Education and Counseling to Prevent Low Back Pain
Recommendations of Other Groups
The American Academy of Family Physicians recommends "back-conditioning exercises" for persons aged 19-64 years who are at increased risk for low back injury because of past history, body configuration, or certain types of activities.82 This policy is currently under review. The Agency for Health Care Policy and Research (AHCPR) recommends patient education about low back symptoms and, in occupational settings, back school. AHCPR has also issued recommendations on the management of acute low back problems.43,83 The American Academy of Orthopaedic Surgeons' "Lift it Safe" program recommends specific lifting techniques to prevent back pain, and exercises to minimize problems with back pain.84 The National Institute for Occupational Safety and Health (NIOSH) does not recommend the use of back belts to prevent injuries among workers who have never been injured. NIOSH recommends that the most effective means of minimizing the likelihood of back injury in the workplace is to develop and implement a comprehensive ergonomics program.85,86
With low back pain affecting the majority of adults in the U.S. at some time during their lives, the associated direct and indirect costs make it one of the most expensive ailments in industrialized countries. At present, studies on the prevention of low back pain and its risk factors do not establish a benefit from intervention. Exercise may be mildly protective against back pain, but data are unavailable beyond 18 months. The best results appeared to occur with comprehensive programs that combined exercise training with other educational interventions. Such intensive programs are more typical of work place interventions, but clinicians might expect similar results if resources were available to duplicate the interventions evaluated in published research. Aerobic exercise appears to be at least as effective as exercises aimed at trunk muscles, and can be readily recommended on the basis of other proven benefits. The studies on back education offer minimal support for the use of such strategies in low back pain prevention. Although some educational interventions may have a modest effect, the variability of the interventions and the fact that none of the studies was conducted in typical clinical settings make it difficult to recommend a specific intervention that might be effective in practice. With respect to corsets or back belts, the evidence is contradictory and hence insufficient to make any recommendation at this time. Indeed, the largest studies suggested that mechanical supports may increase the risk of low back pain and the cost of injury in some individuals. Finally, no studies have examined the effect of modifying smoking, obesity, or psychological factors on back pain risk.