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There is much confusion about the meaning of commonly used words such as backache, sciatica and lumbago. In this book they are defined as follows:

During recent decades, syndromes related to the lower back have been identified by many epidemiological studies. As a result, the incidence of low back pain, and its socioeconomic impact, are well known.¹ Low back pain is so common that only a minority of individuals escape it. Eighty percent of the general population will at some time suffer from low back pain and 20% are suffering at any given time.^2,3 In Western countries, the 1-year incidence rate for backache is between 24 and 36%.^4–6 In the United States, a study of Veteran Affairs outpatients found a 3-year incidence rate of 67%.⁷ Knepel reported that in general practice every tenth patient had back complaints.⁸

Backache and sciatica have also become an increasing socioeconomic problem in industrialized countries: back disorders account for between 1 and 2% of all working days lost9–13 and for 12.5% of all sickness absence days.¹⁴ They are the most common cause of disability among younger adults in the USA.¹⁵ The number of working days per year lost because of low back pain is 1400 per 1000 workers in the USA,¹⁶ and 2600 per 1000 workers in some British factories.^17,18 In the United Kingdom, low back pain was the largest single cause of absence from work in 1988 and 1989 and accounted for 12.5% of all sick days and over £11 billion in direct and indirect costs in 2000.¹⁹ The cost of treatment and compensation for low back syndromes is enormous and increases every year. In 1976, in the USA, the total cost of spinal disorders was approximately $14 billion. By 1983, this figure had risen to $20 billion,²⁰ and by 1991 to more than $50 billion²¹; for 1998, estimates and patterns of direct healthcare expenditures among individuals with back pain in the USA had reached $90.7 billion.²²

Backache and sciatica are complaints rather than specific diagnoses. Although most of these symptoms stem directly or indirectly from lesions of the intervertebral discs, it is widely accepted that low back pain spans a group of disorders with varying causes.

As many as 80% of all cases of low back syndromes relate to the lumbar intervertebral discs; the posterior support structures (facets, ligaments, laminae and fasciae) are directly responsible for less than 20% of cases of back disorders.²³ The evidence for this statement is derived from anatomical and imaging studies, but Cyriax²⁴ came to the same conclusion almost 50 years ago, purely on careful clinical observations: ‘In my experience lumbar disc lesions are responsible for more continuing – yet avoidable – annoyance, frustration, semi-invalidism, general misery and bad temper than any other tissue in the body. In our view, lumbar disc lesions are responsible for well over 90% of all organic symptoms attributable to the back.’

It is remarkable that, in disorders that affect both individuals and society so much, there is so little agreement about possible pathogenesis and pathological entities. Despite the advanced technology available for diagnosis and treatment, the number of patients suffering from backache and sciatica continues to increase.²⁵ It has even been suggested by both the lay press and professionals that the epidemic increase in disability is partly caused by unnecessary technical investigations and too much surgical treatment.²⁶

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