Low back pain is a major health problem in developed countries, and it is most commonly treated in primary healthcare settings. Lifetime prevalence ranges from 49% to 70% and point prevalence from 12% to 30%.1 The management of patients with chronic low back pain varies considerably within and between countries, and within and between healthcare professions.1 In the linked randomised controlled trial (doi: 10.1136/bmj.a884), Little and colleagues compare the Alexander technique, exercise, and massage for people with chronic and recurrent back pain in 64 English general practices.2

One systematic review found that exercise therapy significantly reduces pain and improves function in adults with chronic low back pain, particularly in patients visiting primary care providers because of back pain.3 However, prescription of home exercises alone is not effective for chronic back pain. Subgroup analysis found that exercise consisting of individually …