Detailed guides to painful problems, treatments & more

All Archived Updates for:

Complete Guide to Low Back Pain

This page lists all 212 updates for one book on, Complete Guide to Low Back Pain For a more general summary of everything new around PainScience — recent updates for all articles, new articles, blog posts, and new study summaries, see What’s New on

  1. Jan 7, 2022 — New chapter, ozone therapy —
  2. Dec 26, 2021 — Correction, anticonvulsants chapter — I excessively demonized gabepentin and pregabalin based on an oversimplification of their legal history and inadequate attention to the evidence on efficacy for neuropathy. In fact, these drugs are efficacious for some neuropathies. While those were genuine errors in need of correction, the key message was accurate: they aren't useful for back pain, and corruption is the only reason they were ever given to patients for that purpose.
  3. Nov 19, 2021 — Major upgrade — Substantial clarifications and new information about ominous neuropathy symptoms, based primarily on Hoeritzauer and Angus, and initially inspired by Tom Jesson’s writing about the prevalence of cauda equina syndrome.
  4. Nov 16, 2021 — New chapter, back pain as a disease of civilization —
  5. Sep 11, 2021 — Science update — Added a citation and expert opinion.
  6. Sep 11, 2021 — Minor improvements, alignment — Added some colour and did a little editing.
  7. Jun 5, 2021 — Improvements, strain-counterstrain chapter — More detail and polish.
  8. Mar 11, 2021 — Upgrades — More and better information, mostly achieved in this case by consolidating information from other books in the PainSci library.
  9. Nov 10, 2020 — New section, positional release — Adapted and expanded from an old chapter in my muscle pain book, with more detail and a back pain example.
  10. Aug 30, 2020 — Science update, medications — Cited Ashbrook 2020 on the value of naproxen. Added some additional detail about how/why to experiment with different pain-killers.
  11. Jul 10, 2020 — New section, back beliefs —
  12. Jul 9, 2020 — 2020-07-09 — Added a doctor’s anecdote about treating many troublesome back mice over the years, both his own and his patients.
  13. Apr 9, 2020 — Science update — Nice reference supporting the point that true psychosomatic pain is a rare beast.
  14. Apr 9, 2020 — More information, aging chapter — Discussed the prevalance of severe back pain in older patients, as a good exception-that-proves-the-rule.
  15. Apr 6, 2020 — COVID-19 update — Added information about headaches as a symptom of COVID-19.
  16. Apr 4, 2020 — Edited — The standard one-week-later edit, but better than usual. The purpose of the chapter wasn’t as clear as it could have been on the first try. But I think I nailed it this time — this is about why “coping” is much better than it sounds.
  17. Mar 27, 2020 — New chapter —
  18. Jan 30, 2020 — Addition, back mice chapter — Added a fun pet theory and personal anecdote about the clinical relevance of lipomas.
  19. Jan 30, 2020 — Expanded, specific back pain chapter — Some final elaborations and editing. This topic is now more or less completely addressed, I think.
  20. Jan 29, 2020 — Polishing, hamstring stretching chapter — Miscellaneous editing and improvements.
  21. Jan 14, 2020 — New sub-topic, oral corticosteroids — Compared and contrasted oral and injected corticosteroids; added some colour/context about anabolic steroids.
  22. Dec 13, 2019 — Science update — Added several interesting details about nerve root compression symptom pattern variability, with references.
  23. Nov 23, 2019 — New section, Muscle relaxants (Robaxin, Robaxacet, etc), psychoactives, and sedatives — Previously coverage of muscle relaxants was limited to a small section of another chapter. This new chapter provides about 10x more information and is a complete reboot of the topic in this book.
  24. Nov 23, 2019 — New section, cannabinoids (finally) —
  25. Oct 25, 2019 — Science update — This is probably the final update about antibiotics for back pain. It’s looking pretty closed. Famous last words? We’ll see.
  26. Oct 4, 2019 — Major revision, hamstring stretching chapter — Although the bottom line remains essentially the same, this chapter is now much higher quality in every way. More information, clearer, and fully up-to-date scientifically.
  27. Sep 6, 2019 — Rewritten again, sleep posture etc — This chapter was rewritten along with the chapter on causes of morning back pain, and is about double its previous size.
