Beyond Body as Machine and the Biomechanical Model

The Biobank and HUNT studies show multimorbidity is common: people with chronic back pain may live with two, three or more other diseases, yet care still targets the back and its tissues. Paul lists the many factors that add to treatment burden and slow recovery, from relationships with clinicians and access to care to income, mood, weight and sedentary behavior. The biomechanical model gave physiotherapy autonomy, private practice and self-referral, but it treats tissues rather than people and lacks robust evidence. Quotes from Lederman and Loftus illustrate how it can leave patients feeling fragile and in need of fixing. Linear links between diagnosis and mechanism, such as repeated flexion causing wear and tear, are too simple, and studies show a poor correlation between work posture and low back pain. Back pain is normal and recurs every year or two for many people. The part ends on a shift from a belt of tools to reasoning, reassurance, appropriate discourse and an understanding of placebo.