Document Type : Original Articles


1 Department of Physiotherapy, Lovely Professional University, Punjab, India

2 Consultant Physiotherapist, The Curious Physios (A Physiotherapy and Wellness Clinic), New Delhi, India


Background: Low back pain (LBP) is a global public health issue. Physiotherapy is one of the most imperative conservative approaches for LBP patients. Beliefs of physiotherapists are seen to have a significant impact on treatment choices;
however, beliefs that are not based on current evidence may lead to erroneous clinical decision-making. The present study explored the beliefs of physiotherapy students about low back pain.
Methods: This cross-sectional study was designed to detect the presence of myths among Indian undergraduate physiotherapy students using a predesigned survey outlining the “myths of back pain.” Bachelor of Physiotherapy students
from different academic years of various colleges across India’s north zone participated in the study. Survey questions were designed to identify the myths related to disease pathophysiology, treatment, and diagnostic tools.
Results: A total of 265 physiotherapy students participated in the study. Among the participants, 31.7% were males, and 61.3% were females. The data revealed that most physiotherapy students hold incorrect beliefs, with major myths being (1) LBP is caused by poor posture when sitting, standing, and lifting; (2) LBP will become persistent and deteriorate in later life; and (3) LBP is caused by weak core muscles, and having a strong core protects against future LBP. There were some differences in a few myths based on academic years.
Conclusion: Physiotherapy students have wrong beliefs associated with LBP. Educational programs should work towards developing courses that dispel these erroneous “beliefs.”


  1. Mattiuzzi C, Lippi G, Bovo C. Current epidemiology of low back pain. J Hosp Manag Heal Policy. 2020;4:15–15.
  2. Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, et al. What low back pain is and why we need to pay attention. Lancet. 2018;391:2356–67.
  3. Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:1545–602.
  4. Buchbinder R, van Tulder M, Öberg B, Costa LM, Woolf A, Schoene M, et al. Low back pain: a call for action. Lancet. 2018;391:2384–8.
  5. Bardin LD, King P, Maher CG. Diagnostic triage for low back pain: A practical approach for primary care. Med J Aust. 2017;206:268–73.
  6. Oliveira CB, Maher CG, Pinto RZ, Traeger AC, Lin CWC, Chenot JF, et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J. 2018;27:2791–803.
  7. Zusman M. Belief reinforcement: One reason why costs for low back pain have not decreased. J Multidiscip Healthc. 2013;6:197–204.
  8. O’Sullivan P. It’s time for change with the management of non-specific chronic low back pain. Br J Sports Med. 2012;46:224–7.
  9. Deyo RA, Mirza SK, Turner JA, Martin BI. Overtreating Chronic Back Pain: Time to Back Off? J Am Board Fam Med. 2009;22:62–8.
  10. Gardner T, Refshauge K, Smith L, McAuley J, Hübscher M, Goodall S. Physiotherapists’ beliefs and attitudes influence clinical practice in chronic low back pain: a systematic review of quantitative and qualitative studies. J Physiother. 2017;63:132–43.
  11. Kamper SJ, Apeldoorn AT, Chiarotto A, Smeets RJEM, Ostelo RWJG, Guzman J, et al. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis. BMJ. 2015;350 February:1–11.
  12. Christe G, Nzamba J, Desarzens L, Leuba A, Darlow B, Pichonnaz C. Physiotherapists’ attitudes

and beliefs about low back pain influence their clinical decisions and advice. Musculoskelet Sci Pract. 2021;53 March:102382.

