Ever heard someone saying they have a ‘bad back’? That’s a rhetorical question because ‘bad backs’ are responsible not only for enormous suffering but also have a huge impact on the economy.

In 1950 backache accounted for 1.5 million days of work last but by 1995 this had risen to 115 million (sic) days lost. What on earth are we doing differently? Sitting too long? Working harder? More stressed? Less robust? Less willing to work while in pain?

The very fact that there is such a condition as a ‘bad back’ tells us that we know very little about backs and back pain. Ever heard of a ‘bad heart’, medicine ‘bad brain’ or ‘bad eye’?

Tests can sometimes help by showing a severely prolapsed disc or other very obvious damage but people with back pain can have abnormal MRI results and people in debilitating pain can have normal X-ray and MRI results.

Without accurate diagnoses, illness medical treatment tends to be speculative. Surgery, micro-surgery, steroid injections, manipulation, pain killers, alternatives such as acupuncture and osteopathy – all claim results but no one form of treatment can claim uniformly good results for back pain.

The problem may be that helping back pain may be something that often requires great commitment by the patient. Our bodies are supported not only by our backs but also by a host of abdominal muscles including the very important oblique muscles of the abdomen. Strengthening these muscles by a carefully structure exercise programme can be spectacularly successful and yet I see so many patients who have not been taught and encouraged how to do this.

Is  this  because programmes to strengthen the abdominal muscles and produce core stability are ‘boring’ and are not easily packaged or sold in bottles.

A pity – because they really work.