  28. Sep 6, 2019 — Rewritten again, morning back pain chapter — This chapter is vastly expanded. In fact, it is now one of the largest chapters in any of my books.
  29. Aug 16, 2019 — New section, sacroiliac joint dysfunction —
  30. Jul 31, 2019 — Science update, yoga — A minor science update, long overdue. No change to the bottom line, just more evidence that yoga isn’t exactly curing most people’s back pain.
  31. Jul 13, 2019 — Major revision, prolotherapy — Thorough science update and much more detail. Prolotherapy has gotten a bit of a revival in the last few years, and it’s persistence in the marketplace justifies more detailed coverage of the topic. Unfortunately, the bottom line hasn’t budged: still not recommended for back pain.
  32. May 16, 2019 — Updated — Added some good expert quotes and optimistic perspective on pain education from Moseley.
  33. May 3, 2019 — Science update — A particularly disappointing, predictable update on 2010’s overhyped news about methylene blue.
  34. May 3, 2019 — Science update — A particularly disappointing, predictable update on 2010’s overhyped news about methylene blue.
  35. Apr 25, 2019 — Upgrade, on the erratic quality of chronic low back pain — Modernized the trigger point content and added several paragraphs about sensitization as well.
  36. Mar 24, 2019 — Science update — Pure reinforcement: cited Artus 2010 and Artus 2014, backing up Machado.
  37. Mar 5, 2019 — More information, the role of stress — Added content about personality types and the prevalence of concealed stress and anxiety, inspired by Sapolsky.
  38. Feb 16, 2019 — New section, about the pros and cons of getting an MRI —
  39. Jan 19, 2019 — Expansion, discussion of specific back pain — Today I added a little depth on a couple key points, and commentary on a really interesting example of specific spinal pain from Dr. Stu “There’s No Such Thing As Non-Specific Back Pain” McGill.
  40. Jan 5, 2019 — Science update, medications — Finally added hard evidence of the obvious — over-the-counter pain meds don’t really work — and got into some nuances.
  41. Dec 13, 2018 — Expansion — Continued the process of making this section into a more substantive exploration of the idea of specific back pain, and added a new example, a case study of back pain caused by a tumour on a nerve root.
  42. Oct 27, 2018 — Example added — New sub-section, “A perfect example of a structural problem: cluneal nerve entrapment,” based on a fascinating case study reported by Aota.
  43. Sep 27, 2018 — Substantial editing, neuropathy sections — Merged content from the back and neck pain tutorials, resulting in major upgrades to two important sections in both books.
  44. Sep 27, 2018 — Substantial editing, neuropathy sections — Merged content from the back and neck pain tutorials, resulting in major upgrades to two important sections in both books.
  45. Aug 24, 2018 — Minor improvements — Discussed potential harms of strength training in a little more detail.
  46. Jul 25, 2018 — New section — A new standard chapter for most tutorials summarizing several key concepts about placebo.
  47. Jul 13, 2018 — Important update — Added an important new sub-section about anticonvulsants.
  48. Jun 19, 2018 — Major science update, obesity section — New key new citations and thorough analysis.
  49. Jun 12, 2018 — Upgraded — Added much more detail about the basics of neuropathy and revised everything else quite thoroughly. Expanded the discussion of implications of Jayson as promised last month.
  50. May 3, 2018 — Science update, radiculopathy section — A science update … with quarter century old science about blood supply and radiculopathy (see Jayson). This is just a quick drop-in for now, but it’s fascinating, so I’ll be elaborating more in another update.
  51. Apr 24, 2018 — New section, about back mice (lipomas) —
  52. Mar 2, 2018 — Major revision, introduction to care options — Phase 1 of a reboot of this part of the book. Today I’ve added much more detail to the intro, emphasizing good and bad reasons for seeking help.
  53. Jan 20, 2018 — Major new section — Well, new to the book anyway. It has been available as a free article for quite a while, and it will remain so indefinitely. Although this content is not exclusive to the book, it definitely does belong here.
