Historically, disorders of the musculoskeletal system (in particular, those that originate in the spine) have been very poorly understood. Dr James Cyriax, an English physician (1904-1985), recognized this and developed what he referred to as Orthopedic Medicine, a systematic method of examination and treatment designed to address these problems.

Since then, a number of specialists (in particular Geoff Maitland) have built upon this work.

The two basic principles of diagnosis (both developed by Cyriax) are that:

Once the damaged structure has been correctly identified, the treatment is targeted, specifically at that structure. This is important because the underlying cause of the problem is treated. As a result, not only are the symptoms addressed (such as pain and stiffness), but they are also far less likely to return.

Orthopedic medicine encompasses several treatments. However, with respect to back pain, mobilization (which is notably different from osteopathic and/or chiropractic manipulation) is by far the most effective. It is also extremely safe and widely applicable: up to 98% of all spinal conditions will respond favorably to this technique.

Referred pain is common. This occurs when the brain (which receives and interprets pain signals) is unable to identify the exact location of the problem. As a result, the pain associated with a specific disorder is often not centered on the cause. However, referred pain still obeys certain, clearly defined rules. If these are understood (typically by a person skilled in orthopedic care and medicine) an accurate diagnosis is still possible. Referred pain is extremely important during the diagnosis of spinal disorders.

If the soft tissues associated with the musculoskeletal system (e.g. muscles, ligaments, joint capsules, bursae) are damaged, the patient will experience pain, whether it is referred or not. The pain itself may be intermittent, but if the tissue is pulled (that is, put under tension) the pain can be reproduced. The different types of soft tissue produce pain in response to different types of tension and they do so reliably, allowing an accurate diagnosis to be made. This system of diagnosis is known as ‘Examination by Selective Tissue Tension’.

Mobilization works by restoring the passive mobility of the spinal joints. This is done via carefully applied pressure and/or oscillatory movement.

However, the mobilization that is applied to each region of the spine is subtly different.

For example, when applied to the lumbar region, the procedure involves a small oscillatory movement, combined with some distraction (rotation and manual traction).

However, when applied to the cervical spine, pressure and distraction are applied separately.

Joints in the human body normally move in response to active, muscle contraction. This is referred to as active mobility; however, they can also be moved by an external force, for example by a practitioner using physical procedures. This is referred to as passive mobility.

In theory, if patients were trained in orthopedic medicine, they could mobilize some of their own joints; however, due to its location, it is physically impossible for anyone to mobilize their own spine [without the intervention of the Backtrack™].

All aspects of the treatment can be focused very precisely, and safely, on individual joints and soft tissue. Furthermore, the exact level of force is carefully selected by the practitioner, depending on the nature and severity of the patient’s condition (and the extent to which the patient has improved in previous sessions).

There are no sudden, violent movements. Contrast this, for example, with osteopathic and/or chiropractic manipulations. In relative terms, these are violent, clumsy and poorly targeted.


In our opinion, orthopedic mobilization is the most effective treatment for chronic back pain and serious, spinal disorders. It is extremely safe and widely applicable.

Although the treatment itself is very effective, orthopedic medicine is particularly successful because (in skilled hands) it will produce a very accurate diagnosis. This should not be underestimated; without an accurate diagnosis, any form of treatment is largely futile.

Like any medical discipline, however, people can specialize. We therefore recommend that you see an orthopedic specialist who spends most, if not all, of their time treating spinal disorders.

Note that orthopedics does not rely on imaging techniques (including x-ray; MRI scans; and CT scans) because they are not particularly helpful in determining the exact cause of pain. In general, spinal conditions are very complex; so even when a scan reveals an abnormality in bone or tissue structure, only a very limited diagnosis can be made. For example, virtually all scans are taken with the patient in a fixed position but most conditions are difficult to assess without moving the spine through several degrees of motion.

The patient is asked to perform some of the movements (for example, bending forwards and backwards), and the practitioner performs the rest (for example straight leg raising, pressure and distraction).

For those who wish to learn more about orthopedic medicine, a large number of medical reference books exist, devoted to this field of study. For more details, please visit our Bibliography.


In our opinion, orthopedic mobilization is the most effective treatment for chronic back pain and serious spinal disorders. It is extremely safe and widely applicable:

For those people suffering from serious, chronic back pain, we recommend that you visit Mr. Kuklinski at his Back Pain Clinic (Harley Street, London). However, for those people who can neither afford personal treatment, nor make the trip to London, we recommend that you purchase a Backtrack™.

The Backrack™ is an orthopedic spinal device (invented by Mr. Luklinski), designed to mobilize the spine. By lying on the rack and performing a series of exercises, the patient can reproduce most of the effects of orthopedic spinal mobilization. Please note, however, that the Backrack cannot apply distraction (rotation and traction), nor will it mimic other, specialized forms of treatment that are available to Mr Luklinski. The Backrack™ is, however, (in our opinion) the best product on the market for the treatment of chronic back (and neck) pain.


£200 for initial examination (full cost of treatment is estimated thereafter).

This treatment is relatively expensive. However, Mr Luklinski has over 40 years of clinical experience. In 1973, he trained with Dr Cyriax, who first developed the principles of orthopaedic medicine. Four years later, he trained in Perth, Australia, learning the techniques developed by G D Maitland (a seminal practitioner in the field of spinal Orthopaedic Medicine).