Of all health conditions, low back pain is associated with the greatest number of years lived with disability, and as a group, musculoskeletal conditions are the 2nd largest group impacting on the global burden of health, with only mental health conditions associated with a greater burden.

Historically, musculoskeletal practice focused on addressing traumatic events, primarily fractures and dislocations.  In the 5th Century BCE Hippocrates advocated cauterising the anterior glenoid margin and then binding the shoulder into internal rotation to facilitate shrinkage of the anterior shoulder as a method of managing persistent shoulder dislocations. There is evidence from ancient Egypt (5th dynasty) of a mummy with a forearm fracture immobilised in a splint, and in 1852, Mathijesen, a Dutch army surgeon, described the use of Plaster of Paris to immobilise fractures.

Although the management of trauma continues as an essential component of musculoskeletal conditions, musculoskeletal management has evolved and much of the focus is now centred on the management of non-traumatic presentations, most commonly associated with pain. Hypotheses have been presented to explain the pathoaetiology and management of these presentations. Many of them relate to ‘abnormalities’ of posture where deviations from an idealised norm is the basis for the presenting symptoms.

Examples include forward head posture and its association with headaches, neck, and shoulder pain, lumbopelvic postural abnormalities and low back pain, deviations from subtalar neutral and foot pain. Other examples include an assumption that identified non-traumatic structural abnormalities, such as rotator cuff tears, acromial spurs, medial meniscal tears, and many other presentations typically identified using a variety of imaging formats are the cause of symptoms, and surgery to ‘restore’ normal structure is required to reduce the pain and improve function.

Many of the techniques to restore ‘normality’ have been shown to be placebo procedures and outcomes may relate to the enforced post-surgical relative rest on the tissues and the ensuing graduated rehabilitation. Additionally, outcomes in some presentations may be more dependent on psychosocial factors than physical factors.