  54. Dec 10, 2017 — New section —
  55. Dec 7, 2017 — New section, needles for back pain —
  56. Dec 7, 2017 — Major upgrade, diagnostic nerve blocks — The section has been re-written and expanded significantly, with a key change in position. After reviewing the same scientific papers previously cited more carefully, I decided that they were much less promising than I originally thought. The section has flip-flopped from optimism to pessimism about nerve blocks without a single change in what’s actually cited, just a change in the level of diligence in interpreting the science.
  57. Nov 12, 2017 — Science update — Added a substantive footnote explaining the relationship between ulcers, stress, and H. pylori infection as one of the best examples of a “stress-sensitive condition.”
  58. Nov 2, 2017 — Science update — An important follow-up on August’s major massage evidence update, I’ve now added a summary of the evidence for trigger point massage. Although the topic is not covered in detail here, much study went into making this summary possible.
  59. Aug 19, 2017 — Major update — Rewritten and updated. I revisited all the evidence on massage for back pain, especially integrating Furlan et al (a major 2015 meta-analysis on this topic). The bottom line is now that the science is inconclusive and discouraging instead of optimistic. Sorry, everyone.
  60. Jun 28, 2017 — Minor addition, introduction — Added an excellent recent example of awful back pain information.
  61. Apr 24, 2017 — Minor update — Added discussion of orthotics to treat leg length differences for back pain.
  62. Apr 23, 2017 — New section — An important and interesting acknowledgement that mechanical causes of back pain do exist.
  63. Apr 22, 2017 — New subsection — Added content inspired by decades-old evidence of reduced spinal degeneration in “primitive” cultures where squatting is common. Some light editing of everything else in the chapter.
  64. Apr 22, 2017 — Science update — Added a small but key new point and citation about genetic factors in degeneration; and an important new citation about the disconnect between imaging results and pain.
  65. Apr 13, 2017 — Science update — Discussed important new review of SMT for acute low back pain. Significant revision of the section.
  66. Mar 12, 2017 — Science update — Strong new reference to Andrade et al fully supports the main message of the section.
  67. Mar 11, 2017 — Science update — Newer, better, evidence-based good news about disc herniation resorption.
  68. Mar 8, 2017 — Science update — Updated references for debunking of TENS for back pain. Added ultrasound to the section.
  69. Mar 1, 2017 — Minor improvement — Added a proper summary of Roffey et al, and a relevant personal footnote.
  70. Jan 20, 2017 — Science update — Added discussion of a remarkable example of poor MRI reliability.
  71. Jan 4, 2017 — Major correction — An evidence-based reversal of position and advice about sitting and back pain, correcting a long-standing error: my long-term assumption that too much sitting is a risk factor for back pain was never defensible.
  72. Dec 6, 2016 — Science update — Added commentary on the “do not offer” acupuncture recommendation in the new NICE guidelines for back pain.
  73. Oct 20, 2016 — Edited — Thorough revision and modernization. Although I revised this section just five years ago, it needed it again!
  74. Sep 28, 2016 — Science update — There is now a good scientific concensus on the subject of spinal fusion, thanks to papers like Mannion 2013 and Hedlund 2016. Putting a spotlight on this called for some serious revision and editing. The whole section is greatly improved.
  75. Aug 9, 2016 — Upgrade — Greatly improved information about opioids (and linking to much more information).
  76. Aug 9, 2016 — Upgrade — Added much more information.
  77. Aug 9, 2016 — Correction — Removed overconfident statements about the clinical significance of the effects of psychoactive drugs, plus related minor updates.
  78. Aug 4, 2016 — Minor update — Some editing and new caveats.
  79. Jul 29, 2016 — Science update — Some fresh citations that strongly reinforce the main point of the section, and a few entertaining new examples of weird placebo effects.
  80. Jun 22, 2016 — Safety update — Updated opioid summary for consistency with new CDC guidelines.
  81. Jun 15, 2016 — Update — Added new intro to section about distorted body image.
  82. May 2, 2016 — Minor update — Clarification of the significance of some previously cited science, Ferreira et al.
  83. May 1, 2016 — Science updated — New citations and more information about spontaneously resolving herniations.
  84. Mar 31, 2016 — Science update — Beefed up the evidence that vertebroplasty is an ineffective surgical fix for an allegedly structural problem.
