19One of the most important issues in providing information to patients is to avoid unhelpful metaphors that you may think are useful in explaining the patient’s condition but which may lead to barriers that will affect recovery. Great care should be taken with labels such as 'a , 'crumbling spine', 'instability', ‘disc degeneration’, ‘arthritis’ etc. Whilst these offer a simple, mechanical explanation that patients can easily understand, these labels can carry strong negative messages about permanent damage, potential re-injury and the need to avoid activity rather than encouraginga return to normal activity.

These messages can also be reinforced by X-rays and MRI used to confirm these diagnoses and hence the previous comment about them causing chronicity. These diagnoses are irrelevant in most patients with an episode of LBP as their 'arthritis' was present for many years prior to their present episode and will still be present after it has passed. Communicating the importance of normal movement for overcoming musculoskeletal dysfunction and maintaining general health are much more important. Clinicians need to explain to patients about ordinary low back pain in simple terms that the clinician is also happy in delivering. This may be a return to the old fashioned nebulous term 'lumbago' or perhaps a more technical term such as 'musculosketetal dysfunction'. For those patients then who wish a more detailed explanation of what are the causes and mechanisms of LBP this may be expanded upon.

Once a diagnosis has been established, further information, advice, analgesia or a short course of manipulation may be initiated with are assessment at 6 weeks from the initial consultation.