Lumbar supports and education for the prevention of low back pain in industry: a randomized controlled trial. Are Back Supports Plus Education More Effective Than Education Alone in Promoting Recovery From Low Back Pain?: Results From a Randomized Clinical Trial Brief psychosocial education, not core stabilization, reduced incidence of low back pain: results from the Prevention of Low Back Pain in the Military (POLM) cluster randomized trial Treatment of Chronic Lower Back Pain with Lumbar Extension and Whole-Body Vibration Exercise: A Randomized Controlled Trial The effectiveness of exercise programmes after lumbar disc surgery: a randomized controlled study Evaluation of perifacet injections and paraspinal muscle rehabilitation in treatment of low back pain. A randomised controlled trial. Lumbar supports for prevention and treatment of low back pain: a systematic review within the framework of the Cochrane Back Review Group. The efficacy of an aerobic exercise and health education program for treatment of chronic low back pain. Effectiveness of a Lumbar Support Continuous Passive Motion Device in the Prevention of Low Back Pain During Prolonged Sitting A Prospective Study Evaluating Early Rehabilitation in Preventing Back Pain Chronicity in Mine Workers [Feasability of a back school assessment programme]. Lumbar Supports to Prevent Recurrent Low Back Pain among Home Care Workers Clinical Trial of Postoperative Dynamic Back Exercises After First Lumbar Discectomy The effect of continuous ultrasound on chronic low back pain: protocol of a randomized controlled trial Evaluation of low back pain and assessment of lumbar corsets with and without back supports. Low back pain in young female gymnasts and the effect of specific segmental muscle control exercises of the lumbar spine: a prospective controlled intervention study The Effect of Early Isolated Lumbar Extension Exercise Program for Patients with Herniated Disc Undergoing Lumbar Discectomy Can Exercise Therapy Improve the Outcome of Microdiscectomy? Randomized trial of radiofrequency lumbar facet denervation for chronic low back pain. Occupational loading, health behavior and sleep disturbance as predictors of low-back pain. Effects of hamstring stretch with pelvic control on pain and work ability in standing workers. Exercises and education as secondary prevention for recurrent low back pain. Effect of Lumbar Stabilization and Dynamic Lumbar Strengthening Exercises in Patients With Chronic Low Back Pain
CONTEXT Low back pain is a frequent and costly health problem . Prevention of low back pain is important both for the individual patient and from an economic perspective . OBJECTIVE To assess the efficacy of lumbar supports and education in the prevention of low back pain in industry . DESIGN A r and omized controlled trial with a factorial design . SETTING The cargo department of an airline company in the Netherl and s. PARTICIPANTS A total of 312 workers were r and omized , of whom 282 were available for the 6-month follow-up . INTERVENTIONS Subjects were r and omly assigned to 4 groups : ( 1 ) education ( lifting instructions ) and lumbar support , ( 2 ) education , ( 3 ) lumbar support , and ( 4 ) no intervention . Education consisted of 3 group sessions on lifting techniques with a total duration of 5 hours . Lumbar supports were recommended to be used during working hours for 6 months . MAIN OUTCOME MEASURES Low back pain incidence and sick leave because of back pain during the 6-month intervention period . RESULTS Compliance with wearing the lumbar support at least half the time was 43 % . In the 282 subjects for whom data were available , no statistically significant differences in back pain incidence ( 48 [ 36 % ] of 134 with lumbar support vs 51 [ 34 % ] of 148 without , P=.81 ) or in sick leave because of low back pain ( mean , 0.4 days per month with lumbar support vs 0.4 days without , P=.52 ) were found among the intervention groups . In a subgroup of subjects with low back pain at baseline , lumbar supports reduced the number of days with low back pain per month ( median , 1.2 vs 6.5 days per month ; P=.03 ) . CONCLUSIONS Overall , lumbar supports or education did not lead to a reduction in low back pain incidence or sick leave . The results of the subgroup analysis need to be confirmed by future research . Based on our results , the use of education or lumbar supports can not be recommended in the prevention of low back pain in industry Study Design . R and omized clinical trial . Objectives . To evaluate the effectiveness of a back support plus education versus education alone in promoting recovery from a work-related low back disorder ( WR-LBD ) while simultaneously considering personal , health , and occupational factors and the impact of occupational factors on recovery . Summary of Background Data . No r and omized studies of active industrial workers with low back disorders exist regarding the effectiveness of back supports plus education . Methods . A total of 433 actively employed hourly union workers who had a recent diagnosis of a WR-LBD : 1 ) those who wore a specially design ed back support plus received education on back health ; and 2 ) those who received education on back health only .  