A body in alignment stays in alignment unless acted upon by a force. The force that takes bones out of alignment is very subtle, so subtle that over the years you don't even know it's happening. Muscles gradually become tighter through under use, some more than others, pulling some bones out of alignment. When it comes to the cause of back pain, it's probably best to work on the following assumptions.

- Back Pain is eminently fixable.

- Back Pain goes with a body that is generally in poor condition. For many people a good physical conditioning program, one which includes the aerobic, strength and flexibility elements of fitness will restore function to normal in a short period of time.

- Back Pain goes with a body that's 20 of more Kg over weight.

- Back Pain has a cause. Find the cause and treat it. Back pain rarely comes 'out of the blue'. It's asking a bit too much to keep blaming bad luck. There is a cause. If you can't find the cause, your search for the cure is likely to be fruitless.

- If you can't work out the cause yourself, and it is often difficult to analyse your own posture, go to someone who can, someone who has a good eye for spotting misalignment, someone who can give you a thorough postural assessment. This may be a masseur, yoga teacher, physiotherapist, osteopath, fitness practitioner, physical educator, doctor..., but certainly make sure it is someone who has a good reputation in the field of postural analysis.

- It's a big ask expecting your back to get better by having someone do something to you. Soon or later you have to do something to yourself - like the exercises, which strengthen, loosen and bring the body back into correct alignment.

- Most big problems start of as small problems that you don't address.

- The most likely cause of back pain is misuse of one sort or another, usually over a long period of time. If you've spent 20 or more years sitting down at a desk all day and don't have a regular and systematic strength, flexibility and postural alignment program you can be certain that you're on the way to musculo-skeletal dysfunction; that's if you don't already have it.

- Getting someone to give you an anti-inflammatory tablet and a rub down might give you a warm feeling under your singlet for a couple of days but it won't provide the long term fix which comes with strengthening and loosening the muscles that are designed to keep your body in correct alignment.

- Bones do what muscles tell them to do. If you have back pain, the pain is telling you that the muscles designed to keep your vertebrtae in correct alignment are not doing their job properly. Some of those muscles are far removed from where the pain is. The pain is telling you to realign the bones.

- Treat back pain as a symptom of dysfunction not a cause.

- The cause of back pain is rarely at the site of the pain (trauma excepted).

- Most people have slight postural imperfections, which end up causing pain in other parts of their body. You can spot these imperfections quite easily.

- Postural imperfections are magnified by such things as slouching over the computer, holding the phone between ear and shoulder, and by hand and foot dominance in the sports most regularly played. For many men, placing their wallet in the right back pocket of their trousers twists their pelvis every time they sit down. After 20 years they're permanently twisted and wonder why they've got a crook back. The last thing you want is a therapist getting their hands on your wallet!

- An X-ray and an MRI scan are probably less useful tools for the diagnosis of the cause of back pain than the eyes, the hands and camera. The latter is more likely to provide you with graphic illustration of the nature of your dysfunction.

- It's not the chair, it's how you sit in it. Once you habitually change the natural 'S' shaped curve of your spine into an habitual 'C' shape curve you're setting yourself up for lower back, neck and shoulder pain.

- If muscles are not getting stronger they're getting weaker. If they're not getting looser they're getting tighter. People without a regular and systematic strength and flexibility training program run the risk of back pain.

- Don't ask what your therapist can do for you; ask what you can do for yourself.

- Don't leave it to a therapist to take full responsibility for your dysfunction. If you do something to yourself, like strengthening, stretching and managing your posture better, there is a good chance you'll restore poor function to good.

- Therapy helps speed up the rehab process but it doesn't take the place of the things you need to do for yourself.

- An anti-inflammatory and a muscle relaxant are unlikely to cure your back pain!

- Some therapies when used on their own only provide temporary relief from the symptoms but are not aimed at fixing the underlying cause of the dysfunction.

- It is poor form for someone to do something to you without giving you some insight as to what has caused your dysfunction and without supplying you with exercises to go with the therapy.

- It is an advanced case of stupidity not to do the exercises that a good therapist provides.

- Stretching is necessary but not sufficient. You need to strengthen the muscles which support your body in correct alignment, with specific strength exercises as well as the general exercises that come as part of a regular and systematic strength training program.

- Nutritional supplementation may make a significant contribution to easing back pain, like, glucosamine, chondroitin sulphate, brassica juncea, green lip mussels and vitamin B5.

- There is a synergistic effect when it comes to restoring poor function to good. Use a wide range of modalities, regularly and intensively to speed up the rehabilitation process. Most people spend less time in two years than an elite athlete would spend in two weeks. That's why they never get better.

- Stacking a range of modalities up one on top of the other and increasing the intensity of the rehab process may speed up the recovery process. This is what sports people do to get better quickly.

- If you're on workers compensation for back pain, treat the rehabilitation process as a full time job. If you're used to spending eight hours at work, spend eight hours doing what athletes do to get better quicker.

John Miller