The fall of the postural–structural–biomechanical model
Seven pages on PainSci cite Lederman 2011: 1. Does Posture Matter? 2. The Complete Guide to Patellofemoral Pain Syndrome 3. Complete Guide to Plantar Fasciitis 4. Review of The Trigger Point Therapy Workbook 5. Your Back Is Not Out of Alignment 6. Guide to Repetitive Strain Injuries 7. Sensitization in Chronic Pain
PainSci commentary on Lederman 2011: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.
This article is a bloody brilliant deconstruction of the underlying assumptions of the vast majority of pseudo-quackery in the manual therapies. It’s technical and academic, not for the lay reader, but absolutely required reading for professionals. Be sure to read another excellent and closely related essay, “The Myth of Core Stability”.
original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
Manual and physical therapists often use a postural–structural–biomechanical (PSB) model to ascertain the causes of various musculoskeletal conditions. It is believed that postural deviations, body asymmetries and pathomechanics are the predisposing/maintaining factors for many musculoskeletal conditions. The PSB model also plays an important role in clinical assessment and management, including the choice of manual techniques and the exercise prescribed. However, this model has been eroded by research in the last two decades introducing profound challenges to the practice of manual and physical therapy. This article will examine how the sciences are challenging the PSB model, using lower back pain (LBP) as an example.
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- Common interventional procedures for chronic non-cancer spine pain: a systematic review and network meta-analysis of randomised trials. Wang 2025 BMJ.
- Gabapentinoids and Risk of Hip Fracture. Leung 2024 JAMA Netw Open.
- Classical Conditioning Fails to Elicit Allodynia in an Experimental Study with Healthy Humans. Madden 2017 Pain Med.
- Topical glyceryl trinitrate (GTN) and eccentric exercises in the treatment of mid-portion achilles tendinopathy (the NEAT trial): a randomised double-blind placebo-controlled trial. Kirwan 2024 Br J Sports Med.
- Placebo analgesia in physical and psychological interventions: Systematic review and meta-analysis of three-armed trials. Hohenschurz-Schmidt 2024 Eur J Pain.