Back School

Introduction

Back school is a series of educational and training programs with lessons delivered by a therapist to patients or staff with the goal of treating or preventing back pain.

• They are a common non-pharmaceutical intervention especially in the occupational health setting.
• Although back schools have been used since 1969, their effectiveness in preventing or treating back pain has not been clearly established. [1]

Target group for back training:[2]

• Patients who never had low back pain (primary intervention).
• Return to school (secondary prevention) – eg acute or chronic low back pain episodes; recurrence of specific low back pain; post-spine surgery patients.
• People with low back pain that can be linked to clinically relevant anatomy.

External schools vary in intensity and content.

s.e., s.e. Content Swedish Back School ( four 45 minute sessions over a 2 week period)

1. Anatomy and causes of LBP and psoas position
2. Muscle function and exercise
3. Ergonomics
4. Advice on physical activity
5. An individual pool session under the supervision of a physiotherapist with an analysis of working conditions [3].

Typical Content

The Swedish Back School was developed by Zachrisson Forsell and consists of four 45-minute main audio-visual sessions led by a Physiotherapist.

First Lesson – Discusses the different aspects of back disorders.

• Give all the details of the patient, and introduce the anatomical structure and functions of the back in detail.
• Treatment techniques are discussed and psoas positioning is taught.
• All of the learning takes place while patients are in this position rather than sitting.

Section II – Discusses the mechanical strain at different positions and during different movements.

• Demonstrates the function of the muscles and their effect on the back.
• Instruct patients to perform isometric abdominal exercises and encourage them to continue performing these exercises each day.
• Back muscle exercises are discussed and patients are informed that these exercises place greater stress on the back and risk exacerbation of symptoms.

Section III – includes the practical application of previously acquired theoretical knowledge.

• Patients are asked to describe their own working situation, and the group works to find an appropriate solution for each individual.

Section 4 – mainly consists of encouraging patients to increase their level of physical activity in their leisure time despite their back problems.

• Provides a written summary of the main content of Back School.
• Patients attending the backyard can also enjoy a pool workout under the supervision of a physical therapist. 

Physical Therapy Management

Goals for patients attending fallback schools:

• Functional comfort: protect spinal systems during daily activities and in the work environment
• Reduce symptoms (pain)
• Increasing tissue repair
• Decrease kinesiophobia 

To achieve these objectives, the background school consists of three parts:

1. Education of the anatomy and function of the spine biomechanics physiopathology of frequent back disorders epidemiology… Currently this part of the back school (information) is limited compared to the back school in 1969 [2]. Some examples of educational conferences are e.g. The biomechanical principle: Active loading / stress on the nucleus pulposus causes deformation without changing the size of the nucleus. If constant pressure is applied to the anulus fibrosus it will release fluid. The height of the disk decreases so there is more pressure on the nucleus pulposus. The disc needs compression to maintain the metabolic activity of the disc osmotic system of the disc Lumbosacral Biomechanics. However, if the pressure is too high, the pressure inside the eye increases and can occur in back pain. Some body postures and movements increase this intranasal pressure.[2]
2. Training for posture in standing lifting bending lying sitting etc. It differs from work arrangements:[2] e.g. Banker. A banker sits all day so it’s important to sit upright: If he bends forward while sitting, the intradiscal pressure is supposed to double as high as when standing. Proper sitting posture: with both feet on the floor below the knees at the hips. The hips are slightly higher than the knees and lean straight back against the backrest. It is also important that his business card is in the correct place length; Shelf packer-intradiscal pressure by teaching a box lift see graph R you can determine the intradiscal pressure by two types of lifting. It is by the boss of the lever. As the load and weight arm are smaller the force required to balance the lever is also smaller.[2]
3. Actively protect the spine through active exercises [2][4], such as stretching the muscles of the lower extremities; stretching the erector spinae; kinesthetic training (moving the pelvis so that the anteroposterior tilt of the pelvis is within a comfortable range); strengthening the core (stabilizing function). [2][5]

Key Evidence

From the Cochrane review 3.8.2017

It is uncertain whether Back School is effective for chronic low back pain as the quality of evidence for all treatment comparison outcomes and follow-up periods of the survey was low to very low. Results showed no or insignificant differences, although the quality of the evidence was mostly low Good for Back School effects. There are countless potential variations of the Back School method with regards to the use of different exercises and teaching methods. While current evidence does not warrant their use at Back School, future variants may have different effects and require to study in future randomized controlled trials and reviews [6]