Strength in Evidence Physiotherapy

Imbalances in 2026? 🫪

We still arguing about manual therapy after all this time?

Maybe Voltaire was always right

The deadlift is predominantly a posterior chain exercise. Known for inducing lower back pumps and sick gains

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We still over cuing in 2026?

Failure to use prognosis can lead to more care and harms to the patients. Since in many cases getting care can be worse than just letting a condition run its course of natural history. For example, with hospital admissions for chest pain without signs of heart issues you are significantly more likely to acquire an infection or other secondary complications related to your hospital stay for observations than if you went home.

“historical emphasis has been placed on informing the patient and public about new understandings about the causes and mechanisms of disease and how best to reach a diagnosis and prescribe effective treatments linked to the diagnosis. We argue that an equal emphasis on prognosis may reduce overdiagnosis and over-treatment of patients. “

Watchful waiting appears to have a larger role in many areas of medicine than is currently being used.

“Patients are mostly unaware of the possible harms associated with diagnostic labeling. As the natural history of common musculoskeletal disorder may be self-limiting, we need to study how a watchful waiting approach can be best integrated.”

Trying something a little different

Also this is an editorial

It’s very good overall it goes over a lot of basic information you’d want to know about lower back pain, what the recommendations are for triage and overall statistically how 90-95% of people don’t need to see a surgeon, and less than 1% of people have red flags

It’s mostly still aligned with current evidence with recommendations for triage, assessment, risk stratification and use of BPS principles.

Is a very good handout you could give to coworkers or others and have them get a good introduction into current evidence about back pain

It’s very interesting to see how we specifically cling to ideas that are outdated or proven not to be effective in medicine. While identifying a problem doesn’t offer a solution it should force us to have more conversations about it.

How many gurus online try to say non specific low back pain, shoulder and knee pain don’t exist? How many try to say that we just aren’t good at diagnosing if we can’t come up with a specific label? This simply is false. Evidence shows when red flags are not present in the majority of cases it can be difficult to identify a specific source of nociception. And in many cases the specific underlying tissue doesn’t make a difference for treatment outcomes or pain.

In some cases like trauma yes a source can be easily identified. But do you need to know this without a shadow of a doubt? Probably not. Since it’s not likely to significantly alter out management approaches. It’s ok to be uncertain. I don’t understand why people think that’s such a bad thing or negative. Nothing works in this world like you’d like to think it does. Uncertainty is normal.

Did we ever stop to think about that certain aspect of our medical management is built on shaky foundations and theory? Thst as our evolution of what we know and don’t know about the body changes our relationship with diagnosis and treatment will also need to change and adjust?