  85. Mar 8, 2016 — Minor science update — Added a note about the odds of back pain having a serious cause.
  86. Jan 9, 2016 — Science update — Added some general explanation of cognititive-behavioural therapy, with a key reference.
  87. Dec 16, 2015 — Science update — Added discussion of a popular acupuncture-for-back-pain paper, Cherkin 2009. Which is not fit to line a birdcage, in my opinion.
  88. Dec 10, 2015 — Edited — Modernization of trigger point summary, more science, and more acknowledgement of controversies.
  89. Dec 4, 2015 — Edited — Modernization of trigger point summary, more science, acknowledgement of controversies.
  90. Nov 4, 2015 — Science update — Added surprisingly good news about methylene blue injections.
  91. Nov 4, 2015 — Science update — Added surprisingly good news about methylene blue injections.
  92. Sep 1, 2015 — Science update — There’s been more study of the role of bacteria in back pain. And still not enough!
  93. Mar 3, 2015 — Science update — Added information and references about transitional vertebrae and Bertolotti’s syndrome.
  94. Feb 28, 2015 — Science update — Added 3 good references and a diagram about how much “wiggle” room nerve roots have.
  95. Oct 23, 2014 — Minor update — Added a reference for reassuring data about recovery rates.
  96. Jul 25, 2014 — Major update — The first complete professional editing of this book has now been completed. Although the difference will not be obvious to most readers, several hundred improvements and corrections were made, and it is definitely a smoother read.
  97. Jul 11, 2014 — Minor update — Added Digital Motion X-ray.
  98. Jul 8, 2014 — Minor update — Plugged a good quality microbreaking reminder app Backache… which was actually inspired by this book. Very cool!
  99. Jul 8, 2014 — Minor Update — Added some humour: a funny video about a core strengthening product.
  100. Apr 24, 2014 — New section — A minor topic, but one of the most overdue sections I’ve ever added to the book: I’ve been asked about these devices a lot over the years.
  101. Jan 8, 2014 — Rewritten — Cleaned up and modernized, more information, especially a more useful and evidence-based self-treatment tip.
  102. Jan 8, 2014 — Rewritten — Cleaned up and modernized, more information, especially a more useful and evidence-based self-treatment tip.
  103. Jan 1, 2014 — New section —
  104. Dec 23, 2013 — Minor update — Added some great backup from a terrific surgeon blogger — who advocates for the necessity of testing placebo surgeries, exactly as I have in this section for many years.
  105. Dec 20, 2013 — Expanded — Added subsection on electroacupuncture.
  106. Dec 20, 2013 — Science update — Reporting on the greatest hits of back pain science (Machado 2009, a source of several important points here and in other sections).
  107. Sep 26, 2013 — Science update — Some science showing that the effect of hamstring tightness on back function/pain isn’t exactly potent.
  108. Sep 12, 2013 — Science update — Interpretation of a little junky new science about Pilates.
  109. Aug 13, 2013 — Comedy update — Added an amusing, extended example from the TV show, The IT Crowd.
  110. Jul 20, 2013 — Minor update — Added a quote that beautifully expresses the reason for treating chronic pain with … maturity.
  111. Jul 20, 2013 — New section — An overdue upgrade! This way pain and fear power each other is now explained much more clearly and thoroughly than before. It’s noteworthy that, with this update, Dr. Lorimer Moseley’s valuable perspective on back pain is now fairly well-represented in this book.
  112. Jun 5, 2013 — New section — Important new chapter about a hype-hot news item.
  113. May 29, 2013 — New evidence — Rare good news: the first good quality scientific test of “the confidence cure” had promising results — which is just about the best thing that could have happened to this chapter.
  114. Apr 4, 2013 — Minor update — Interesting, useful new reference.
  115. Mar 29, 2013 — Minor update — Upgraded risk and safety information about Voltaren Gel.
  116. Jan 26, 2013 — Major update — All major professional treatment options now summarized.
  117. Jan 26, 2013 — New section — New standard section I’m introducing to most of the tutorials to “manage expectations.” Too many readers assume there’s going to be a specific miracle treatment plan.