Demographic , health , medical , and occupational factors were obtained through interview or abstract ion of computer files ; individual ergonomic exposures were measured with a lumbar motion monitor . Outcomes evaluated over a 12-month period included : self-reported measures of back pain , back pain disability level , physical health , mental health , and administrative measures of recurrence , lost work time , and medical care utilization . Results . There was no difference between the study groups with respect to mental or physical health , low back pain , back pain disability , neurogenic symptoms , lost work time , likelihood of recurrence of an episode of a back disorder , or other administrative measures of healthcare utilization or lost work time . However , significant decreases in low back pain , low back pain disability , neurogenic symptoms , and an increase in physical health were observed over the 12 months of observation in both study groups . The only occupational variable found to influence was plant group whereby service parts operations workers in the back support plus education group experienced a lower likelihood of WR-LBD recurrence . Conclusion . Although there was no overall effect on self-reported recovery or administrative measures or lost work time between the study groups , a back support plus health education may have some value in preventing recurrent WR-LBD in industrial workers who work in psychosocial environments and perform manual material h and ling tasks similar to those found in parts distribution centers Background Effective strategies for the primary prevention of low back pain ( LBP ) remain elusive with few large-scale clinical trials investigating exercise and education approaches . The purpose of this trial was to determine whether core stabilization alone or in combination with psychosocial education prevented incidence of low back pain in comparison to traditional lumbar exercise . Methods The Prevention of Low Back Pain in the Military study was a cluster r and omized clinical study with four intervention arms and a two-year follow-up . Participants were recruited from a military training setting from 2007 to 2008 . Soldiers in 20 consecutive companies were considered for eligibility ( n = 7,616 ) . Of those , 1,741 were ineligible and 1,550 were eligible but refused participation . For the 4,325 Soldiers enrolled with no previous history of LBP average age was 22.0 years ( SD = 4.2 ) and there were 3,082 males ( 71.3 % ) . Companies were r and omly assigned to receive traditional lumbar exercise , traditional lumbar exercise with psychosocial education , core stabilization exercise , or core stabilization with psychosocial education , The psychosocial education session occurred during one session and the exercise programs were done daily for 5 minutes over 12 weeks . The primary outcome for this trial was incidence of low back pain result ing in the seeking of health care . Results There were no adverse events reported . Evaluable patient analysis ( 4,147/4,325 provided data ) indicated no differences in low back incidence result ing in the seeking of health care between those receiving the traditional exercise and core stabilization exercise programs . However , brief psychosocial education prevented low back pain episodes regardless of the assigned exercise approach , result ing in a 3.3 % ( 95 % CI : 1.1 to 5.5 % ) decrease over two years ( numbers needed to treat ( NNT ) = 30.3 , 95 % CI = 18.2 to 90.9 ) . Conclusions Core stabilization has been advocated as preventative , but offered no such benefit when compared to traditional lumbar exercise in this trial . Instead , a brief psychosocial education program that reduced fear and threat of low back pain decreased incidence of low back pain result ing in the seeking of health care . Since this trial was conducted in a military setting , future studies are necessary to determine if these findings can be translated into civilian population s . Trial Registration NCT00373009 at Clinical Trials.gov - http:// clinical Study Design . A r and omized controlled trial with a 6-month follow-up period was conducted . Objective . To compare lumbar extension exercise and whole-body vibration exercise for chronic lower back pain . Summary of Background Data . Chronic lower back pain involves muscular as well as connective and neural systems . Different types of physiotherapy are applied for its treatment . Industrial vibration is regarded as a risk factor . Recently , vibration exercise has been developed as a new type of physiotherapy . It is thought to activate muscles via reflexes . Methods . In this study , 60 patients with chronic lower back pain devoid of “ specific ” spine diseases , who had a mean age of 51.7 years and a pain history of 13.1 years , practice d either isodynamic lumbar extension or vibration exercise for 3 months . Outcome measures were lumbar extension torque , pain sensation ( visual analog scale ) , and pain-related disability ( pain disability index ) . Results . A significant and comparable reduction in pain sensation and pain-related disability was observed in both groups . Lumbar extension torque increased significantly in the vibration exercise group ( 30.1 Nm/kg ) , but significantly more in the lumbar extension group ( + 59.2 Nm/kg ; SEM 10.2;P < 0.05 ) . No correlation was found between gain in lumbar torque and pain relief or pain-related disability ( P > 0.2 ) . Conclusions . The current data indicate that poor lumbar muscle force probably is not the exclusive cause of chronic lower back pain . Different types of exercise therapy tend to yield comparable results . Interestingly , well-controlled vibration may be the cure rather than the cause of lower back pain Objective : To compare two different exercise programmes versus a control group , after lumbar disc surgery . Design : A prospect i ve , single-blind , r and omized controlled study . Setting : Outpatient clinic of Istanbul Faculty of Medicine , Department of Physical Medicine and Rehabilitation . Subjects : Sixty patients diagnosed as having single level lumbar disc herniation with clinical examination and MRI evaluation and who had undergone lumbar discectomy ( post-operative first month ) at a single level . Patients with serious pathologies involving the cardiac and respiratory systems that could prevent them from doing exercises were excluded . Intervention : The patients were r and omly split into three groups . The first group received an intensive exercise programme and back school education while the second group received a home exercise programme and back school education . The third group was defined as the control group and did not receive education or exercise . Main measures : The patients were evaluated at the beginning and end of the treatment with clinical parameters , pain levels , endurance tests and weight-lifting tests , modified Oswestry Disability Index , Beck Depression Inventory , Low Back Pain Rating Scale and return to work . Results : The groups doing exercises experienced a decrease in the severity of pain and disability , also functional parameters showed better improvement than the control group . The intensive exercise programme was better than the home exercise programme . Conclusions : It seems that intensive exercise is more effective in reduction of pain and disability , but whether it is cost-effective is not clear BACKGROUND Lumbar paraspinal muscle dysfunction and Low Back Pain are strongly correlated . The best treatment for non-specific Low Back Pain is still controversial . OBJECTIVE To evaluate the efficacy of lumbar multifidus muscle retraining exercises and perifacet multifidus injections in the treatment of Low Back Pain . MATERIAL AND METHODS 63 patients with non-specific LBP , with or without leg pain , and magnetic resonance images of paraspinal muscle degeneration only , were r and omised to one of three treatment groups : A- Back education and st and ard physiotherapy for 10 weeks , B- Back education and gym ball exercise for 10 weeks or C- Perifacet injection into the lumbar multifidus muscle with methylprednisolone . The Oswestry Disability Index was used as the primary outcome measure and the SF-36 , modified Zung depression index , modified somatic perception and McGill pain question naires were used as secondary outcome measures . RESULTS 56 patients completed the trial . The Oswestry Disability Index improved in general from a mean of 29.9 to 25.9 , but there were no statistically significant differences between the groups . Low back pain improved most in group C ( P<0.02 ) , while physical activities and social functioning were improved the most in group B ( P<0.03 ) . CONCLUSION Perifacet injection and back education including a gym ball exercise program may be more effective than back education alone in relieving pain and improving physical capacity respectively . Back education including gym ball exercise could be used for non-specific Low Back Pain , as the ultimate goal should be to restore function STUDY DESIGN A systematic review of r and omized and nonr and omized controlled trials . SUMMARY OF BACKGROUND DATA Lumbar supports are used in the treatment of low back pain , but also to prevent the onset ( primary prevention ) or recurrences of a low back pain episode ( secondary prevention ) . OBJECTIVES To assess the effects of lumbar sup-ports for prevention and treatment of nonspecific low back pain .  