When one reviews the progress in the understanding of this problem one must realize that real advances have been made in the past twenty years. Better methods of diagnosis have been developed and an ever increasing knowledge of many of the underlying causes has helped to develop an understanding of this condition. The problem still remains a broad one, with many phases yet to be understood.
In making a diagnosis, I have found it convenient to divide backache into the following groups:
In most cases of acute backache an accurate diagnosis cannot and should not be attempted on the first examination. Usually the picture is so masked by pain and muscle spasm that a satisfactory examination cannot be made. Often, with two or three days of rest, the clinical picture will so change that the diagnosis will be entirely different from the one that was considered likely at first