Sorry I have caused some confusion. My whole point is that nothing is black and white and that pain control is everything. Pain does not equal damage. If seeing an osteopath helps ease the pain it has solved the problem. If applying ultra sound eases the pain it has solved the problem, but please do not start talking about things in term of damage. Rarely is damage a reason for a persons on going pain and functional restriction. Yes, I have read Waddell's Back Pain Revolution, and I am sure this is his major point.

Where do your figures for the natural history of back pain come from? Here are the ones that I use:

Persistence for several months is common:
Linton et al (1998) 43%
Hillman et al (1996) 47%
Waxman et al (2000) 42%
Szpalski et al (1995) 36%
Croft et al (1998) 75%

Symptoms Are Slow to Resolve After 3 Months
LBP after 3/12 44%, LBP 12/12 40%. (Philips & Grant 1991)
LBP 7/52 54%, LBP 12/12 42%. (Cherkin et al 1996)
LBP 3/12 48%, LBP 12/12 42%. (Thomas et al 1999)

Relapse is common
Proportion of patients with more than one episode in a year:
Linton et al (1998) 57%
Brown et al (1998) 55%
Heliovaara et al (1989) 45%
Toroptsova et al (1995) 65%
Klenerman et al (1995) 72%

Regarding the genetic link look at "Genetic Factors associate with lumbar modic changes" Daavittila et al. The conclusion states, "Genetic variations in IL-1 cluster and MMP-3 gene were found together to associate significantly with type 2 modic changes".
Ken Cheung (Hong Kong) has been doing some recent research on the Genetic link. I have been unable to find the specific paper I got the quote from but it does seem that people that are genetically pre-disposed to Back Pain are 10 times more likely to suffer with back problems in a manual job than those that do not have the particular gene. There is no increased incidence in non-physical jobs.

I am not suggesting that only approaches with very good evidence are considered. The interventions used obviously depend on the individual patients presentation and the clinician’s assessment. I did not mean to imply that because natural recovery occurs you should not do anything. Most patients do require some kind of help on the road to recovery. I am a manual therapist of 20 years experience, specialising in LBP, not an academic, and I use all the interventions that most therapists use but I think it is important to let patients know what evidence is out there. So my first reply to “chak”, who started this thread would be to give him the hopefully re-assuring bit of evidence that most disc prolapses resolve with time, he just needs help to get him through this particularly painful part of his life.

Have you read Explain Pain by Lorimer Moseley?