METHODS The Medline , Cinahl , and Current Contents data bases ; the Cochrane Controlled Trials Register up to September 1999 ; and the Embase data base up to September 1998 were all search ed . References of identified trials and systematic review s were review ed and the Science Citation Index used to identify additional trials . Method ologic quality assessment and data extraction were performed by two review ers independently . A quantitative analysis was performed in which the strength of evidence was classified as strong , moderate , limited or conflicting , and no evidence . RESULTS Five r and omized and two nonr and omized preventive trials and six r and omized therapeutic trials were included in the review . Only 4 of the 13 studies were of high quality . There was moderate evidence that lumbar supports are not effective for primary prevention . No evidence was found on the effectiveness of lumbar supports for secondary prevention . The systematic review of therapeutic trials showed that there is limited evidence that lumbar supports are more effective than no treatment , whereas it is still unclear whether lumbar supports are more effective than other interventions for treatment of low back pain . CONCLUSIONS There continues to be a need for high quality r and omized trials on the effectiveness of lumbar supports . One of the most essential issues to tackle in these future trials seems to be the realization of adequate compliance Low back pain is one of the most common and important musculoskeletal disorders . In addition , chronic low back pain can deteriorate the patient 's physical , psychosocial and socioeconomic status . The objective of this quasi-experimental research was to assess the efficacy of an aerobic exercise and health education program in the treatment of chronic low back pain .  Seventy-two patients whose ages ranged from 30 to 50 years who had chronic low back pain were enrolled and r and omly assigned into two groups . Eight men and 28 women in the experimental group participated in a series of 3 health education sessions and an aerobic exercise training program . Nine men and 27 women in the control group received regular health education and a lumbar flexion exercise program . After a 3-month period of treatment , the results revealed the experimental group had statistically significant improvement of pain score and resting pulse rates when compared to the values of the control group ( p-value < 0.001 and < 0.01 , respectively ) . The average serum High Density Lipoprotein-Cholesterol ( HDL-C ) in the experimental group was also significantly higher ( p-value < 0.05 ) than that of the control group . This health education program is useful and may be applicable to patients with chronic low back pain  as an alternative treatment Study Design . Subjective ratings of discomfort were compared between a fixed lumbar support and lumbar support continuous passive motion ( CPM ) device . Objective . To compare a fixed lumbar support with a lumbar support CPM device during prolonged sitting . Summary of Background Data . To prevent low back pain during prolonged sitting , an inflatable lumbar support CPM has been developed . There are no studies that compare static lumbar support with lumbar CPM using the same pressure in the cushions . Methods . A total of 31 male volunteers without low back pain sat in the same chair for a 2-hour period on each of 3 consecutive days under 3 r and omized test methods : 1 , no lumbar support ; 2 , static lumbar support ; and 3 , lumbar support CPM . Each subject rated low back pain , stiffness , fatigue , and buttock numbness on a visual analog scale ( VAS ) .  Fixed lumbar support and CPM device were compared with a same inflation pressure in the cushion . For 10 subjects , the whole body posture and the pressure distribution changes of the human-seat interface during CPM were evaluated . Results . Compared with no lumbar support , a significant improvement in VAS scores for low back pain , stiffness , and fatigue was obtained with both static lumbar support and with lumbar support CPM ( P < 0.005 ) . A significant ( P < 0.005 ) improvement for buttock numbness was obtained only with lumbar support CPM . There were no statistical differences in all VAS scores between the fixed lumbar support and the CPM device . A forward rotation of the pelvic region was obtained during inflation of the cushion during CPM . Significant differences ( P < 0.05 ) were found between cushion inflation and deflation periods both in contact areas and in the peak pressures at the human-seat interface . Conclusion . There were no statistical differences in the subjective ratings of discomfort between the fixed lumbar support and the CPM device Study Design . This was a prospect i ve study . Objectives . To evaluate the results of education and early rehabilitation in the prevention of  back pain chronicity  in coal mine workers . Summary of Background Data . A new mine was established in central Queensl and , Australia . Preventing chronicity is important in the treatment of back pain in the industrial setting , because back pain is often refractory to treatment . Back pain patients also constitute the majority of compensation cl aims . Methods . A back pain program was instituted that comprised work force education , early injury reporting , first aid at the mine , and changing workplace psychosocial perceptions . Management employees were actively involved . The time off work , number of cl aims per hundred workers , and costs per cl aim were compared with another mine in the area . Results . The median time to return to work was 10 days . In the study group the