Management Of Back And Leg Pain In Ancient Medicine

Low back and sciatic pain has been one of the most common and disabling spinal disorders recorded in medical history. The role of the spinal canal's contents in extremity function is well demonstrated in the Dying Lioness (Fig. 1), a ca. 650 bc. Assyrian artwork.

In the writings of Hippocrates (460-370 bc) one can find references to the anatomy of the brain, brachial plexus, and sciatic nerve. In animal dissections it appears that he had difficulty in differentiating tendons from peripheral nerves. However, he attributed the development of paresthesia, weakness of the limbs, and fecal and urinary retention to spinal cord compression (1).

On the basis of his animal and human dissections, Aristotle (384-322 bc) described vertebrate anatomy (2). Erasistratus (250 bc) distinguished between the role of motor and sensory nerve fibers in his findings from cadaver dissections (3).

Avicenna (980-1037 ad), a Persian physician and philosopher who was born in Bokhara, also wrote extensively on human anatomy and the peripheral nerves. However, his writings make no clear reference to sciatic pain. His text Canon of Medicine formed the cornerstone of medical practice for ensuing centuries. Avicenna condemned the reliance on mysticism and astrology in medicine (4). His writings were translated into Latin and included in the medical curriculum of European universities. Avicenna's principal method of treating spinal disorders by traction and manipulation remains an accepted practice in many centers at present (Fig. 2), (5,6). A calligraphy (Fig.3), dating

From: Arthroscopic and Endoscopic Spinal Surgery: Text and Atlas: Second Edition Edited by: P- Kambin © Humana Press Inc., Totowa, NJ

Islamic Miracles And Modern Science
Fig. 1. The dying lioness, ca 650 bc. (Reprinted with permission from refs. 1 and 42.)
The History Scoliosis
Fig. 2. Avicenna's a "Method of Treating Spinal Disorders by Traction and Manipulation." (Reprinted with permission from ref. 5.)

to 1400 ad demonstrates the depth of curiosity of the times, and the information that was gathered from cadaver dissections. Their illustrations show the presence of 6 cervical, 12 thoracic, and 5 lumbar segments. The origins of the brachial plexus from the cervical segments, the intercostal nerves from the thoracic nerves, and the sciatic nerve

from the lumbar segments are described. In addition, the two divisions of the sciatic nerve as it extends into the lower extremities are shown.

In the ancient literature there is no reference to surgical management of sciatic pain. However, the use of traction, local cauterization (Fig. 4), cupping, bloodletting, and opioids was common in Arabic, Persian, and Islamic medicine and subsequently in European medicine. Acupuncture has been practiced in Chinese medicine for centuries.

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