You bend down to pick up a sock and your back goes. There's no logic to it. It's an ordinary morning and an ordinary sock. What to do next?

Advice on back pain has undergone a revolution. Out go the drugs and bed-rest. In comes rapid, active treatment, with appropriate exercise positively encouraged, although a day or two of semi-immobility may be advised immediately after the injury.

The problem, says Ann Thomson, chairwoman of the British Association of Chartered Physiotherapists in Manipulation, is that response from GPs, usually the sufferer's first port of call, is extremely patchy. Too often there is no examination, simply advice to take pain-killers, rest and return in two weeks if pain continues.

"But what does a doctor mean by rest or a patient understand by it? It depends on the injury. For some people, lying in bed for 48 hours may be fine. For others, lying or sitting in bed could be the worst possible thing. For some people we would work out a balance of standing and sitting. The treatment must be tailored to the patient," Ms Thomson says.

In best practice, a patient should be expertly examined and referred immediately for further expert advice and "physical therapy", which could be physiotherapy, osteopathy or chiropractic.

This view is now enshrined in recommendations to the Government from the Clinical Standards Advisory Group in a special report on low back pain. The report is out to consultation before guidelines on treatment are accepted and disseminated by the Department of Health.

"The real thrust of the report was to tackle back pain early to prevent it from becoming a chronic condition. The three elements are competent examination of the patient, and the right management and education to make sure the patient understands what the problem is.

"You might advise the right sort of rest and then an exercise programme for the rehabilitation. You might advise the patient to be off work for a couple of days or you might supply a corset or use strapping, just as you would strap an ankle, so the patient can stay active," Ms Thomson says.

The problem is far from trivial, both for the sufferer and for society, even though "it's my back, doctor" has become synonymous with malingering. In Britain, more than 100 million working days are lost each year because of back pain, and patients with "chronic" backs who have been off for two years are unlikely to get back to work. Back pain costs the NHS almost pounds 500m a year.

British Chiropractors' Association: 01734 757 557; General Council and Register of Osteopaths: 01734 576 585; Chartered Society of Physiotherapy: 0171 242 1941; Organisation of Chartered Physiotherapists in Private Practice: 01702 392 124; National Back Pain Association: 0181-977 5474.

CELIA HALL

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