number of cl aims and costs per cl aim were significantly less ( P < 0.01 ) as compared to the control group . Conclusions . This was an easy to institute , inexpensive back pain program , which succeeded in preventing back pain chronicity in the studied group of mine workers , with no worker being off work for more than 60 days OBJECTIVES Testing the feasability of a back school assessment programme in two population s of people suffering with chronic low back pain . MATERIAL Twenty-nine patients were r and omly included in a chronic low back pain assessment programme ( 15 patients waiting for back school and 14 patients after back school ) . METHODS The programme was made of the measure of the age , the sex , the body mass index , the pain ( VAS , St Antoine Hospitals Pain Question naire - SAPQ ) , the anxiety , the depression , the RIII nociceptive reflex , the fingertip-floor distance , the strength of the flexors and of the extensors of the lumbar spine ( CybexR 6000 isocinetic dynamometer ) , the lumbar function ( EIFEL , Dougados ) , the Dallas self- question naire . The Back School Education programme was made of five sessions ( information , ergonomics , extension exercises ) . RESULTS Comparing the two population s we did not observe significant differences concerning the age , the body mass index , the anxiety and depression levels , the pain ( VAS , SAPA , RIII nociceptive reflex ) , the lumbar stiffness , the lumbar disability , the quality of life ; the patients who had achieved back school had a peak torque of the flexors and a ratio flexors/extensors significantly lower . Comparing men and women we observed significant differences in the SAPQ and the muscles strength . The SAPQ was correlated with the depression and anxiety levels , the lumbar disability , the peak torque of the flexors . The VAS was correlated with the age , the lumbar stiffness , the depression level , the peak torque of the flexors . The RIII nociceptive reflex was correlated with the ratio flexors/extensors . CONCLUSION This study present some biases but this objective assessment of chronic low back pain appeared as feasible . The pain must be investigated in term of intensity , expression , alleviation . The impairment of the flexors muscles in women and after back school has to be confirmed . The different tests are relevant to determinate the efficiency of the back school programmes Context Lumbar supports are commonly used to prevent low back pain , but evidence on their effectiveness is lacking . Contribution This trial assigned 360 home care workers with a history of low back pain to a short course on healthy work habits , with or without worker-directed use of a lumbar support . Over 12 months , participants assigned to lumbar support had a similar number of sick days but fewer days with low back pain than did those assigned to the course only . Implication Adding lumbar supports to instruction on healthy work habits may decrease low back pain recurrence , but not absenteeism , among workers with previous low back pain . The Editors Low back pain is a common problem that results in high medical expenses , work absenteeism , and disability ( 1 ) . The reported 1-year prevalence ranges from 15 % to 40 % in a general population ( 2 ) and from 44 % to 72 % among home care workers ( 3 , 4 ) . Various ergonomic aids are marketed for the prevention of low back pain . Workers frequently use lumbar supports to prevent back pain ( 5 ) , but the effectiveness of such supports remains unclear . Recent systematic review s of the sparse evidence on lumbar supports ( 6 , 7 ) concluded that no evidence exists for the effectiveness of  lumbar supports  in the primary prevention of low back pain in the workplace , but 2 of the 4 included r and omized , controlled trials ( 8 , 9 ) reported that lumbar supports might be effective in workers with a history of low back pain ( secondary prevention ) . However , these findings were derived from subgroup analyses , and evidence from direct research on secondary prevention was not available . In cohort studies , a history of low back pain proved to be a strong predictor for the incidence of new episodes of low back pain ( 1012 ) . Home care workers with a history of low back pain may therefore be well suited to secondary preventive measures . In a previous uncontrolled feasibility study , we found that home care workers who had frequent episodes of low back pain reported adherence rates of 61 % to 81 % with lumbar supports and a 45 % decrease in pain intensity when using lumbar supports ( 13 ) . We design ed the current trial to evaluate the effectiveness of adding worker-directed use of lumbar supports to a short course on healthy working methods to reduce low back pain and work absenteeism among home care workers with a history of low back pain . Methods Design Our r and omized , controlled trial included 2 groups . The control group received a short refresher course on healthy working methods provided by their employer at the start of their employment ( Appendix ) ; primary and secondary care for the management