It was not until 1998-99, I found incidentally that stretching the knee tactfully in extension keeping hip joint at 90 degree and the back flush on floor in some patients with long-standing sciatica could relieve them of leg pain considerably but momentarily. Such relief achieved through stretching knee passively in some started brain storming. I never found lumbar spine traction as a useful modality of treatment. But the observations made in some patients did prove that there was momentary release in pressure on nerve roots while stretching knee keeping hip steady at 90 degree and lumbar spine flush to the floor. This maneuver was similar to William's hamstring stretching exercise done with the help of a steady wall. William's exercises are designed to open the exiting neural foramen and open up the facet joints. However, in long-standing pain patients, it could not work effectively. In such cases, I thought there was need for counter-traction. That is how the upper limbs came to the rescue! Counter-traction created by hands holding great toes and then self-stretching of hamstrings by extending hips really started working better in giving relief. That is how lumbar spine distraction came into practice. The same maneuver was studied making drawings. And it was found amazingly correcting many associated structural changes like increased lumbar lordosis and positive Thomas test suggestive of contracture of hip.

Geometric study was carried out drawing three sides, one side upper limbs, other side lower limbs with flexed knees and base being the whole back. In trying to make a perfect triangle by correcting flexed knees on the side of lower limbs, theoretically the length of base [side with whole back] had to increase! That was suggestive of creation of perfect distraction at lower back.

Recently, on studying the follow up MRIs of many patients, it was concluded that the same distraction exercise also improves the nutrition of intervertebral disc also by seeing the changes of improved hydration of otherwise desiccated disc. It also corrected the alignment of lumbar spine in many. It became a policy to put all my patients having degenerative lumbar spine disorder with neural compression or even instability on lumbar spine distraction, gradual abdominal strengthening and lumbar spine balancing 8exercises at least for 4 weeks before considering them for surgery. The rate of surgery had dropped down to less than 30 percent. Surprisingly, no patient was lost to follow up.

I sincerely hope that the reader clinicians use this strategy described for the management of syndrome of common backache with or without sciatica and have their own judgment.

It was a pleasant surprise for me to get an opportunity to write a book on degenerative lumbar spine disorder. I had no better opportunity to express my experience of conservative treatment of low backache and sciatica than writing a book! Now when this book is ready and getting published; I wish to thank everyone in Jaypee Brothers Medical Publishers for giving me an opportunity.

I express my sincere thanks to Prof PS Nagpaul, my teacher, for providing useful corrections in the manuscript of the book.

I express my sincere thanks to Dr Viren Shah, Dr Sushil Mansinghani, Mr Abraham Varghese and other technicians of Baroda Imaging Centre for providing me with complete imaging facilities for this book.

It was a huge task. I worked ignoring my family especially my sons, Siddharth and Srikant, on a number of occasions where they would need me. I express my deep gratitude towards my children and my wife, Rameshwari, for her endless inspiration as always.