for Sciatica or Lumbago.--Needless to say, a large

number of conditions occur which may be called sciatica or lumbago,

but which are due to the most varied causes. An affection of any of

the joints in this neighborhood will produce pain to which is often

added tenderness and occasionally swelling, and nearly always

disability. Disease of the lower part of the lumbar spine due to

tuberculosis is often in its earlier stages called lumbago. Indeed,

without careful investigation showing that there is a special point of

tenderness, some irregular fever and that the muscles are in spasm

to protect the underlying joints from use, it is difficult to

decide just what is the affection in a particular case. I have seen

three physicians diagnose a one-sided tenderness and pain in muscles

with disability as lumbago, when the course of the disease proved that

it was tuberculosis of the sacro-iliac joint. Any of the bones or

joints in this neighborhood may give rise to pain, tenderness and

spasm of muscles and it is important not to make the facile diagnosis

of lumbago, unless careful investigation has eliminated all underlying

organic conditions.



There are other conditions not infrequently mistaken for lumbago or

sciatica which are interesting. Needless to say unless they are

definitely recognized there will be no relief afforded for any

discomfort of a permanent character, though the coal-tar products will

give temporary surcease of pain. Occasionally internal hemorrhoids

produce an achy discomfort in the lower part of the back that is

described as lumbago, and unless the physician is careful to

investigate he may tentatively accept that diagnosis. Proper

regulation of the bowels and the use of gluten suppositories will

often practically cure the condition, though there will be relapses

whenever constipation returns. Chronic posterior urethritis sometimes

simulates painful conditions very low down in the back or in one hip

or the other. Usually in that case there is a chronic inflammatory

condition in the seminal vesicle on the side to which the symptoms are

referred. Occasionally over-distention of the seminal vesicles, as

seen in widowers who have been accustomed for many years to regular

evacuation of them, may cause so much pain and disability in the

region of the hip on one side as to be mistaken first for lumbago and

then even for tuberculous hip joint disease. Artificial emptying of

the seminal vesicle by milking through the rectum will usually afford

relief. In all of these cases as soon as the exact diagnosis is made,

the patient's mind is relieved of a serious burden of anxiety and it

is usually not difficult to bring a great measure of relief.





Old Injuries and Discomfort.--Many of the painful conditions

described as lumbago are due to old injuries, to wrenches and sprains

in this region due especially to heavy lifting and to the laceration

of ligaments from over-exertion.





Typhoid Spine.--Protracted cases of typhoid are sometimes followed

by pain in the lumbar or sacral regions, developing usually after a

slight jar or shock, sometimes after a fall or even following a severe

injury, which are really the result of the physical condition of the

patient. Stiffness, aching discomfort on movement and sometimes

tenderness on pressure are present. Often there are associated

neurotic symptoms of various kinds. This used very commonly to be

considered rheumatism and occasionally one still sees cases so

labeled. On the other hand, much more serious conditions, as Pott's

disease, abscess of the liver, or some form of spondylitis, may be

suspected. Absence of temperature is almost the rule and usually is

the pathognomic differential against these. The whole condition is

usually a neurosis though there may be some perispondylitis. The

treatment is to increase the patient's nutrition, which has usually

suffered to a marked degree, and get the mind off the condition in the

back. Concentration of attention on it will make it very

uncomfortable, so that even heavy doses of opiates will scarcely

relieve the discomfort, and this emphasis of attention will further

disturb the mind and develop neurotic symptoms. Diversion of

attention, gentle movements, plenty of air, and regulation of the

functions of the body will bring about a cure.





Stooping Occupations.--Occupations are especially important in lumbago

and people who have to stoop much, above all those who do hard work in

a stooping position--lifting, pushing, sawing, planing, and the

like--are particularly prone to suffer. Miners working where the

height of the vein does not permit them to stand up are commonly

subject to it. Any one who has to assume, or has the habit of

assuming, a stooping posture for long hours may suffer from lumbago.

Constrained position predisposes more than hard work. Tailors, though

in a sedentary occupation, often suffer from it.