This lecture aims to bring the management of lower back pain in the work place in line with current evidence. For too long the occupational health management of lower back pain has sat in an extremely biomedical framework concentrating on spine position, lifting equations and manual handling training. Here I attempt to reconceptualise what care for back pain in the work place should or could look like based on an up to date biopsychosocial approach. I draw on the work of Peter O’Sullivan, Lorimer Mosely and Ben Darlow plus many more to introduce how culture, language and the way we approach assessment and treatment of back pain at work needs to change.