of low back pain was available as usual ( 14 ) . The intervention group received a lumbar support in addition to usual care . The intervention and data collection continued for 12 months after enrollment . The Medical Ethical Committee of the Erasmus University Medical Center , Rotterdam , the Netherl and s , approved the study . Participants All participants were recruited from employees of a large home care organization in Rotterdam . During staff meetings , all present team members completed a brief survey about study inclusion criteria that was distributed and collected by the team managers . We included persons who performed medical care or domestic tasks as a home care worker , were experiencing low back pain symptoms at the time of inquiry or had experienced 2 or more episodes ( on 2 consecutive days ) of low back pain symptoms in the 12 months before the inquiry , did not have specific low back pain ( for example , due to rheumatoid arthritis or vertebral fractures ) , and were not pregnant at the start of the study . Because of a possible association between lumbar supports and increased blood pressure and heart rate , we excluded workers receiving medical treatment for high blood pressure ( 15 ) . Employees who met the inclusion criteria received detailed information about the trial , and those who agreed to participate provided written consent . R and omization In the Netherl and s , home care workers provide 1 of 8 functions , each of which requires different skills and tasks . To ensure a balance in workload and working conditions between the 2 study groups , we stratified r and omization by these 8 functions . We also stratified r and omization by low back pain experience at baseline ( current pain vs. past pain ) . The r and omization process used a computer-generated r and om-number table with 16 strata ( 2 low back pain by 8 workplace functions ) , arranged in blocks of 8 within each stratum . After baseline measurements were completed , colleagues who were not otherwise involved in the study and who were blinded to participants ' baseline characteristics used the r and om-number table to allocate each participant to 1 of the study groups . Intervention All participants in the intervention group were instructed to wear the lumbar supports on working days on which they had or expected they might develop low back pain . Participants could select 1 of 4 types of lumbar supports , supplied by Bauerfeind B.V. , Haarlem , the Netherl and s. LumboTrain and LumboTrain Lady are individually adjustable , hook- and -loop fastening , fully elastic supports that are available in 5 sizes for men or women . LumboLoc and LordoLoc are more structured supports , with integrated stays in the back , that have individually adjustable hook- and -loop fastenings and are available in 6 sizes . Participants chose the lumbar support on the basis of fit and wearing comfort , and they were not given advice to direct their choice from among the 4 available supports . When measured by the research er for the lumbar support , the participants were advised to wear the support for a few days in a row , regardless of low back pain , in order to become accustomed to it . The expected duration of wearability of the lumbar supports was 1 year . The costs of the lumbar supports were 75 for LumboTrain and LumboTrain Lady , 56 for LumboLoc , and 50 for LordoLoc . Outcome Measures Our primary outcome measures were the number of days that participants reported low back pain per month and the number of calendar days of sick leave that participants took during the 12-month intervention . Secondary outcome measures were the average severity of low back pain in the previous week , rated on a scale of 0 to 10 ( 16 ) , and functional status in the previous week , measured by using a Dutch translation of the Quebec Back Pain Disability Scale ( on which 0 corresponds to no disablement and 100 corresponds to fully disabled ) ( 17 , 18 ) . Participants used a calendar to record the days per month on which they experienced low back pain . The intervention group was also asked to record on the calendar whether they had worn the lumbar support ;  thus , the calendars also served as a monitor for adherence to therapy . The calendars were collected for review after 1 , 3 , 6 , 9 , and 12 months . The number of calendar days of sick leave was derived from the staff register and was provided by the home care organization at the end of the study ; this information covered 15 months , from 3 months before the start of the study until the end of the intervention . We could gather only general data on sick leave because employees are not obliged to specify their illness for the employer when they report themselves ill , and registration by a company doctor starts from 6 consecutive weeks of sick leave . We collected information on self-reported , low back painrelated sick leave ; however , this was not a predetermined outcome , and the results should be interpreted cautiously . We administered a question naire at baseline to obtain information on the secondary outcome