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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." Anything 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

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.

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