When are specific physical interventions needed to treat pain?

The Challenge

The low back pain literature suggests that a specific intervention (e.g motor control exercises, targeted strengthening etc) are no more effective than general graded activity interventions.  Suggesting that treating pain is not really about fixing some sort of impairment that is causing the persisting problem.  

Revisiting the spinal flexion debate: prepare for doubt

Revisiting the spinal flexion debate: prepare for doubt

Whether the spine should flex repeatedly and under load is an old debate that we are still having having and we should be having it because I don't think its settled.  I thought it was settled 20 years ago but I should have challenged my biases more.  The basic question is whether you are at less risk for pain/injury if you minimize the flexing movement of the lumbar spine during activities and if minimize the flexed position when lifting heavy. The case to minimize flexion is laid out in this article here detailing how the Canadian Military has removed the sit-up and trumpeted the death of the sit-up. Link here.  I have probably taught 1000s of people to hinge at their  hips and try to minimize spinal flexion during many activities...certainly activities that demand high loads on the spine...But is this right?