Swimming provides the body an opportunity to bring many muscles into activity at the same time. It encourages contolled mobility and, without putting undue strain on the spine, promotes muscle elasticity. It is valuable for people with back problems: the water provides support and the exercise can be undertaken without stressing the spinal column. The buoyancy of the water minimises the effects of gravity, making it easier to move.

Free style and the backstroke give the whole body regular and rhythmic movement but rely on a rotation of the spine. If you swim breast stroke, try not to keep your head out of the water all the time, as this extended position can put a strain on the neck. Try wearing goggles and learn to breathe out with your face under the water. In this way the head is kept in line with the body and the neck stress minimised. Exercise within the painfree threshold.

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job – temporarily, or even permanently. Even if this possibility raises great difficulties, it needs to be considered seriously. Traditionally, it is thought that people who refuse to ‘give in’ to back pain are the very ones who are most likely to be plagued by repeated attacks. This could result in the underlying condition, which caused the attacks, becoming chronic. (In medical language, chronic means long-term.)

A recent approach by some doctors to patients’ attitude to pain is to advise tackling it more directly. Many people become controlled by pain. Exaggerated fears may need investigation and unravelling. While the cause of back pain must always be sought, frequently pain persists even when the initial cause is cured. Desensitising the region wherethe pain originated can avoid the problem of ‘chronic low back pain’.

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The profession-To train to be a physiotherapist in Australia you must complete a four-year course at one of the schools of physiotherapy at university. A student who passes the examinations qualifies for state registration and therefore membership of the Australian Physiotherapy Association. Physiotherapists work in hospitals, in the community, in special schools, in industry and sports, and also in private practice (and may visit a patient in his own home). It is a closed profession, meaning that only registered persons may call themselves a physiotherapist and therefore practice physiotherapy. Contact the Australian Physiotherapy Association in your State for more information.

Physiotherapy is an independent profession and practitioners may accept people for treatment who are not referred by doctors.

There are a large number of physiotherapists in private practice. They may be able to give treatment more quickly than through the public system.

Some health authorities have physiotherapy services. Patients are referred to them, often by the consultant at the out-patient clinic they are attending. In many cases, physiotherapy clinics will accept patients by direct referral from GPs.

The doctor making the referral sends to the physiotherapy clinic the necessary information about the patient and the condition, including X-rays, with suggestions for the aims of the treatment, but often leaving the choice of treatment to the physiotherapist’s discretion. All physiotherapists assess their patients and plan out the treatment program.

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Everyone is familiar with the ache in the bones that goes with influenza; many other viral infections are able to produce some degree of inflammation in the joints. Occasionally the pain may be particularly severe in the lower back. In such cases, however, there are sure to be other symptoms such as a high temperature or a sore throat, and if the infection affects the digestive organs, there may be diarrhoea, nausea and loss of appetite. These symptoms indicate that the back pain, which is part of the infection, is likely to go when the infection goes.

Kidney stones and kidney infections may also produce lower back pain, usually to the side but there, too, there are usually tell-tale symptoms, such as fever and pain on passing urine.

Women-There are some kinds of non-spinal back pain that are reserved for women. Displacements of the womb, such as uterine prolapse, resulting from the strains of childbirth, can in some cases produce pain in the lower back. So can fibroids (benign tumours) in the womb. Both conditions can be put right, usually by surgical measures.

But normal conditions, such as pregnancy and menstruation, can also give rise to back pain. In pregnancy, hormonal changes before childbirth cause ligaments to soften and slacken, and this can cause strain, particularly in the sacroiliac joints; the weight of the growing foetus also throws additional strain on the spine. In menstruation, period cramps are sometimes felt as referred pain in the structures of the back.

Stress-The mental stress caused by an attack of back pain can reinforce the effects of muscle spasm, and in turn be made worse by it, in a vicious circle. Muscle spasm is a possible result of tension.

A major problem is fear of pain, sometimes not so much fear of the pain itself as fear that it is really more serious than anyone supposes. The remedy then is to seek authoritative reassurance.

It also seems very probable that mental tension, stress and anxiety, unexpressed fears and worries can actually start off an attack of backache by increasing muscular tension throughout the body. (This also makes you more vulnerable to muscular and joint strain which may even lead to some sort of mechanical displacement.) There are cases in which stress-reducing measures, or perhaps counselling, rather than treatment is what is needed to relieve the pain.

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The spine plays a part in the movements of most other parts of the body. Moving the head in relation to the chest causes movement in the cervical and upper thoracic vertebrae; moving the arms also moves the thoracic spine; the lumbar spine is involved in movements of the upper part of the trunk in relation to the pelvis, and in moving the legs.

The spine and gravity-The vertical force exerted on the human body by gravity varies according to the position the body assumes. Gravity is least stressful in the lying-down position, and the stress is well distributed in moving on all fours (which is one reason why back pain victims sometimes have to revert to crawling); but the erect stance of homo sapiens is maintained in defiance of gravity, and the gravitational load exerted on the head, arms and upper trunk is taken mainly by the vertebral bodies, and the intervertebral discs. (Back problems are, however, not exclusive to those who happen to stand erect. There is a popular misconception that if only we walked on all fours, we would have no back problems. But some animals undoubtedly do have back troubles: horses, dogs especially dachshunds.)

The muscles, too, undergo gravitational stress, depending on the direction of movement. In bending, the downward movement of the trunk is helped by gravity, with the muscles and ligaments controlling and limiting the descent; in straightening up, the muscles must do all the work, against gravity, but once the upright position is achieved, they do not need to work very hard to maintain it.

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