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Last Wednesday night while carrying a bucket of water from the well, Hannah Williams slipped upon the icy path and fell heavily upon her back. We fear her spine was injured for though she suffers acute pain in her legs she cannot move them. The poor wild beautiful girl is stopped in her wildness at last.


Low back pain accounts for at least 5% of general practice presentations. It is a massive problem worldwide. The most common cause is minor soft tissue injury, but patients with this do not usually seek medical help because the problem settles within a few days.

Most back pain in patients presenting to GPs is postulated to be due to dysfunction of elements of the mobile segment, namely the facet joint, the intervertebral joint (with its disc) and the ligamentous and muscular attachments. This problem, often referred to as mechanical back pain, will be described as vertebral dysfunction—a general term that, while covering radicular and non-radicular pain, includes dysfunction of the joints of the spine, although the specific origin in most instances cannot be determined. It is therefore appropriate to refer to this as ‘non-specific back pain’.1

Key facts and checkpoints

  • Back pain accounts for 2.6% of all presenting problems in Australian general practice.2

  • In the US it is the commonest cause of limitation of activity in those under the age of 45.3

  • Approximately 85–90% of the population will experience back pain at some stage of their lives, while 70% of the world’s population will have at least one disabling episode of low back pain in their lives.3

  • At least 50% of these people will recover within 2 weeks and 90% within 6 weeks, but recurrences are frequent and have been reported in 40–70% of patients; 2–7% develop chronic pain.4

  • It most commonly occurs in those aged 30–60 years, the average age being 45 years.5

  • It is difficult to assign a specific pathoanatomical cause in acute back pain (perhaps 8–15%),6 but the most common cause is probably a minor muscle/ligament strain (often don’t present to a doctor), followed by dysfunction of the intervertebral joints of the spine (‘mechanical back pain’) and spondylosis (synonymous with osteoarthritis and degenerative back disease).

  • L5 and S1 nerve root lesions represent most of the cases of sciatica presenting in general practice. They tend to present separately but can occur together with a massive disc protrusion.

  • An intervertebral disc prolapse is causative in only 6–8% of cases of back pain,3 and only a small fraction of those require urgent diagnosis and surgical treatment.


To develop a comprehensive diagnostic approach, the practitioner should have a clear understanding of the possible causes of low back and leg pain (see FIG. 28.1) and of the relative frequency of ...

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