  118. Jan 26, 2013 — Major update — All major self-treatment options now summarized.
  119. Jan 19, 2013 — Edited — Nothing in particular has changed, but it’s definitely a better chapter now.
  120. Dec 7, 2012 — Science update — Added (more) evidence showing the role of smoking in chronic back pain.
  121. Nov 10, 2012 — Science update — New reference strongly supporting a key, controversial point.
  122. Nov 2, 2012 — Minor update — Added an intriguing quote about evolution and the lack of back pain in hunter gatherers.
  123. Oct 28, 2012 — Science update — Put “foot fear” in context with some reassuring high heels science.
  124. Oct 26, 2012 — Science update — Added evidence that the stakes are high with chronic pain: it may even shorten lives.
  125. Oct 24, 2012 — Minor update — Added a new suggestion for safe, pleasant self-tractioning.
  126. Oct 24, 2012 — New section —
  127. Jul 4, 2012 — Science update — Interesting evidence that massage therapists cannot reliably find the side of pain by feel.
  128. Jun 7, 2012 — Minor update — Added a fine example of taking yoga very, very seriously as an option. See first footnote in section.
  129. Apr 27, 2012 — Update — Editing, and several new paragraphs about safety issues.
  130. Apr 27, 2012 — Minor update — Some simple revision for clarity and quality, and a bit more content.
  131. Apr 4, 2012 — Science — More science, and a few substantial new footnotes fielding common concerns and questions.
  132. Mar 21, 2012 — Science update — Clarified information about pelvic tilt, and beefed it up with some more science.
  133. Mar 7, 2012 — Minor update — Important new, skeptical footnote about the dangers of the powerful narcotic drugs.
  134. Dec 16, 2011 — Science update — More evidence of the exercise effects are limited and non-specific. See the paragraph starting “Does spinal function improve … ”
  135. Dec 10, 2011 — New section —
  136. Dec 1, 2011 — Updated — Added scientific cases studies, examples, pictures and video of true dislocation and abnormal anatomy to help drive home the point that even significant spinal joint dysfunction can be surprisingly harmless … never mind subtle joint problems.
  137. Nov 25, 2011 — Minor update — Minor, but fun — a great quote about models of slipped discs, and a good new image to help it along.
  138. Nov 23, 2011 — Rewritten — Improved and expanded. In particular, intramuscular stimulation (IMS) was “demoted.” I am disillusioned with it and no longer want to promote it without strong caveats.
  139. Nov 3, 2011 — Major science update — Detailed reporting on some new yoga science. Significant re-writing of the section ensued. Sometimes new science does not back up my preconceptions: I’ve changed my tune here somewhat.
  140. Nov 1, 2011 — Minor update — Added a couple great points/quotes from doctors about overuse of MRI, as reported by Gina Kolata for the New York Times.
  141. Aug 26, 2011 — New science — I stumbled across a fantastic scientific paper about the prevalence of nerve pinches (hint: it’s low). Excellent perspective.
  142. Aug 26, 2011 — New section — A key concept covered in the trigger points tutorial long ago, but so relevant to low back pain that I decided it needed to be here as well.
  143. Aug 26, 2011 — New section — This section is a summary of an important concept that’s been available in a free article since late 2008, but it really needed to be emphasized here.
  144. Aug 12, 2011 — Minor update — A few new paragraphs summarizing an important new study of massage for low back pain with disappointing results.
  145. Jul 29, 2011 — Minor update — Added a reference about the poor overall quality of online information about common injuries. See Starman et al.
  146. Jul 13, 2011 — New section — More information about an important characteristic of muscle-dominated back pain.
  147. Jul 12, 2011 — Major update — Totally renovated section: re-written, reformatted, expanded, upgraded. A few new checklist items were added, most were expanded, and all were clarified. A separate and handier “quick” checklist was added to the existing “slow” checklist.
  148. Jun 19, 2011 — Major update — Major improvements to the table of contents, and the display of information about updates like this one. Sections now have numbers for easier reference and bookmarking. The structure of the document has really been cleaned up in general, making it significantly easier for me to update the tutorial — which will translate into more good content for readers. Care for more detail? Really? Here’s the full announcement.
  149. May 11, 2011 — Minor Update — Added evidence that spinal fusion surgeries are not just ineffective but often harmful (Nguyen).
  150. May 11, 2011 — Minor update — Added a fascinating science item about the effect of anti-inflammatory gels on back pain (Huang).
