Dr. Julia Alleyne, BHSc(PT), MD, CCFP, Dip. Sport Med MScCH, is a Family Physician practicing Sport and Exercise Medicine at the Toronto Rehabilitation Institute, University Health Network. She is appointed at the University of Toronto, Department of Family and Community Medicine as an Associate Clinical Professor.
Abstract
Back education or “Back Schools” are used both as a method of prevention and, in conjunction with traditional rehabilitation and exercise programs, as a component in treatment of recurrent or persistent low back pain. It is challenging to evaluate the effectiveness of this educational effort. Models have varied from brochures, booklets and simple office conversations to formal scheduled classes. Content has ranged from purely mechanical instruction to complex cognitive behavioural therapy. Essential to success is the ability to integrate the instructions into activities of daily living. The composition of those lessons remains the subject of continuing debate.
Key Words: Back School, education, body mechanics, prevention, pain management.
Back Education Principles
Back education classes were first developed in 1969 in Sweden and called "back school". Sessions included theoretical information, exercise demonstrations and instruction in proper body mechanics.1 The first Canadian attempt, which was developed independently but with many of the same components, was started in Toronto in 1974.2 The effectiveness of low back education has been questioned for decades and it has been difficult to draw clear conclusions because the benefits seem to vary depending on whether intervention is delivered preventively, in sub-acute phase rehabilitation or after the symptoms have subsided. The main elements of various iterations are consistent but the delivery and format varies significantly. Comparing one program to another or the impact of one approach over the value of a different method is challenging. Deciding what patient is suitable or at what stage in the recovery education is best assimilated are open questions.