Where is the lumbar pain coming from?

This presentation proposes that the majority of persistent lumbar pain comes from chemical abnormalities within the disc. On this basis, a review of clinical experience and basic studies suggests that active mechanical therapy is the most rational approach to treat the disc. Avoidance of the habituation to pain and inactivity is supported. Rest treatment becomes a societal question rather than a medical question. Ultimately assessment of disc chemistry with appropriate instrumentation will allow the instillation of therapeutic agents within the disc itself. Extended rest, and passive physical therapy no longer have a rational place in the treatment of persistent back pain.