  151. May 11, 2011 — Minor Update — Long overdue, I finally added some science to this section, showing that the connection between low back pain and obesity is weaker than it seems (Wright).
  152. May 5, 2011 — Minor Update — Added some interesting references about sensation (Luomajoki) and the relationship between back pain and a disrupted “body schema” (Bray).
  153. Feb 17, 2011 — Upgraded — New artwork from artist Gary Lyons, plus some important new references.
  154. Feb 17, 2011 — Minor Update — Added a fun and informative quote from the TV show House.
  155. Jan 12, 2011 — Updated — Added some new evidence about back pain and aging, and a nice new graph.
  156. Jan 7, 2011 — Minor update — Just added a link, but a really great link! The CBC show Marketplace did an amazing job last year reporting on spinal decompression machines. Well worth a look — the show and their show page is probably now the single best source of information on this topic.
  157. Jan 7, 2011 — Minor update — Some editorial cleanup on core strengthening, and I a link to a good summary of recent research.
  158. Dec 29, 2010 — Like new — Re-written and significantly expanded.
  159. Dec 29, 2010 — New section —
  160. Oct 1, 2010 — Major Update — Rewriting and expansion of the Special Supplement on spinal manipulative therapy.
  161. Sep 21, 2010 — Updated — Added a much more detailed description of the Hancock et al study, and in fact turned it into the main substance of this section.
  162. Sep 15, 2010 — Updated — Added a very beefy footnote about some new research showing that muscle imbalance does not result in higher rates of injury. This almost should have been a new section, but I decided to just make it a ginormous footnote — footnotes are there for delving if you want to, that’s the idea! You can read a summary of the research in the bibliography (see Hides et al), but the relevance to back pain is spelled out in detail here. And it’s interesting.
  163. Aug 25, 2010 — Upgraded — Section now includes discussion of that bizarre and already infamous paper in the New England Journal of Medicine (see Berman). I also make an important new point: exactly why acupuncture placebos are such a problem for low back pain patients in particular.
  164. Aug 7, 2010 — Like new — Rewritten. I’ve lost track and can’t be bothered to go back into the archives to figure it out for sure, but I think that this section was brand new (but never announced) late in 2009, and then this past week I gave it a substantial upgrade: it is now one of the best-referenced chapters in the book, and it says as much as probably needs to be said on the subject — or more!
  165. Aug 6, 2010 — New cover — At last! E-book finally has a “cover.”
  166. Jun 5, 2010 — Minor update — Added a scientific thumbs down for transcutaneous electric nerve stimulation (TENS).
  167. Jun 5, 2010 — New section — A surprising scientific thumbs up for comfrey ointment was worth a whole new small section.
  168. Feb 13, 2010 — Minor update — Added clear evidence that family doctors don’t do a good job caring for patients with low back pain, and that a myth-busting ebook like this is still important.
  169. Jan 23, 2010 — Major upgrade — Rewritten and significantly expanded information about medications.
  170. Jan 23, 2010 — New section —
  171. Jan 23, 2010 — New section — An important update: a major new section that goes a long way to substantiating one of the most important points of this tutorial.
  172. Jan 23, 2010 — Major upgrade — Rewritten and significantly expanded information about medications.
  173. Jan 22, 2010 — New section — Having debunked expensive spinal traction using expensive decompression machines, here are some ideas for cheaper and safer methods of tractioning.
  174. Jan 21, 2010 — New section —
  175. Nov 25, 2009 — New section — Today I found a way to say some simple things about the power of self-treatment that have been “on the tip of my tongue” for years now. It all evolved from writing about an important bit of research, showing that manual therapists cannot (reliably) diagnose trigger points.
  176. Nov 24, 2009 — A little extra scientific evidence to make the point “” This new study from the Lancet puts the nail in the coffin of the MRI myth: it’s now just about as busted as a myth can get.
  177. Oct 12, 2009 — New section, “,” based on interesting new scientific evidence. The research is explained in a short free article, but I discuss it in quite a bit more detail here.
  178. Sep 28, 2009 — Overhauled all the diagnosis sections — — reorganizing and editing here there and everywhere. Three sections were added or almost completely re-written. In particular, information about nerve blocks was added, and disc herniations are discussed in more detail than before.
