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| Keywords: ChronicBackache1041.png CHRONIC BACKACHE--REYNOLDS AND LOVETT Journal of the American Medical Association Chicago Ill 1910 REYNOLDS Edwards AND LOVETT Robert W PD Image ChronicBackache1040 png PD-old told that she ahould cnll~ult nn orthopedic surgeon but that ~r nlany specialists should be under the control of a neurologist whom she should ee frequel1t1 · and persi ltently j referred to Dr J J Putnam with con~nt of Dr Chandler with written opinion to this effect; referred by Dr Putnam to R 'V L Examination by R 'V J showed that the patient stood with slight left lateral curve and in 1\ general stumped attitude The lumbar region wa ii flat the dOTu1 region rounded and the pees were inclined to be held slightl flexed She complained that she felt as if her back were lIot hollow enough j anel to 1ft relief she assumed a position with more lumbar curve in bich the knees straightened She showed marked tenderness over the left sacroiliac joint and felt Rome pain in the left leg A radiognph showed that the sncroiliac joint were norniaL She was provided with properly fitled therapeutic corseh giving marked 8upport in the lumbar region and 'which were tight around the pelvis and was started on exercises She was Dot markedly improved by this treatment at the end of a month Orthopedic trentment lun-ing failed to afford relief Dr Putnam put the patient under general rcst-cure methods in a hospital His observation there convincing him that the left-sided pain was genuine and persistent and its catamenial exncerhntion pronounced he requested another examination from E R Examination without anesthesin was again negative but under anesthesia the presence of a slightly enlarged hard non·tender Jeft Fallopian tube was demonstrated and a few days Jater the abdomen was opened The Jeft tube proved to be strai~ht and patent but with much thickened and indurated walls; the corresponding ovary slightly enlarged sclerotic and containing a very Jarge number of sroaJl tense cysts scattered through it like a charge of birdshot The left ovary and tube were removed and abdomen closed KormaJ convl\lp5cence Patient declared that all abnormal sensations in left side had dj~ap· peared On getting lip there \\' however some Jeft·sided sacroiliac backache relieved by a therapeutic corset Patient returned to Dr Putnam's care 'Vhen last heard from one year after operation she considered herself well In thi~ case the essential factor was at first missed and th~ ease considered orthopedic After longer observation the detec· tion and cure of the abdominal lesion resulted in spontaneous relief of the apparently static symptoms CASE 4 -Patient of R 'V L a health and well-developed young woman a professionaJ teacher of gymnastics at the end of a very hard 'ear developed severe sacraJ backache for which advice was Bought She was-at the time wearing a small girdle She was treated by corsets and one of Cook's back pIiots The pain disappeared immediateJy and an observation was made showing that the center of gravity had been mov ed back 1lh inches This change was so great that a second observation was taken a week later for purposes of verifh~l\tioll with identical results Fig 11 The relief was permanent and the case was evidently one of pure back-strain induced by overexertion and therefore relieved by the change of balance and conioiequent relief to the posterior musculature without further trel\tment CASt 5 -Plltient of R 'V L a married woman 34 ~-enrs old of ratl1 '1 JCfoi i than average p1ty~ique had been fairly well until her confinement a year an 1 a half previous Shortly after getting about she began to hllve pain in the back and in olle leg and st wding wa J A C'Compl\uied by great discomf rt She had lost ftt>5h nnd was ver;y nervous and apprehen81vP' Examinl\tion indicated that the backache was apparently static She had heen treated h ' o teopathy without succ 's~ and 11lter the diatrnosis of a relaxed sacroiliac joint hRcl be~n made For this nCplaster-oi-Pl\ris j'lcket had been app1i >d nll l Worn without any relief of the pain -hen she was seen lw wore a steel lJack-brace and a neutral corset An attempt wa ' made to throw the center of gmvit ' backward by means of a properly made corset rcinforcetl by 1\ light tempercll steel bM'k bracc to throw her b h\nce bnck; thi gave immediate 'om fort alld gentle exerci se8 were bt gllll n three wCt'ks ollie wa~ pradically free from p tin had I ailll'li ill flesh nlll1 \n\S improving as to her nen/olls infoltabilil y In this 'ase of evident back-stndn tll ' w e of the onlinary npplialll l's to <plint the lnlck did tlot give relit which W lfol obtnincl1 lJy ch \Ilgiu¥ the body lJalance by corsets <center>APPLICATION OF EXPERIMENTAL DEDUCTIONS TO CLINICAL CONDITIONS</center> It becomes evident from the most caHI1 1 consideration that in this class of cases there exist two elements the gynecologic and the orthopedic and an analysis of the probable primary cam;e of the p in therefore becomes nece~sarJ That forward displacement of the center of gravity induces increased effort of the posterior musculaturc back-strain has been demonstrated in our experimental section That such excessive or prolonged muscular effort may be translated into pain spasm and irritability is not only more or les ; a matter of common information but Illa ' be supported by quotation of certain wellknown analogous instances If the arm is held out horizontally after two or three minutes the muscular effort is translated into an ache The spROm and irritability of the ciliary lIluscle which is overstrained to accommodate for astigmatism is well known The pain and dragging in pronated and flat feet is generally admitted to be due to muscular and ligamentous strain 'l'hat back-strain sufficiently long continued induced by an unduly forward position of the center of gIRdty may be translated into backachc seems evidcnt The unduly forward position of the center of gravity which induces backache we believe to be usna v caused bv one of three factors '- Peculiarities in the form and proportions of the skeleton not neees � � rily outside of normal limits resulting in a type of figure with a center of gravity markedly far forward General muscular relaXAtion leading to a slumped relaxed attitude Tenderness of intra-abdominal or intrapeiric organs inducing the patient to aS~llllle a Stoopillg or other s rained position to relieve intra·abdominal or mtrape1ric pressure The gynecologic cases de8cribed above belong in the latter class and though it is eddent that the field of intra-abdominal or other vis< el· l lesions which may cause such attitudes is wider than that covered by any merely gynecologic cases yet they are presented as the most frequent representatives of a large cl s for the purposes of this paper It is further evident from the anatomy that in the case of the comparatively unprotected sacro-iliac joints even the painful spasms of the dorsal musculature may and probably do fail to prevent painful tension on the connective tissue ligaments and fascire placed th<re to regulate extremes of motion '\'jthout denying the occasional existence pf abnormally movable sacro-iliac articulations mostly puerperal we believe that undue tension on connective tissue from overstrain is sufficient to explain the symptomatology of most cases of apparent functional ucrangement of the E lcro-iliac joints without invoking the po ib1e existence of an abnormal Jllr r ility to explain it further <ref>9</ref> <center>DIFFEHEXTIATJON OF CASES AND TREATMEXT</center> Our obserrations would be of little value to ourselves or to others were 'we not preparef1 to formulate cr -t lin Permanent corset treatment Reynolds and Lovett - Chronic Backache | ||||
