I know..! It’s 2021, we see the word “plague” and our brain processes “pandemic” or “epidemic” or “outbreak” – but this “plague” is rather the affliction and torment; not a strain of Covid-19 for the coccyx. If you were feeling a bit Old English, Germanic or a bit 1821, you’d be saying, “Sciatica and back pain are the bane of humanity”.
However you want to put it, it is about strain and a pain. And it’s universal at that.
Ancient Greeks and Romans had sciatica, although it was attributed to a disease of the hip until the early 1760s. It was only then that the distinction was made between pain of the nerve and pain of the joint. Whomever those patients of discovery at the time likely considered it a great pyrrhic victory with the excruitiating agony still shooting down their leg.
Similarly, there has always been back pain.
However incomplete it is, the earliest surviving surgical text is the Edwin Smith papyrus from about 1500BC. Ironically, it abruptly ends in the middle of a detailed description of acute back pain.
Tantalisingly, the unknown Egyptian scribe, (or ‘sesh’) whose back pain annotation was left unfinished, was apparently subsequently sent somewhere else to copy down an older transcription instead. It could have been anything. Magic spells, legal contracts and wills, medical procedures, tax records, or genealogies; and maybe (and this is purely personal conjecture) there was a low stool to sit on, rather than a reed mat, for instance.
Immediately into this second task, our dutiful and hapless scribe ceased his labours and promptly dropped dead.
Hilarious, when it isn’t you; and brings to mind the Monty Python sketch where Ernest Scribbler writes the Funniest Joke in the World, reads it to himself and literally dies laughing.
Both the scribe and papyrus were buried in a tomb near Thebes, where 3500 years later in 1862, grave robbers found the contents and sold them to Edwin Smith, a 40-year-old American dealer and collector of antiquities. Curiously, for all the detail on that papyrus, there is no mention of the last words of this sesh being, “My back is killing me!” or indeed his name.
Maybe he was called Ernest Scribbler the Scribe.
It’s interesting to note that for all the physiological detail the Edwin Smith papyrus holds, it provides no clue to what the ancient Egyptians thought about backache, or how they deemed best to treat it. There is complete ambiguity in the last sentence which gives no clarity whatsoever on whether the treatment decision was rest, or mobilisation. And no record of natural treatments for sciatica back pain.
We long ago revered the innovations and revolutionary thinking of this ancient culture, so it’s unsurprising that therein lay a most modern controversy.
By the 4th century, Roman physician Caelius Aurelianus offered plate depictions of the spinal column, complete with intervertebral disc spaces. He concluded that “Virchow’s Tumor” (sciatica), although most commonly found in those of middle age, could actually occur at any age, following “… a sudden jerk or movement during exercise, unaccustomed digging in the ground, lifting a heavy object from a low place, lying on the ground, sudden shock, a fall, or continuous and immoderate sexual intercourse.”
Ah yes; all fun and games until someone puts their back out, but and at least progress was being made.
A century later, Hippocrates prescribed rest, massage, heat, dietary changes, and music.
It was, however, the Arabic and Turkish worlds of the 15th century that made many advances in the care of the spine. Sciatica unmanaged with analgesics was treated with cautery.
From one intense pain to the absolute extreme, one would think.
In 1764 and for some time after, sciatica was known as “Cotugno’s disease” which is only useful to know for pub trivia nights and having an interesting medical certificate to hand to your boss.
By 1800, physicians generally believed that back pain was the result of muscles holding a build up of rheumatic phlegm, basically caused by cold and damp. 19th century treatments commonly consisted of remedying the rheumatism via accepted measures of the times: such as relief of constipation, blistering and cupping.
It appears that in general, over millennia, sciatica and back pain has garnered much interest and study, and overall, there has been basic little change in treatment. For both multidisciplinary pain treatment and more invasive approaches, such as spinal surgery, there is still only low-to-moderate effectiveness.
Although most will recover from an episode, in the Western world one-in-five adults will develop a chronic disability, and this statistic continues to increase due to our aging populations. The global socioeconomic impact is in the quadrillions.
Sufferers for whom multidisciplinary and hospital care is necessary, often bear very high personal and financial impacts; and unfortunately long-term stable work ability and quality of life outcomes are still very poor.
So what can be done?
Avoid the injury, it seems. As it turns out, however, the ancients offer much wisdom. Be less sedentary. Do your utmost to be physically supple and flexible, and develop strong core strength. Find a healthy discipline that suits you; whether it be yoga, tai chi or any other low impact, high strength activity, and embrace that choice as an integral part of your lifestyle. Make useful dietary changes; it was Hippocrates who first stated, “All disease starts in the gut” and contemporary scientific research certainly validates that.
Should you suffer an episode of sciatica or back pain, you could seek out practitioners on social media. And while you’re doing that, there’s no harm in taking that Hippocratic view toward rest, massage, heat, dietary changes, and music.