Keep in mind that this is the opinion of just one physical therapist who attended. My views may be different that your own. I generally enjoyed meeting and getting to know and understand the individuals that were present at the forum, and I think that overall it gave me a much better understanding of where many researchers and primary care physicians are coming from. I also had to remind myself that this as a conference about what primary care physicians can do to help their patients. Although I can practice without a referral, I am not a primary caregiver per se.

Those of us looking for mechanical lesions and treatments were disappointed for the most part. The research emphasis for the conference was dealing with chronic LBP and it’s associated absenteeism and psychosocial factors. The theme of the conference was getting providers to use the guidelines for the treatment of LBP that are readily available. Research and small group discussions tended to focus on the "barriers to implementation" and why those barriers arise.

The poster presentations were the only forum for the discussion of lesions and actual treatment programs for LBP. Main lectures and presentations were about identifying psychosocial yellow flags, the current reports on rates of disability, as well as the overall latest information on the factors that influence disability claims attributed to LBP, and the financial, social and health consequences of such claims. The short research and proposal presentations (4-7 minutes) addressed issues discusses in the large forums, and included research looking into the identification of reasons and populations of practitioners who did not practice within the latest established guidelines. The poster presentations were the only part of the conference that seemed treatment focused. Most of these studies concentrated on non-specific exercise programs for LBP with a non-specific diagnosis. No subclassifications of clinical syndromes were used (although all seemed to exclude sciatica or referred pain) because the general belief among the researchers was that none could be reliably identified. The exercise programs were all (except for one presentation) composed of 20-30 sessions of 60-90 minutes. Some did have components of stabilization, but all had aerobic exercise as the major component.

There was an interesting poster presentation by Julie Fritz comparing two types of treatment for LBP. One group was treated using the current American guidelines (NSAIDs, some modified activity, with emphasis on general exercise, returning to work and not "over-diagnosing") and the other group were evaluated and treated per the method proposed by Delitto, et al. Julie is an associate of his at Pitt. The Delitto group recovered more quickly, and had a significantly earlier reduction of symptoms.

The major presenters were not particularly concerned with hiding their bias. Waddell stated onstage that one of these days Bogduk would realize that his search for a lesion "…is futile." There were no mentions of mechanical lesions from the major speakers, however, the clinicians at the conference were concerned about the apparent lack of concern for mechanical causes in the presence of many good studies that implicate such problems. Researchers were generally content with following "the current evidence" from systematic reviews and basic research. All of this current research does not subclassify LBP, and in this way can be considered methodologically "clean." Several researchers found themselves engaged in interesting conversations about mechanical lesions, and were told about some of the good literature currently out there.

The rest of the conversations and presentations focused on how many practitioners used the current guidelines, read the current literature, etc. Most of the concentration focused on "barriers to implementation." The presentations focused on getting clinicians to follow the latest guidelines and research, although the Australians had a better idea. They made public service announcement featuring sports stars and other celebs with easy slogans. I thought about how many times I’ve seen people fight for things and change behavior based only on a catchy jingle. The slogans were "Back Pain…Don’t take it lying down," and "Walk away from LBP." Both emphasized minimal treatment, continuation of daily activities, and general exercise. There were 12 different ones, and the spots that we saw were diverse – meant to appeal to different groups of people.

My overall impression is that this conference had a tunnel-vision scope looking only at the chronic workman’s compensation patients, disability claimants, and those with significant psychosocial involvement. Those people compose less than 30 of my patients. What am I supposed to do with the rest of them? From what I’m told by the research at this conference (and the researchers at this conference) is that all of my treatments are not efficacious, and that I should be putting all of them on a 20-session exercise program meeting 90 minutes, three times per week