Interesting...

In defense of my statement about the knife wound, it was about electrotherapy not solving problems...

I agree that low back pain is common and nearly everyone will experience it at some stage of their life no matter who, what, where, when or why.

I would argue that the body doesn't necessarily heal itself particularly well after an injury. People often develop habits and patterns and coping strategies that are quite mal-adaptive - that is the strategies are bad for them despite trying to assist themselves in their pain. That is often why you will see patients with chronic pain 2 years after the initial injury. Everyone has written them off as malingerers but a simple change to movement patterns, motor control, sequencing of muscle activity etc will change the loading on their perpetually inflammed structures and healing begins.

I agree that we help to increase the time between episodes and decrease the time of suffering.

About follow-up studies - I think you mean that people are going to hurt their backs anyway so why produce evidence to support an argument that physio won't prevent future occurrences, right?

If that is so, I agree. There are so many things that go on with an individual, especially one who is feeling better, that it is impossible to so that because they had a relapse, the effect of physio is not long-lasting enough.

For instance, i had a patient who had terrible back pain and saw me 3 times with complete resolution of their pain. She came back in 3 weeks later complaining of back pain. However, this time it was completely different. Initially she had sciatica with radiating pain down the left leg. This time, she had pain in the upper L/S from being hit during sport. Completely unrelated areas of pain in the L/S. No recurrence of the initial pain. But still back pain...

The reason why I am so deadset against electrotherapy is because to me it is only a band-aid. There is not enough support for it. I appreciate its other uses such as time-filling, soothing and time to speak with the patient when using U/S and of course the strong placebo effect it has. I also do use it as a "band-aid" for pain so I can get in and do something that is painful first then make them feel a little better for a short time (and warn them!).

A collegue is doing his PhD on ?pain beliefs and some of his initial data suggests that those who believe you should always bend at the knees to lift/pick something up tend to have the most pain/disability (I hope I got that correct!). Which says to me that people who are in pain tend to be the ones who try to correct their posture when lifting. But even lifting "experts" cannot prevent their L/S from flexing during a deep squat to lift a 10kg weight (reference currently eludes me).

I would love to see more studies showing a good outcome for manual therapy and specific, appropriate exercise vs rest, general exercise and electrotherapy...