Table 2.

How treatment beliefs were expressed in relation to specific treatments

	Credibility — perceived mechanisms	Effectiveness and effects	Concerns
Medications	Relaxes muscles; enables detachment; reduces inflammation: ‘I use ibuprofen when I’ve got a problem and ibuprofen’s like a miracle drug because it relaxes the muscles and takes away the pain.’ (Female, FG4)	Temporary relief; prevents worsening; enables activity; last resort: ‘I don’t think it’s a way of getting over, you know, it’s not going to fix your back, but it’s a way of helping just make it a little bit easier for yourself.’ (Male, FG12)	Side effects; poly-pharmacy; addiction and desensitisation; masks pain and could lead to further damage: ‘You take one tablet but then you have to take two or three tablets to counteract that one tablet that you’re taking.’ (Male, FG13)
Exercise	Strengthens muscles; reduces stiffness; improves mental state; weight loss: ‘The only thing I found useful there in a more permanent place is exercise [...] to strengthen the muscles so that they hold the spine in a more useful position.’ (Male, FG7)	Temporary relief; maintenance; enables activity; cure: ‘There’s not a cure, because there is no reversing it and that’s what they told me so the only way to do it is to maintain it and to do that is to have exercise.’ (Male, FG2)	Injuring the back; difficulties maintaining motivation: ‘If you start to feel a little bit of an improvement, it’s an encouragement to keep on at it, but then you get a bad day and you just don’t you — just can’t face doing any exercise so you just give up on it in the end.’ (Female, FG11)
Manual therapy	Realigns the spine; releases the nerves; strengthens muscles: ‘If you’re misaligned, it’s putting additional pressure on nerves, cartilage, all sorts of things and when you realign that into the correct position that releases that pressure which reduces the pain.’ (Female, FG10)	Temporary relief; maintenance; prevents worsening; cure: ‘[The practitioner] slowed down the rate at which it got worse but he didn’t improve it.’ (Male, FG10)	Feeling sore after manipulation; causing further damage; ‘cracking’ bones: ‘You lie on this bed and the first thing he does is crack your back so one part’s up there and one part’s down and all of a sudden he pulls this lever and you think, my god my back’s broken.’ (Female, FG5)
Acupuncture	Stimulates nerves; relaxes muscles: ‘The energy lines generally follow the major nerve roots as well [...] by stimulating the nerve passage ways, and stimulating the nerve roots, you can get them to switch on, switch off, or reset effectively.’ (Female, FG10)	Temporary relief; cure: ‘Lasted about 4 months, three sessions and it lasted about 4 months and that was you know.’ (Male, FG8)	Fear of needles; needling painful: ‘You haven’t got to look at the needles, they are gonna be in your back, so that doesn’t phase me, it’s not the thought of it, it’s actually seeing them go in to your skin.’ (Male, FG12)
Combined psychological and physical approach	Teaches self-management; improves posture; releases tension: ‘When you go to a course like that, everybody’s in the same situation and you know, and it was you know, and you learn you learn a lot about you know how to look after your own back.’ (Female, FG11)	Last resort: ‘I think it’s basically telling you that you’ve got your bad back and you’re going to have to look after it for you, you keep yourself fit by doing gentle exercise.’ (Female, FG11)	Being diagnosed (stigmatised) with a psychological disorder; controlling pain is difficult to learn: ‘At first I found it very hard to get my head around what he was saying and even now, I try to do it if I’m in a really bad day, my back or my knees of whatever’s hurting, I can lay there and really try it but I find it very, very hard to think that mind over matter is …’ (Male, FG13)
Spinal fusion	Not discussed.	Last resort; medium-term solution: ‘Surgery is a last resort, you know, you try, like you say, all of that on there, then you know, you come to the end of the road and that’s the only option they got, they ain’t going to operate just for the sake of operating.’ (Male, FG9)	Inherent risks of surgery; implications of permanent changes to the spine: ‘It’s a loss almost, it’s to me it’s almost a sadness because you’ve already embarked on having limitations and obviously as you get older, the limitations may increase.’ (Female, FG8)