Cowboy-booted Canadian spine surgeon Hamilton Hall says he has had back pain since he was 17.
"I was working a construction summer job while at university - I often say ever since I was just young enough or dumb enough to not do anything about it," he said.
"I walked like a monkey because I couldn't straighten up.
"In those days if I had gone to see somebody, I don't know what they would have done but it would have been awful.
"They would have put me in a cast or something - they certainly would have told me to give up working construction and do nothing, all of which is just stupid advice."
Professor Hall was in Hawke's Bay for a presentation to doctors and to open The Back Institute treatment centre in Hastings.
There are more than 150 Back Institutes in Canada after he founded the first one in Toronto 45 years ago "in a moment of weakness".
He has swum against the tide in his treatment methodology, but the tide is turning - his method is taught in three Canadian provinces' medical schools. He said medicine had taken the wrong path in trying to treat back pain as a disease. "We sold to the public - it is only a matter of time before we find out what's going on.
"We have all these MRI images and it sounds like we are just on the verge.
"What's happened is we really haven't solved the problem - not even close.
"When you look at the impact of back pain on the public, it is as bad today or worse than it was 50 years ago.
"Medicine has done wonderful things, we have cured diseases and understand what makes tuberculosis and even HIV, but still back pain is the commonest cause of recurring lost time for work.
"Of all the things we face, back pain stops us more than everything else.
"What has been sold to the public is, 'We know the cause - it's going to be this or that and we will get some images and we'll cure you'.
"But nobody gets cured - there is no cure for back pain because in reality what we are recognising after a long time looking in a wrong direction is that most back pain is not related to an illness, injury or anything, it is just part of being alive.
"It is a human condition like grey hair.
"We have been trying to cure that for 100 years and haven't been any more successful.
He said while doctors understood where pain could come from in patients' backs there was no good method to pinpoint where an individual's pain was coming from.
Instead the focus should be on how the back pain limits a patient's function.
"What movements hurt, what movements feel better, where is your pain located.
"There are many things I can learn from you just by examining and listening to you.
"When you put it all together it creates a recognisable pattern of back pain. It turns out there are limited ways it can affect you.
"In medical parlance these are called syndromes - a collection of signs and symptoms which come together in a predictable fashion and which respond to treatment in a consistent manner.
"So rather than saying, it's your disc or joint I will say, I recognise your pattern/syndrome and I know what to do to treat it.
"I've avoided the mistake of spending months trying to figure out what it could be and I've gone straight to getting you better."
He said the methodology of recognising the syndromes was not something doctors were well trained in.
"They'll just order an MRI.
"It is well documented that when using an MRI to find out what's wrong, the outcome is worse.
"The MRI shows you so many things that are not quite right with your back and the doctor can spend a lot of time chasing the wrong thing."
He said through collecting a thorough history, examination and observation of treatment response, most patients suffered one of four common syndromes.
"More than nine out of 10 people with back pain have their pain because of a minor mechanical problem and nothing more.
"Over time backs show the signs of wear the same as everything else.
"If I recognise the problem and give you a physical treatment for it and you respond to that treatment so the pain goes away, then you and I are both satisfied.
"As a surgeon I have to know the exact source of pain, but surgery is only necessary in less than 5 per cent of all backs."
He said his syndrome-recognition system was "so obvious and simple" that some were skeptical.
At Hawke's Bay Hospital he gave doctors the history of how the system had evolved.
"It is simple but it is not easy, because unless you know how to ask the questions and get the answers you must get, you'll make the wrong call.
"Back pain sufferers who did not have a simple mechanical problem are very easy to recognise. There is a small, small number who may have something wrong but I pick that up in my first interview."
He said back pain had been "medicalised" and there was no cure because there was no disease. "It's a mechanical problem and I fixed the mechanics. There is no magic in what I do - it's just simple mechanics."