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March 15, 1958


Author Affiliations

Ann Arbor, Mich.

Director, Department of Physical Medicine and Rehabilitation, St. Joseph Mercy Hospital (Dr. House), and member, Department of Orthopedics, St. Joseph Mercy Hospital, and Associate Professor of Bone and Joint Surgery, University of Michigan (Dr. O'Connor).

JAMA. 1958;166(11):1285-1290. doi:10.1001/jama.1958.02990110021005

Many cases of low back pain are caused by hyperextension of the lumbosacral part of the vertebral column. They are associated with signs of compression or irritation of the lumbar or sacral nerve roots and with pain radiating down the course of the sciatic nerve. The history frequently reveals an injury, as from lifting, and examination reveals local muscle spasm. The conservative program of treatment for this condition consists of five successive steps: maintenance of proper position while lying in or getting out of bed, next certain exercises of abdominal and gluteal muscles in bed, then certain exercises while standing and walking, later more strenuous exercises in the lying and standing positions, and finally attention to specifc postural problems related to the patient's occupation. He must learn ways to carry out his normal work without extending the lower segments of his vertebral column. The crux of the program is the pelvic tilting associated with this undesired extension. Two case histories illustrate the effectiveness of the program. Of 247 patients with low back pain and sacral or lumbar radiculitis, only 18 failed to respond to this conservative treatment.