  179. Sep 25, 2009 — Polished and expanded the section, “.”
  180. Aug 6, 2009 — Added a reference to some really fascinating new research about vertebroplasty — yet more evidence that structural “instability” isn’t actually the main problem in back pain, because “stabilizing” doesn’t actually help.
  181. Jul 24, 2009 — The sections on and have been condensed into finely tuned summaries, and link to external articles covering these topics in much greater detail.
  182. Jul 16, 2009 — Small but good new section “.” Hat tip to Dr. Tarzwell for suggesting this one: I had previously neglected the (obvious) importance of this particular medical speciality for back pain patients.
  183. Jul 7, 2009 — Important safety update. The section “” has been upgraded, based on a much more careful and thorough translation of the best and most recent medical guidelines, and links out to a new free article with considerably more detail for patients who are concerned about an ominous cause of their low back pain. I’m really happy with this update: for some time now I’ve known that I needed to “cover my butt” with better information about more serious causes of low back pain — they are rare, but they do exist. I was inspired to do so by a case study from a physician I know, who encountered a patient with back pain that was actually caused by a cancer. That story convinced me that it was time to make sure my readers know when to worry about low back pain, and when not to.
  184. May 30, 2009 — Minor update. Started a new section, “.”
  185. May 26, 2009 — Minor update. Added a solid new reference concerning the overuse of X-ray and MRI.
  186. May 17, 2009 — Another new section this morning — a long overdue debunking of prolotherapy, a particularly classic example of a therapy that has failed to prove efficacy after 50 years and numerous fair scientific tests. I recommend the section not just for the useful information, but because it’s quite an interesting topic. See “.”
  187. May 16, 2009 — Substantive new section, “,” summarizing some common causes of low back pain, such as facet joint dysfunction and injury. Such topics were missing from the tutorial before because they are so hard to diagnose accurately, because professionals and patients alike to over-react to the very idea of them, and because they are almost invariably complicated by muscle pain that becomes more prominent than the original problem. Nevertheless, these problems have a place in the tutorial.
  188. May 16, 2009 — Small new section, based on some persuasive scientific reviews recently published in the journal Spine: “.”
  189. Apr 1, 2009 — The visual design of the site was upgraded over the past several days. Although this is not an update to the content of this tutorial, it is nevertheless a significant upgrade for all of them — like publishing new editions of books with better typesetting and layout. The new design is even cleaner and reader-friendly; it now looks that good in most web browsers; and pages load as much as 50% faster. Many under-the-hood improvements will make it much easier for me to improve tutorial content. The tutorials are now well-oiled machines of digital publishing goodness, vastly superior to the low-production values of most eBooks. More information about the upgrade is published on the front page.
  190. Mar 15, 2009 — Two completely new and large sections about scoliosis — one section about dubious diagnosis of scoliosis and the exaggeration of the importance of it in low back pain, and another section about how scoliosis is more or less impossible to therapize. Both sections include interesting case studies and lots of great examples of nonsense in low back pain management — this is the most substantial addition to the tutorial in several months. The new sections are: “” and “.”
  191. Feb 27, 2009 — Minor update: added/clarified a good reference to the scientific literature regarding acupuncture for low back pain.
  192. Feb 15, 2009 — Added a new appendix to the tutorial today, just something interesting that I couldn’t find a good place for in the main body of the tutorial: “.”
  193. Feb 2, 2009 — Some small but important updates to the section, “.” This section still suggested that optimism about acupuncture was justified. Recent scientific evidence has continued to hammer away at acupuncture, and optimism can no longer be justified. You can read about the most recent acupuncture evidence in, Does Acupuncture Work for Pain?.
  194. Jan 6, 2009 — New section about sleeping factors, “
  195. Dec 6, 2008Physical Therapy just published a new review of a form of therapeutic exercise for the low back (“motor control” training, which is a form of the better known concept of core strengthening), and I’ve integrated it into the tutorial. See the section “.”