measures and demographic characteristics ; history of low back pain ; job characteristics ( among others , the Job Content Question naire , Dutch translation [ 19 ] ) ; and other possible confounders , such as additional work ( hours per week and type ) , preference for study group assignment , confidence in pain reduction with use of the lumbar support ( scale of 0 to 10 ) , and confidence in improved functioning ( scale of 0 to 10 ) . Follow-up question naires were administered at 3 , 6 , 9 , and 12 months to measure the secondary outcomes . In the intervention group , these question naires also measured the general satisfaction with the lumbar support ( scale of 0 to 10 ) , several items on comfort of wearing ( 5-point Likert scale ) , and adherence to use of the lumbar support ( 7-point Likert scale ) . We recorded spontaneously reported side events and asked participants about side effects in the question naires . Statistical Analysis We estimated that with a power of 80 % , a significance level of 0.05 , and an SD of 20 days , we would need 140 participants in each study group to demonstrate a difference of 7 days of low back pain per year or sick leave per year between the 2 groups . To prevent inadequate power because of participant withdrawal or low adherence to therapy , we sought to enroll 400 home health care workers . We used a longitudinal marginal model with generalized estimating equation estimates to analyze the data , according to intention-to-treat principles . For the primary outcomes ( number of days of low back pain and number of days of sick leave ) , we used a negative-binomial count data model with a log-link and an exchangeable correlation structure . Covariates ( history of low back pain , body mass index , additional work , and pregnancy during follow-up ) were added to the model separately and were used in the final model if they statistically significantly contributed to the model ( P < 0.05 ) . The scale scores of the secondary outcomes were analyzed by using a normal distributed model and an exchangeable correlation structure . To investigate model misspecification and the effect of missing data , we performed sensitivity analyses in which we used various structures for the working correlation to estimate the models and used multiple imputation techniques to analyze 5 imputed data sets for missing data ( 20 ) . For all analyses , we used SAS , Ninety-six patients who had undergone first-time discectomy for herniated lumbar intervertebral discs were consecutively r and omized to two physical rehabilitation programs : a program of high-intensity , dynamic back extension and abdominal exercises with occurrence of low back pain being the limiting factor or a traditional program of mild , generally mobilityimproving exercises within pain limits . Both groups underwent 14 hours of treatment during a 6-week period 5 weeks after surgery . At 26 weeks ' follow-up , results indicated that patients who did the high-intensity exercises experienced greater success with regard to the patient disabilityindex and work capabilities . After 1 year , a trend that favored the use of intensive exercises could be observed . No differences were found in pain or objective measurements . A rehabilitation program of intensive exercises with occurrence of back pain being the limiting factor appears to increase patient behavioral support , result ing in work capacity improvements and patient self-rated disability levels . The results indicate that a 6-wk , 14-hr postoperative rehabilitation program is inadequate if objective postoperative deficit improvements are the desired goal Background Chronic non-specific low-back pain ( LBP ) is one of the most common and expensive musculoskeletal disorders in industrialized countries . Similar to other countries in the world , LBP is a common health and socioeconomic problem in Iran . One of the most widely used modalities in the field of physiotherapy for treating LBP is therapeutic ultrasound . Despite its common use , there is still inconclusive evidence to support its effectiveness in this group of patients . This r and omised trial will evaluate the effectiveness of continuous ultrasound in addition to exercise therapy in patients with chronic LBP . Methods and design A total of 46 patients , between the ages 18 and 65 years old who have had LBP for more than three months will be recruited from university hospitals . Participants will be r and omized to receive continuous ultrasound plus exercise therapy or placebo ultrasound plus exercise therapy . These groups will be treated for 10 sessions during a period of 4 weeks . Primary outcome measures will be functional disability and pain intensity . Lumbar flexion and extension range of motion , as well as changes in electromyography muscle fatigue indices , will be measured as secondary outcomes . All outcome measures will be measured at baseline , after completion of the treatment sessions , and after one month . Discussion The results of this trial will help to provide some evidence regarding the use of continuous ultrasound in chronic LBP patients . This should lead to a more evidence -based approach to clinical decision making regarding the use of ultrasound for LBP.Trial registration Netherl and s Trial Register ( NTR ) : A method is described for evaluating the progress of patients with back pain .  