In the past, most healthcare providers would have described LBP as a purely physical problem. Recent studies have shown that chronic LBP is more complex than that. Long-lasting LBP seems to be a combination of physical, mental, and social factors. That means that attitudes can be important in successfully treating chronic LBP.

The authors looked at the way six physical therapists in England treated patients. Researchers interviewed the therapists and observed treatment sessions. The therapists strongly believed in the value of their experience and techniques. The therapists also showed very strong beliefs about "good" and "difficult" patients.

Patients were considered good if they had simple injuries and took an active part in treatment. Patients who wanted quick results and didn't follow treatment plans closely were seen as difficult. The authors note that patients with complex problems were also seen as difficult. This was not because of the patient's personality, but because of the therapists' problems treating them.

Despite recent research, the therapists generally believed that LBP had purely physical causes. Sometimes the therapists would say that a patient's mental state might be part of the problem. However, they still did not recommend treatment that would address the mental factor.

The authors concluded that the therapists' beliefs did affect treatment. Beliefs affected the way therapists gave information to patients. It also affected how likely they were to send a patient to a specialist. The authors say that it is very important for therapists to remember that it isn't only the patient's attitude and beliefs that matter.