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How to prevent low back pain

https://doi.org/10.1016/j.berh.2005.03.001Get rights and content

This chapter summarizes the European Guidelines for Prevention in Low Back Pain, which consider the evidence in respect of the general population, workers and children. There is limited scope for preventing the incidence (first-time onset) of back pain and, overall, there is limited robust evidence for numerous aspects of prevention in back pain. Nevertheless, there is evidence suggesting that prevention of various consequences of back pain is feasible. However, for those interventions where there is acceptable evidence, the effect sizes are rather modest. The most promising approaches seem to involve physical activity/exercise and appropriate (biopsychosocial) education, at least for adults. Owing to its multidimensional nature, no single intervention is likely to be effective at preventing the overall problem of back pain, although there is likely to be benefit from getting all the players onside. However, innovative studies are required to better understand the mechanisms and delivery of prevention in low back pain.

Section snippets

Basic epidemiology

The lifetime prevalence of non-specific (common) low back pain is estimated at 60–70% in industrialized countries (1-year prevalence 15–45%, adult incidence 5% per year). The prevalence rate during school age approaches that seen in adults1, 2; it increases from childhood to adolescence3 and peaks between ages 35 and 55.4 Symptoms, pathology and radiological appearances are poorly correlated. Pain cannot be attributed to pathology or neurological encroachment in about 85% of people. Recent

Outcomes and interventions

The guidelines working group spent considerable time debating the focus of the guideline and attempting to produce a working definition of ‘prevention’. Taking account of the epidemiology of back pain, the working group concluded that prevention of the first onset of common low back pain is, to all intents and purposes, likely to be impracticable. It was considered that, overall, non-specific low back pain is important not so much for its existence as for its consequences. Therefore, the

Evidence

The guideline is evidence based and evidence linked, relying on systematic searches of the scientific literature up to the end of 2003. In the first instance, systematic reviews (and existing guidelines) were sought, supplemented by individual scientific studies where systematic reviews and evidence-based guidelines were not available. The evidence was reviewed and discussed by the entire working group, as were the resultant recommendations; the process is best summarized as systematic

Evidence

Two systematic reviews18, 19 and one primary care guideline20 were found on exercise for prevention in the general population. All the authors' main conclusions were that physical exercise has a positive effect in the prevention of back pain, further episodes and work absence. Effect sizes were reported to be small to moderate. One systematic review found for pregnant women21 concluded that water gymnastics has a preventive effect on future back pain.

Recommendation

Physical exercise is recommended to prevent

Summary

The general nature and course of commonly experienced LBP means that there is limited scope for preventing its incidence (first-time onset). Because primary causative mechanisms remain largely undetermined, risk factor modification will not necessarily achieve prevention.

There is considerable scope, in principle, for preventing the consequences of LBP, e.g. episodes (recurrence), care seeking, disability and work loss. Overall, there is limited robust evidence for many aspects of prevention in

Acknowledgements

This chapter is a summary of the European Guidelines for Prevention in Low Back Pain. The contribution of the members of the working group is gratefully acknowledged: Federico Balagué, Greet Cardon, Hege R Eriksen, Osmo Hänninen, Emma Harvey, Yves Henrotin, Aage Indahl, Amnon Lahad, Annette Leclerc, Gerd Müller, Allard van der Beek. The full guideline is freely available at www.backpaineurope.org.

References (66)

  • S. Taimela et al.

    The prevalence of low back pain among children and adolescents: a nationwide, cohort-based questionnaire survey in Finland

    Spine

    (1997)
  • F. Balague et al.

    Non-specific low back pain in children and adolescents: risk factors

    Eur Spine J

    (1999)
  • G.B.J. Andersson

    The Epidemiology of Spinal Disorders

  • L. Hestbaek et al.

    Heredity of low back pain in a young population: a classical twin study

    Twin Res

    (2004)
  • A.J. MacGregor et al.

    Structural, psychological, and genetic influences on low back and neck pain: a study of adult female twins

    Arthritis Rheum

    (2004)
  • G.L. Phelps et al.

    Treatment and outcomes in occupational low back pain: a practice evaluation and comparison with national and international guidelines

    J Agromed

    (2004)
  • A.L. Nachemson et al.

    Epidemiology of neck and low back pain

  • P.R. Croft et al.

    Outcome of low back pain in general practice: a prospective study

    BMJ

    (1998)
  • H.C.W. de Vet et al.

    Episodes of low back pain: a proposal for uniform definitions to be used in research

    Spine

    (2002)
  • L. Hestbaek et al.

    Low back pain: what is the long-term course? A review of studies of general patient populations

    Eur Spine J

    (2003)
  • A.K. Burton

    Back injury and work loss: biomechanical and psychosocial influences

    Spine

    (1997)
  • W.E. Hoogendoorn et al.

    Systematic review of psychosocial factors at work and in private life as risk factors for back pain

    Spine

    (2000)
  • S.J. Linton

    A review of psychological risk factors in back and neck pain

    Spine

    (2000)
  • C. Ihlebæk et al.

    Are the ‘myths’ of low back pain alive in the general Norwegian population?

    Scand J Public Health

    (2003)
  • I.B. Scheel et al.

    Blind faith? The effects of promoting active sick leave for back pain patients: a cluster-randomized controlled trial

    Spine

    (2002)
  • S.J. Linton et al.

    Preventive interventions for back and neck pain problems: what is the evidence?

    Spine

    (2001)
  • A. Lahad et al.

    The effectiveness of four interventions for the prevention of low back pain

    JAMA

    (1994)
  • US Preventive Services Task Force. Primary Care Interventions to Prevent Low Back Pain in Adults: Recommendation...
  • G. Young et al.

    Interventions for Preventing and Treating Pelvic and Back Pain in Pregnancy (Cochrane Review)

    (2003)
  • M.N. van Poppel et al.

    A systematic review of controlled clinical trials on the prevention of back pain in industry

    Occup Environ Med

    (1997)
  • R. Buchbinder et al.

    Population based intervention to change back pain beliefs and disability: three part evaluation

    BMJ

    (2001)
  • M.W Heymans et al.

    Back schools for non-specific low back pain (Cochrane Review)

    (2004)
  • P. Fauno et al.

    Soreness in lower extremities and back is reduced by use of shock absorbing heel inserts

    Int J Sports Med

    (1993)

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