If you have low back pain, instead of rushing to your own doctor, first try the most conservative management you can. Dr William Kirkaldy-Willis, retired emeritus professor of the Department of Orthopaedic Surgery at the University of Saskatchewan College of Medicine in Canada and a world-renown advocate of conservative management, believes that back pain can only be sorted out with a multidisciplined approach and that conservative management can help many of those with problems formerly thought to be the province of the surgeon. In Kirkaldy's view, only about 5-10 per cent of patients with disc herniations require surgery.
* Consider working with a fully trained and qualified, experienced chiropractor, osteopath or physiotherapist first. The Manga Report (August 1993), put together by Professor Pran Manga, former director-general of the Health and Social Policy Directorate of the Canadian government, analyzed the published evidence worldwide. His conclusion: 'Spinal manipulation applied by chiropractors is shown to be more effective than alternative treatments for lower back pain.' One such study (The Lancet, 28 July 1990) showed a seven-point advantage of chiropractic treatment over conventional hospital management on a Oswestry disability index.
* Don't consent to a myelogram under any but the most desperate circumstances and only after you've had a second expert opinion. MRI and CT scanning have largely replaced myelograms for all but certain specific conditions.
* Surgery will potentially help only disc herniation, instability, stenosis, spondylolisthesis, and scoliosis. If you don't have a definitive diagnosis of any of the above, don't consent to be put under the knife.
* Find an orthopedic specialist in sympathy with the teachings of Kirkaldy-Willis. If you can afford it, get hold of Managing Low Back Pain by Kirkaldy-Willis and Burton (Churchill Livingstone, Edinburgh and New York), which will help to put you on an equal footing with your orthopedic specialist.
* Find a 'back school' which will educate you about the cause of your pain, good daily low back care and an early return to full functioning.
* Contact grass-roots organizations like the Action Group for Relief of Pain and Distress in the UK (Hills View, Aller Road, Dolton, Winkleigh, Devon EX19 8QP). (For information on self-manipulation, send lb2.50 for their book 'A Safety Net'.)