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Table 1 Concepts targeted during the spinal management module in BSc-2

From: Changes in physiotherapy students’ beliefs and attitudes about low back pain through pre-registration training

Unhelpful beliefs Messages delivered during the BSc-2 module
Back pain is due to structural damage • Degenerative changes are frequent in asymptomatic population [2, 34]
• Little association between degenerative changes and the level of pain and disability [35, 36]
LBP is a serious condition • LBP is very frequent and normal [2, 37]
• LBP due to serious pathology is rare [2, 38, 39]
Biomedical or biomechanical factors are the major cause of LBP • LBP is a multidimensional condition [2, 40]
It is necessary to find the source of pain to treat LBP • It is difficult/impossible to accurately determine the tissue source of LBP [2]
• Identifying the source of pain does not lead to better outcomes [2, 41]
LBP is due to “something” out of place that needs to be corrected • LBP is not due to “something” out of place [2, 42, 43]
• Manual therapy has short term effect and works as a pain modulating technique (no structural changes following manual therapy) [18, 44]
• Guidelines recommend active exercises as first line treatment [18, 45]
Bending/lifting with round back is dangerous for the back • Biomechanical studies do not consistently support that lifting with a straight back is better [46, 47]
• Epidemiological studies do not support flexion as an independent risk factor for LBP disability [48]
• Manual handling training (doing less flexion) has no effect on LBP [51, 52]
• Patients with LBP move with a more rigid spine (less flexion and more muscle activity) [53,54,55]
• Psychological factors are associated with a more rigid movement [16]
There is right and wrong ways to move • Movement is very variable and there is no right or wrong way to move [54, 58, 59]
• Confidence to move seems more important than how you move [13]
• If a movement is painful, you can temporarily adapt it. But in the long term, all movements should be promoted and trained (improving tolerance) [60]
The back is vulnerable and needs to be protected • Loading has positive effects on the back [61, 62]
• Disuse has negative effects on the back [63]
• The back can positively adapt to load [64]
Bad postures (particularly slumped postures) cause back pain • There is no right or wrong posture [65, 66]
• Posture is very variable [67]
• Lumbar spine posture is not an independent risk factor for LBP [68]
• Patients with LBP often show a hyperactivity of trunk muscles [55, 69]
Core stabilisation exercises are important to treat LBP • Patients with LBP move with a more rigid spine (and naturally adopt more “neutral” postures) [53]
• There is no association between transversus abdominus or lumbar multifidus activation and clinical outcomes [70, 71]
• Stabilisation exercises are not more effective than other types of exercises [72, 73]
• The idea that the back needs to be stabilized may elevate fear avoidance beliefs [11, 72]
Important factors that need to be modified during physiotherapy treatment are muscle strength and mobility (physical factors) • Improvement in physical factors alone do not explain improvement in disability [74]
• Self-efficacy, pain-related fear and psychological distress are important to address [75, 76]
• Physiotherapy intervention can improve psychological factors through education and active treatment (e.g. gradual exposure, promoting self-efficacy) [78]
  1. LBP Low back pain