Bart W. Koes
Backache affects many people. It is estimated that 80 to 90 percent of adults will have backache. Some will experience only one or a few episodes of backache, but in a considerable number pain recurs regularly and sometimes a chronic pain syndrome develops.

Backache sometimes occurs acutely and sometimes gradually, and in some the back pain is accompanied by radiating symptoms in the leg. Fortunately, in many cases the pain decreases within a few weeks and eventually disappear, for some the symptoms will persist for months or even years.

Despite the fact that back pain occurs so often, in most cases it is not known what exactly causes the pain. In only a very small percentage (around 5 percent) the symptoms can be attributed to an underlying serious illness or condition, such as malignancy, fracture or infection. But in the vast majority of patients the cause is unknown. There are many tissues, muscles, bones and joints in the back, all of which can be responsible for back and leg pain.

The authors of the book in front of you present their insights about the origin and course of backache in a very clear way. An important role is reserved for the intervertebral disc. Step by step, it is explained what the disc is and what happens if a disc herniation occurs. A complex matter is explained in a simple way, using good examples and insightful illustrations. Partly because of this, the book will suit both care providers and patients. Much attention is given to performing daily activities and also to various exercises and exercise programs that are useful for the patient.

There are not many books that describe backache and hernia symptoms in such a clear and insightful manner. Jan Willem Elkhuizen and Menno Iprenburg deserve all compliments for this valuable contribution to the literature.

Bart W. Koes
Professor of General Practice, Erasmus Medical Centre, MD, PhD Rotterdam
Erasmus Medical Center Rotterdam, the Netherlands


Gijs Lemmers
This book offers a clear overview of the problems associated with low back pain, for both (para) medics and lay people. With the help of many drawings, photos and models, scientifically substantiated, it is made clear what exactly happens when someone puts his or her back out. Why does acute lumbago often look so much like it is caused by a disc hernia, but sometimes isn’t? The intervertebral disc appears to work differently to what many professionals currently assume.

Johan Cruijff, the Dutch world-famous international football player, once said, “You will see it only when you get it.” The reader of this book will gradully come to understand why and how symptoms arise and what they can do about them, which is much more often than many think. For many people action may contribute to a reduction in back pain and radiating leg pain (sciatica).

Some new exercises are described. We have had the opportunity to try these within our national spine organization for some time, and yes, they can really contribute to recovery and even work surprisingly quickly.

Not all hernias need surgery, but sometimes this is inevitable. Also in this area the reader gets a nice overview of the available options.

There are many different factors that can contribute to causing and prolonging episodes of back pain. It is important that these are properly mapped by the right professional. And that is no mean feat in today’s healthcare.

All in all, this book offers a wealth of information, and with this the authors achieve their goal: to bring light to the black box of misunderstood back pain.

Gijs Lemmers
PhD candidate ‘The Best Care for Low Back Pain’, MSc, FT, MT
Complex Diagnostics, Research & Development
Fysius Back Experts, Nijverdal, the Netherlands


J.N. Alastair Gibson
Lower back pain causes more disability than any other clinical condition and is becoming more common with increasing age. Yet it is often poorly treated and the consequences of ineffective care are dire. Surgeons, physiotherapists, osteopaths and other health workers may direct their practice based on their own excellent expertise but it is clear that each should understand the contribution that others could make if cross-referral took place.

In order to provice a sound rationale for treatment Menno Iprenburg and Jan Willem Elkhuizen have collaborated to clearly describe the pathology underlying acute and chronic low bacl pain. It is only by first understanding the basis science that practioners may prescribe optimal therapies. In each circumstance the authors have striven to support their recommendations with sound scientific evidence. Importantly, a section is devoted to exercise management directed at self-care by patients to mitigate their symptoms.

It is a pleasure to welcome this handy book. It will appeal not only to the experienced therapist but tp the paptient who may have been left with “no hope of cure”.

J.N. Alastair Gibson, DSc, MD, FRCSEd
Spinal surgeon
The Royal College of Surgeons of Edinburgh, Scotland


Erik Traupe
Back pain is a truly widespread disease. In Germany, about every third citizen regularly suffers from back pain. Back pain is the underlying cause of many sick leaves, resulting in around 79 million days of incapacity for work each year. The economic damage is immense.

An entire industry has developed around back pain. Back pain treatment costs between 25 and 35 billion euros a year! In more than 600,000 patients per year, the admission diagnosis for inpatient hospital treatment is “back pain”. According to representative statistics, the number of spinal surgeries has increased by around 71 % since 2007…

This book aims to help prevent back pain. It is not only intended for those affected by back pain, but also offers some interesting new insight for the interested specialist. The two authors not only explain the pathophysiological causes of this widespread condition but also offer real-life advise on how to avoid back pain or, if affected, how to alleviate back pain through easy-to-follow, effective exercises.

I congratulate my teacher and friend Menno Iprenburg and his co-author Jan Willem Elkhuizen – both experts in their fields – with this book, which not only offers a lot of interesting information, but is also fun to read.

Erik Traupe, PhD, MD, Spinal Surgeon  
Head of Spine Surgery
Helios Weißeritztal Clinics
Freital Clinic
Sachsen, Germany