Extension or flexion for the lumbar spine

One of the most common conditions referred for physiotherapy is low back pain and yet I suppose there would be few of us who have any clear-cut idea on the relative place of flexion and extension exercises in its treatment. Similarly, I suppose few of us who have read overseas literature on the subject have not been confused by the differences of opinion expressed as to whether people should be taught to stand with a flattened lumbar curve or not, or whether a patient should be rested with a lumbar pillow or with the knees supported in Fowler's position to allow the lumbar curve to flatten. The problem can be divided into two parts, one dealing with the treatment of pain and the other dealing with prophylaxis, and it is the latter which I will discuss first.