Over the last 10–15 yr there has been considerable academic interest in the community management of low back pain. This has been due, at least in part, to the high indirect costs, resulting largely from lost production, that have been attributed to spinal problems. Although questions still remain about how those working in primary and community care should manage back pain, the combination of new epidemiological studies [1], careful systematic reviews of existing data [2] from completed trials [3, 4] and ongoing trials [5], plus guideline development [6] and implementation [7], and new models of service delivery [8], are changing the conservative management of back pain in the community. This overall approach could be used as a model for addressing the community management of other painful musculoskeletal disorders for which this clarity of approach is not evident; for example, knee pain in older people.