Basis, indications and risk

Treatments Basis, indications and risk Patient information Postural hygiene Back School Overall Posture Re-education (OPR) Exercise Maintaining level of Activity Bed rest Pharmacological therapy Neuroreflexotherapy (NRT) Spinal column surgery Surgery for Pain and Pain Clinics Vertebral manipulation Behavioral treatment Epidural injections Facet joint infections Trigger point and ligament infections Rhizotomy Corsets and lumbar belts Traction Physical therapy/physiotherapy Electromyografic Feedback TENS: Transcutaneous electrical Nerve Stimulation Shoe insoles and shoe lifts Acupunture Recommended treatments

Back School

Classes are given on spinal structure, how it works and why the back can hurt, while providing postural recommendations to prevent the onset of pain.

Evidence of effectiveness

1. Scientific studies have been carried out to evaluate the efficacy of "Back Schools". Some of the existing recommendations based on scientific evidence indicate that the inconsistent outcomes of some studies are probably due to the difference in class methodology and contents. Those recommendations consider that study results have proven the efficacy of "Back Schools" in occupational settings, but not in other scenarios.
2. Research studies also show that the "Back School" is more efficient in transmitting information and applying it to daily life activities than handing out an educational booklet with postural recommendation.
3. On the other hand, in almost all studies performed, class attendants rated their satisfaction as high, and their knowledge of back issues improved remarkably. One of the studies with the most outstanding results showed that the "Back School" obtained a reduction of 60% in sick leave due to back pain, which generated savings much above its costs.

Risks and contraindications

Since it consists of a method for transmitting information, there are no risks or contraindications.

Indications

"Back School" is indicated in patients with back pain or in healthy individuals exposed to potential risks, especially within occupational settings, since this is where its efficacy has been proven. Workers who perform physical exertion or maintain sedentary postures can also benefit.

Overall postural reeducation (OPR)

Contrary to the "Back School", reeducation is given individually and consists of a detailed analysis of each person's faulty postures, in order to teach him/her how to correct them.

Theoretical base

The rationale is that faulty postures are frequently used in daily activities, standing up, sitting or working. It is assumed that these postures put an excessive or asymmetric load on the back, which increases the risk of suffering recurrent or constant back pain. The OPR shows patients these postures in a mirror and teaches them how to correct them.

Evidence of effectiveness

There are no methodologically correct studies that evaluate the effect of OPR.

Risks and contraindications

1. Some authors defend the importance of the patient's personality type, anxiety and personal dissatisfaction as factors for suffering back pain and add that obviously apprehensive patients may increase their obsession about back pain by focusing on posture guidelines. To minimize that risk, the patient should know that postural hygiene is focused on allowing him/her to lead a normal life, rather than restricting it. In fact, the attitude toward pain is as important, or more than, postural hygiene in preventing the appearance of back pain.
2. OPR cost is remarkably higher than "Back School". Time dedication is greater since each professional is dedicated to one single patient-pupil at a time.

Indications

It is accepted that OPR may be indicated in patients with recurrent back pain attributed totally or partially to faulty posture, who require longer or more personalized attention to correct faulty postures.