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Your Back Is Not Out of Alignment

This page lists all 32 updates for one article on, Your Back Is Not Out of Alignment 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. May 27, 2019 — Audio version reboot — I just re-did the audio version of this article, including dozens of updates in recent years. I’ve also changed the way I produce audio versions so that I can easily updated individual chapters in the future. The audio is available on request to visually impaired readers, and as a perk for all eboxed set customers.
  2. Feb 26, 2019 — Update/correction — Meniscal fraying is no longer a good example of a clearly structural problem with a clear structural solution, not that we know that so much mensical repair surgery is ineffective. Corrected and clarified
  3. Jan 21, 2019 — New sub-topic — Added some thoughts and a new citation about muscle “imbalances” (over and under-developed muscles on one side or the other).
  4. Nov 20, 2018 — Example added — New sub-section, “A perfect example of a structural problem,” based on a fascinating case study reported by Aota.
  5. Aug 1, 2018 — Science update — Added a key citation Lewis et al and elaborated a little on my recommendations.
  6. Aug 1, 2018 — Science update — Beefed up the description of the alternative to structuralism, and added a new citation and a few old ones.
  7. Nov 23, 2017 — Science update, evidence review section — Cited Wallace et al: knee osteoarthritis prevalence doubled in the 20th Century independent of age and weight.
  8. Sep 12, 2017 — Science update — Cited evidence that leg length differences cannot be reliably diagnosed.
  9. May 26, 2017 — Science update, evidence review section — Quoted and cited Tumminello et al on “the corrective exercise trap,” a topic closely related to structuralism.
  10. May 15, 2017 — Science update, evidence review section — Cited evidence of poor correlation between hip pain and radiographic signs of arthritis (Kim et al).
  11. Nov 17, 2016 — Content added — Greg Lehman’s “Fundamentals of Treatment” — some specific guidelines for structuralism-free treatment.
  12. Nov 16, 2016 — New section —
  13. Nov 12, 2016 — New section — “Manual therapy needs to get beyond being ‘manual’.”
  14. Oct 4, 2016 — Science update — Added an excellent scientific example of how disk herniations are less clinically significant than most people expect … but they still matter.
  15. Aug 9, 2016 — Minor update — Supported the claim that nocebo is an issue with a great quote from Flynn et al.
  16. Jul 8, 2016 — Science update — Cited Salata et al.
  17. Jun 28, 2016 — Science update — Added subsection on risk factors for running injuries.
  18. Jun 8, 2015 — Upgrade — This article went viral on Facebook today. As I often do when an article gets a crapload of traffic, I did some work on it: a table of contents and a bunch of miscellaneous editing and polishing.
  19. Jul 9, 2014 — Added interesting perspective from veterinary medicine: as with humans, correlations between structure and pain and disability in animals are poor.
  20. Dec 24, 2013 — Added evidence that being a dirty rotten pronator is … no big deal. Also (finally) added a concluding section about alternatives to structuralism.
  21. Dec 12, 2013 — Added a quote from a professional reader supporting my opinion of the prevalence of structuralism.
  22. Oct 23, 2012 — A thorough, modernizing edit and general cleanup. A number of references added, a few tired and weaker ones removed.
  23. Mar 21, 2012 — Added evidence that lumbar curvature doesn’t matter.
  24. Nov 7, 2011 — For balance, cited rebuttals to Lederman in Journal of Bodywork & Movement Therapies: see Chaitow.
  25. Aug 12, 2011 — Added an important new reference about “structural” massage for low back pain.
  26. Jul 9, 2011 — Added information about Functional Movement Screening, based on Schneiders et al.
  27. Apr 21, 2011 — Added much more detail to the example of my own deformed foot.
  28. Apr 17, 2011 — Some revision to the introduction to make it more readable and interesting.
  29. Dec 28, 2010 — A correction: Australian League Football is not “soccer.” Thanks to Nick A. for the heads up on that. And some clarification of the evidence concerning muscle asymmetries and injury rates in players.
  30. Aug 23, 2010 — Added some thoughts about the prevalence of structuralism, inspired by a Facebook discussion with some colleagues.
  31. May 11, 2010 — An extensive edit for humour, charm and accuracy. Several references were upgraded, Diane Jacobs’ wonderfully sassy definition of structuralism was added to the introduction, and Dr. Eyal Lederman’s brilliant essay is now prominently recommended: “The fall of the postural–structural–biomechanical model in manual and physical therapies: Exemplified by lower back pain”.
  32. Apr 7, 2010 — Added quite a few thoughts about how professionals are able to overlook obvious observations that contradict their beliefs about structuralism.