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Ben, Please let us know what you did with the patient and his progress. Frank and Sam, Very interesting debate about McKenzie Physiotherapy and diagnosis... and we haven't even got into the theory of the McKenzie model. I better get Donelson's article out again and have a good read. But from memory, they compared it to discograms and there is questions surrounding the reliability of discography in diagnosing symptomatic discs. Based on what I have read so far, nothing has been shown to be more effective in terms of managing back pain with or without radicular signs. I am sure we all have come across studies by Cherkin et al (1998) that showed no difference between Mckenzie Physiotherapy, chiropractice manipulations and educational booklet. As well, a meta-analysis of clinical trials on the efficacy of the McKenzie Physiotherapy regime presented at the MPAA conference in 1997 has not shown it to be a superior treatment compared to other therapies. Acknowledging the limitions and restrictions on these and other studies, it does point towards the question: are manipulative therapy approaches the same? What is the common denominator. Hsieh et al (Spine, 11 p 1142, 2002) did a study looking at the effectiveness of four conservative treatments (back school, joint manipulation, myofascial therapy and combined joint manip/myofascial therapy) in subacute low back pain. All four treatments were as effective. To quote Jull and Moore (Manual Therapy 7(2) p63, 2002): "The arguments of the superiority of one approach or another seem redundant. The question we should be asking clinically and in research is how one technique might stiumulate the central nervous system differently to another.... the clinical challenge is to have expertise in a variety of approaches and to be able to select which patient is responsive to which approaches for most expedient and effective treatment." Henry***