Limited imaging and an early return to normal activities

The new clinical guidelines issued by Britain's Royal College of General Practitioners highlight new principles of back pain management that have emerged in the past decade.1 The era of routine radiography, strict bed rest, corsets, and traction has passed. It has been replaced by parsimonious imaging, early return to normal activities, and greater emphasis on exercise to prevent recurrences or to treat chronic pain. Physical activity is guided by setting goals (even if there is some discomfort) rather than by the traditional dictum to “let pain be your guide.” These newer concepts are based on steadily improving scientific evidence, and represent a major shift from the earlier paradigm of rest and pain contingent treatment.

Many observers would now argue that back pain is a nearly ubiquitous part of human experience, is often the earliest sign of normal age related changes in the body, and has been over medicalised in this century. Back pain has always been with us (arguably even more prevalent in an earlier era of more physically demanding jobs), yet work disability due to back pain is a modern epidemic. Modern medical care has not …