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    Education and Counseling to Prevent Low Back Pain

    Clinical Intervention

    Although there is some evidence that exercise (flexion, extension, aerobic, or fitness) protects against the development of low back pain, the effect is modest and of unknown duration, and the interventions have not been demonstrated in typical clinical settings. Thus, there is insufficient evidence to recommend for or against counseling patients to exercise specifically to prevent low back pain ("C" recommendation). Recommendations for regular physical activity can be made on other grounds, including its proven efficacy in preventing coronary heart disease, hypertension, obesity, and diabetes. There is insufficient evidence to recommend for or against educational interventions or the use of mechanical supports in the prevention of low back pain ("C" recommendation). Given some evidence that mechanical supports may increase the risk of low back pain, recommendations can be made against their use except in the context of comprehensive programs where their use can be carefully monitored to avoid injury. There is insufficient evidence to recommend for or against risk factor modification specifically for the prevention of low back pain ("C" recommendation). Screening for obesity and counseling to prevent tobacco use are recommended based on proven benefits unrelated to low back pain.

    Worksite screening and job placement practices are beyond the scope of this report (see NIOSH recommendations85-87).

    Note: See the relevant background paper: Lahad A, Malter AD, Berg AO, et al. The effectiveness of four interventions for the prevention of low back pain. JAMA 1994;272:1286-1291. Copyright 1994, American Medical Association.

    The draft of this chapter was prepared for the U.S. Preventive Services Task Force by Ann S. O'Malley, MD, MPH, and Carolyn DiGuiseppi, MD, MPH, based on a background paper prepared by Amnon Lahad, MD, MPH, Alex D. Malter, MD, MPH, Alfred O. Berg, MD, MPH, and Richard A. Deyo, MD,


    1. Liebenson CS. Pathogenesis of chronic back pain. J Manipulative Physiol Ther 1992;15:299-308.

    2. Frymoyer JW. Back pain and sciatica. N Engl J Med 1988;318:291-300.

    3. Frymoyer JW. Can low back pain disability be prevented? Bailliere's Clin Rheumatol 1992;6:595-606.

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