When I was a young GP, an elderly woman came to me with pain in the middle of her back on mild exercise. At first I thought it was a form of angina, the pain coming from her heart, but an electrocardiogram was normal.

However, she did have diabetes, and very poor circulation in her feet, a common complication of long-standing diabetes. I thought that the arteries supplying blood to the middle region of her spine might be similarly affected, so that her pain could be due to a poor blood supply to her spinal cord.

I arranged for her to be seen urgently by a vascular specialist, with a view to possible surgery or appropriate medical treatment, and advised her to rest until she saw him.

Unfortunately, her employers took her instead to a man who in those days was described as a ‘bone setter’. Tragically, he manipulated her back, and she became permanently paralysed from the waist down. The manipulation had finally blocked off her ailing artery, and the area of spinal cord that it had supplied with blood died off. There was no possibility of recovery from it.

So before anyone takes the decision to manipulate or stretch the spine, they must make sure that they will do not harm. The first rule for anyone treating back pain is to take a thorough history of the pain and to perform a complete physical examination. If the pain is caused by disease of an internal organ, there are usually other symptoms that point to it.

For example, pain radiating to the back from a diseased gallbladder is made worse after eating fatty foods. People with gallbladder problems are often tender just under the margin of the ribs in the front of the abdomen, to the right of the midline.

A swelling liver, perhaps due to hepatitis or other liver disease, may start with the same symptoms.

Back pain that is really indigestion, due to stomach ulcers or an inflamed stomach, is often linked to pain in the front of the abdomen, above the navel, in what doctors call the epigastrium. Back pain caused by pancreas problems is usually a constant dull ,boring ache in the same place.

Back pain linked to kidney trouble centres on the angle between the ribs and the spine on either side. It may radiate down and around the front of the abdomen, into the groin, and in men into one testicle.

So if you have a persistent back pain, make sure you know the cause before subjecting yourself to manipulation. It’s a good idea to see your doctor about it first.