In some respects the results of this trial are disappointing because they do not support a widely administered

approach to training unsupported sitting. However, by not spending selleckchem time on training unsupported sitting, therapists and patients can concentrate on practice of functional activities. Patients probably learn appropriate strategies to sit while mastering these activities and adjusting to a largely seated life, thus rendering additional training for unsupported sitting redundant. We acknowledge the assistance of Vivian Lau, Fatema Akhter, Corny Marina Momen, Paresh Chakma, and all the patients and staff of the Moorong Spinal Unit, Australia, and Centre for Rehabilitation of the Paralyzed, Bangladesh. We also thank Joanne Glinsky and Josh Trametinib solubility dmso Simmons for

rating the videos. Ethics: The study was approved by the ethics committees of the Northern Sydney Area Health Service and Royal Rehabilitation Centre, Sydney Australia. We certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed. All participants gave written informed consent before data collection began. Competing interests: None declared. Support: The Rehabilitation and Disability Foundation. “
“Low back pain remains a common disabling condition (Bogduk and McGuirk, 2002, Walker et al 2004) that is immensely costly in Australia (Rahman et al 2005) and the United States of America (Luo et al 2004). There is evidence that many individuals with acute low back pain develop persistent or recurrent low back pain (Henschke et al 2008, Pengel et al 2003, Abbott and Mercer, 2002). The cause of acute low back pain is ‘non-specific’ in approximately 95% of cases (Hollingworth et al 2002). Nevertheless, physiotherapists

have developed various below algorithms for diagnosis of the condition (Deyo, 1993, Winkel et al 1996) and many clinical interventions have been proposed and are used for the treatment of acute low back pain (Deyo, 1993, March et al 2004, Reid et al 2002). Recent guidelines assert that there is ‘fair’ evidence that spinal manipulative therapy provides a small to moderate benefit (a 5 to 20 point reduction in Oswestry Disability Index score) in the treatment of acute low back pain (Chou et al 2007). However, most international guidelines for treatment of non-specific acute low back pain recommend spinal manipulative therapy as a second-line intervention after first-line treatment of simple analgesics and advice (van Tulder et al 2006, Koes et al 2001) and this position is supported by contemporaneous meta-analyses, which concluded that spinal manipulative therapy was not more effective than recommended first-line intervention for treatment of non-specific acute low back pain (Assendelft et al 2003, Ferreira et al 2003) and chronic low back pain (Assendelft et al 2003).