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Hi, Firstly let me apologise for taking so long to reply to this post. I have looked over the pdf and I think this is an excellent article that effectively raises 2 points. 1.) Are global responses/variations causes or consequences of change from the norm (or in this case symptoms) and 2.) How effective is gross structural modelling. The first point is realistically the old chicken and egg argument, which is hugely difficult to answer. While the authors indicate that changes in posture do not have a direct correlation with LBP, anyone who has spent a day in bad shoes will know that changes in posture do have an effect. One question is how adaptable are we? How can we identify the cut-off point at which changes become an issue??? A more difficult question is do these changes occur in response to pain/dysfunction then exacerbate the problem? Or do they cause the problem and then make it worse? Of course it should also be considered that variations in posture/structure are simply coexisting variations and are not related…. In order to try and answer these questions we need to consider the second point. The second point is of particular interest to our group. Advances in technology have allowed greater analysis of subjects providing a plethora of data. Suddenly we can record hundreds (or even thousands) of times per second from a multiple sources. Does this mean we are now more accurate? Or simply that we have more data to consider? In a statistical dataset 1 millisecond can be considered a significant change - but functionally does that reflect dysfunction? With the development of artificial neural networks and the progression towards integration between finite element analysis and musculoskeletal modelling it’s an exciting time to be asking these questions. However with the ‘eroding’ of traditional theories we need to take technological advances back to the basic questions – ‘what is normal’? ‘What is abnormal’ and ‘how big is the gray area’ (borderline range)? I look forward to hearing other opinions on the paper. Thanks Dan

I agree that we adapt and that unless some excessive imposed demand is placed dupon us, generally we become accustomed to our environment. My point with the shoes is that unaccustomed changes do have an effect - even if it is temporary. Unfortunatley this presents practitioners with the greater task of approaching patient assesment without the structure of thing like the PSB. I have noted with interest that recently research has started to highlight the dangers of 'double dipping' into research resources (e.g. using a small pool of undergraduate students as subjects). I note that in lederman's paper there are some details about the subjects in various studies - I wonder if there has ever been a meta-analysis of models such as the PSB considering the subjects used to establish the models? Thanks Dan