  196. Aug 30, 2008 — I published a major upgrade today (by far the largest ever I think). The tutorial gained about 10,000 new words and many miscellaneous improvements. Most of the new content is in the second half of the tutorial. In particular, there are now much more detailed treatment recommendations. Previously, the tutorial leaned too heavily on the idea of the “confidence cure” for low back pain. Even though I do not believe that low back pain is an all-in-your-head problem, some readers may have been left with the impression that the solution is all in your head — which I regret. As important as the confidence cure is, it’s just as important for low back pain patients to have concrete, evidence-based treatment and self-treatment options to pursue (especially treatment options for resolving muscular trigger points in the low back). I’m happy to say that those options are now thoroughly explored. A great deal of content was moved from the trigger points tutorial and adapted specifically for low back pain, and I also spent a lot of time adding miscellaneous practical tips and tricks and re-organizing the entire tutorial. It’s a different e-book! It has the same spirit as before … but with dramatically more practical advice.
  197. Jun 11, 2008 — Some major upgrades today! This is really where the power of a “web text” really shines, because this new information is based on bleeding edge, just-published science. I finally launched a new major chapter about surgery, “” kicking it off with a brand new section about “” And a large section, “” formerly an appendix, was updated and added to the new surgery section. Other sections about different types of surgery are planned for the relatively near future.
  198. Apr 20, 2008 — Integrated new information (in several places in the tutorial) related to the recent Journal of the American Medical Association study showing that increased spending on spinal pain (i.e. expensive surgical procedures especially) has not generally been helping people. See Back Pain Spending Surge Shows No Benefit in the New York Times.
  199. Jan 18, 2008 — Added valuable new section, “.”
  200. Jan 15, 2008 — Edited and expanded a few footnotes for clarity and to add a little more scientific evidence to the pile.
  201. Dec 19, 2007 — Today I took some existing content and reorganized it into several new “reality check” sections to help readers make sense of the many questionable theories out there about the cause of low back pain. There were many changes throughout, but most of the new content is in two of those sections, “” and “.”
  202. Nov 11, 2007 — Added a table to the section “,” illustrating the differences between nerve pain and trigger point pain. You can also find the same table in the free article Nerve Pain Is Overdiagnosed.
  203. Oct 7, 2007 — Added a good case study example in “”, and added a long overdue new section about self-treatment of trigger points, “.” It’s rudimentary for now, but will soon be expanded, and of course it links to more complete articles elsewhere on
  204. Sep 28, 2007 — Added new section “” based on interesting new evidence from Archives of Internal Medicine.
  205. Sep 20, 2007 — Added a new section based on terrific new science from Archives of Physical Medicine & Rehabilitation. See “.”
  206. Sep 18, 2007 — Confused about whether or not to ice or heat the low back? I just added a new section, “.” The section is short, but it links to another (free) article that just got a bunch of major upgrading, so the details are available to anyone. And I upgraded the along with it.
  207. Sep 9, 2007 — A new study of back surgery published in New England Journal of Medicine inspired a major expansion and upgrade to the section, “.”
  208. Aug 20, 2007 — Added the substantial “” section, which discusses competitive back pain cure products, and critically reviews a prominent back pain program called “Lose the Back Pain.” Also spent a couple hours starting to seriously upgrade the treatment recommendations. Historically, this article relied too heavily on the idea that simply understanding back pain was significantly therapeutic in itself — that is true, but it’s not the whole story. The process of beefing up other self-treatment advice began today.
  209. Aug 5, 2007 — Added the “
  210. Aug 4, 2007 — Added the “” section to make it more certain that no reader with truly ominous back pain symptoms is inappropriately reassured by this article. Most back pain is not as serious as people think — but some back pain really is serious!
  211. Jun 5, 2007 — “Modernized” 122 footnotes. When I first published this article, it was the first heavily footnoted document I’d published on the internet, and my methods were clumsy, labour-intense, and error-prone. I’ve installed a much more reliable and user-friendly bibliography system on since then, but only just now got around to converting the messy old footnotes into the shiny new kind of footnotes. Hope you like ‘em!
  212. Mar 25, 2007 — Thoroughly revised all the sections discussing yoga (), and added the section. This was in response to some feedback from a client who wisely pointed out that I was too critical of yoga and meditation as a back pain treatment. In my eagerness to make it clear to readers that they don’t have to do yoga and meditate, I neglected to mention that it actually is a good option for people who want to practice yoga and meditation. Good point! Thanks, Sandra.