The ABCs of Low Back CareIdeally, there should be a balance between what is demanded of us in our daily lives and what we can physically handle. For patients with low back pain, this balance has often been thrown out of whack. These patients may attempt more activities than they can tolerate. Or they may have less physical ability than they need to get through their days.
The authors believe that low back pain isn't just physical--it has to do with mental and social factors as well. In this view, treatment of back pain needs to address all these parts in order to help the patient achieve a healthy, balanced lifestyle. A back "school" in the Netherlands seemed to provide exactly this kind of treatment, addressing the whole person rather than the low back alone.
The goal of the back school was to help patients toward their ideal load of activities and level of performance. Generally, patients went to the school 12 times over about four months. During this time, they did physical activities such as circuit training and aqua jogging to improve their aerobic performance, range of movement, and strength. They also learned about the mental and social components of back pain. They were trained in body awareness so they better understood their limits.
Fourteen patients went to back school. Ten other patients were put on a waiting list. Both groups had an equal number of men and women. Patients in both groups had experienced low back pain for more than three months. Before and after back school (or after one month's time, in the case of the waiting list group), patients completed a series of physical tests and questionnaires.
The back school seemed to improve patients' physical abilities and in many cases to give them an edge over patients who didn't do the program. Patients in back school improved their aerobic performance, range of movement, and strength. Compared to patients on the waiting list, back school patients had more strength and achieved a higher heart rate while lifting. They also felt they were able to work harder during lifting tasks.
Back school patients showed improved mental health and social functioning after treatment. However, waiting list patients started out showing better mental health and social functioning and came out ahead in these areas.
Patients who went to back school improved their physical functioning, health, and ability to do daily tasks. By the end of the study, they far surpassed the waiting list group in these areas.
From these results, the authors conclude that back school helped patients toward better health and functioning. The authors don't think this was due to the physical training alone, though. The back school seemed to improve patients' responses to signals that they might be doing too much or that they could safely do a little more. The authors believe that this program helped patients to understand the need for balance. By doing so, patients might be better able to control back pain.
Audy P. Hodselmans, MSc, PT, et al. Short-Term Outcomes of a Back School Program for Chronic Low Back Pain. In Archives of Physical Medical and Rehabilitation. August 2001. Vol. 82. No. 8. Pp. 1099-1105.
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