  1. Delitto A, George SZ, Van Dillen L, Whitman JM, Sowa G, Shekelle P, et al. Low Back Pain. J Orthop Sport Phys Ther. 2012;42:A1–57.
  2. McCabe E, Jadaan D, Munigangaiah S, Basavaraju N, McCabe JP. Do medical students believe the back pain myths? A cross-sectional study. BMC Med Educ. 2019;19:235.
  3. Nieminen LK, Pyysalo LM, Kankaanpää MJ. Prognostic factors for pain chronicity in low back pain: a systematic review. PAIN Reports. 2021;6:e919.
  4. Buchbinder R, Underwood M, Hartvigsen J, Maher CG. The Lancet Series call to action to reduce low value care for low back pain: an update. Pain. 2020;161:S57–64.
  5. Darlow B, Dowell A, Baxter GD, Mathieson F, Perry M, Dean S. The Enduring Impact of What Clinicians Say to People with Low Back Pain. Ann Fam Med. 2013;11:527–34.
  6. Eysenbach G. Improving the quality of web surveys: The Checklist for Reporting Results of Internet E-Surveys (CHERRIES). J Med Internet Res. 2004;6:1–6.
  7. Suhail A, Slathia S, Quais S, Poulter DC. Do “Myths” of low back pain exist among young Indian college-going adults with a history of low back pain? A cross-sectional study. Bull Fac Phys Ther. 2021;26:21.
  8. O’Sullivan PB, Caneiro J, O’Sullivan K, Lin I, Bunzli S, Wernli K, et al. Back to basics: 10 facts every person should know about back pain. Br J Sports Med. 2020;54:698–9. doi:10.1136/bjsports-2019-


  1. Deyo RA. Low-back pain. Sci Am. 1998;279:48–53.
  2. Picavet HSJ. Pain Catastrophizing and Kinesiophobia: Predictors of Chronic Low Back Pain. Am J Epidemiol. 2002;156:1028–34.
  3. Ihlebæk C, Eriksen HR. Are the ``myths’’ of low back pain alive in the general Norwegian population? Scand J Public Health. 2003;31:395–8.
  4. Stewart M, Loftus S. Sticks and stones: The impact of language in musculoskeletal rehabilitation. J Orthop Sports Phys Ther. 2018;48:519–22.
  5. Majid K, Truumees E. Epidemiology and Natural History of Low Back Pain. Semin Spine Surg. 2008;20:87–92.
  6. O’Sullivan P. Diagnosis and classification of chronic low back pain disorders: Maladaptive movement and motor control impairments as underlying mechanism. Man Ther. 2005;10:242–55.
  7. Hill JC, Whitehurst DGT, Lewis M, Bryan S, Dunn KM, Foster NE, et al. Comparison of stratified primary care management for low back pain with current best practice (STarT Back): A randomized controlled trial. Lancet. 2011;378:1560–71.
  8. Wertli MM, Rasmussen-Barr E, Weiser S, Bachmann LM, Brunner F. The role of fear avoidance beliefs as a prognostic factor for outcome in patients with nonspecific low back pain: A systematic review. Spine J. 2014;14:816-836.e4.
  9. Crombez G, Eccleston C, Van Damme S, Vlaeyen JWS, Karoly P. Fear-Avoidance Model of Chronic Pain. Clin J Pain. 2012;28:475–83.
  10. Vasseljen O, Unsgaard-Tøndel M, Westad C, Mork PJ. Effect of core stability exercises on feed- forward activation of deep abdominal muscles in chronic low back pain: A randomized controlled trial. Spine (Phila Pa 1976). 2012;37:1101–8.
  11. Lederman E. The myth of core stability. J Bodyw Mov Ther. 2010;14:84–98.
  12. Mannion AF, Caporaso F, Pulkovski N, Sprott H. Spine stabilisation exercises in the treatment of chronic low back pain: A good clinical outcome is not associated with improved abdominal muscle function. Eur Spine J. 2012;21:1301–10.
  13. Smith BE, Littlewood C, May S. An update of stabilisation exercises for low back pain: A systematic review with meta-analysis. BMC Musculoskelet Disord. 2014;15.
  14. Wong AYL, Parent EC, Funabashi M, Kawchuk GN. Do changes in transversus abdominis and lumbar multifidus during conservative treatment explain changes in clinical outcomes related to nonspecific low back pain? A systematic review. J Pain. 2014;15:377.e1-377.e35.
  15. Lederman E. The fall of the postural-structural-biomechanical model in manual and physical therapies: Exemplified by lower back pain. Journal of Bodywork and Movement Therapies. 2011;15:131–8.