Various symptoms were scored on analogue scales and spinal motion was measured by various techniques . These data were integrated to make subjective and objective indices respectively . Reasonable reproducibility of the measurements was obtained . This technique was used to eluci date the role of the lumbar support in surgical corsets in relief of back pain .  Sufferers from back pain were r and omly allocated to corsets with and without lumbar supports . There was significant improvement in those with a support compared with those without . On the other h and objective changes measured with the corset removed did not differ between the 2 groups . This study indicates that the spinal support in a lumbosacral corset makes a significant contribution towards the relief of symptoms Prospect i ve controlled intervention study . To evaluate a specific segmental muscle training program of the lumbar spine in order to prevent and reduce low back pain in young female teamgym gymnasts . Teamgym is a team sport comprising three events : trampette , tumbling and floor programme . In a recent study , it was found that teamgym gymnasts practice and compete despite suffering from back pain . Specific muscle control exercises of the lumbar spine have shown good results in reducing pain intensity and functional disability levels in patients with low back pain . To our knowledge , this type of training has not been studied in an adolescent athletic population before . Fifty-one gymnasts , with and without LBP , 11–16 years old , from three top-level gymnastics team participated in the study comprising 12 weeks . Every day the gymnasts answered a question naire regarding low back pain . After baseline ( 4 weeks ) the intervention group performed a specific segmental muscle training program . Twenty-four gymnasts ( 47 % ) reported low back pain during baseline . Nine gymnasts failed to answer the question naire every day and the following results are based on 42 gymnasts ( intervention group , n = 30 , and control group , n = 12 ) . Gymnasts in the intervention group reported significantly less number of days with low back pain at completion compared to baseline ( P = 0.02 ) . Gymnasts in the control group showed no difference in terms of days with low back pain or intensity of low back pain between baseline and completion . Eight gymnasts ( out of 15 ) with LBP in the intervention group became pain free . Specific segmental muscle control exercises of the lumbar spine may be of value in preventing and reducing low back pain in young teamgym gymnasts OBJECTIVE : To determine the effects of a postoperative early isolated lumbar extension muscle-strengthening program on pain , disability , return to work , and power of back muscle  after operation for herniated lumbar disc . METHODS : Seventy-five patients were r and omized into an exercise group  ( 20 men , 15 women ) and a control group ( 18 men , 22 women ) to perform a prospect i ve controlled trial of a lumbar extension exercise program in patients who underwent lumbar microdiscectomy or percutaneous endoscopic discectomy .  Six weeks after surgery , patients in the exercise group undertook a 12-week lumbar extension exercise program . The assessment included measures of lumbar extensor power by the MedX ( Ocala , FL ) lumbar extension machine , muscle mass of multifidus and longissimus ( L4–L5 cross-sectional area ) by computed tomography . All patients completed the visual analog scale and the Oswestry disability index to assess pain and disability , respectively . Return to work data were also investigated . RESULTS : After the exercise program , significant improvements were observed in the exercise group versus the control group for lumbar extensor power ( 51.67 % versus 17.55 % , respectively ; P < 0.05 ) , the cross-sectional area of multifidus and longissimus muscle ( 29.23 % versus 7.2 % , respectively ; P < 0.05 ) , and the visual analog scale score ( 2.51 versus 4.30 , respectively ; P < 0.05 ) . The percentages of returning to work within 4 months after surgery were significantly greater in the exercise group than in the control group ( 87 % versus 24 % , respectively ) . Although this was not statistically significant ( P > 0.05 ) , the Oswestry disability index scores in the exercise group were better than that in control group ( 24.6 versus 30.6 , respectively ) . CONCLUSION : These results support the positive effects of the postoperative early lumbar extension muscle-strengthening program on pain , return to work , and strength of back muscles in patients after operation of herniated lumbar disc Study Design . A prospect i ve r and omized controlled trial of exercise therapy in patients who underwent microdiscectomy for prolapsed lumbar intervertebral disc . Results of a pilot study are presented . Objective . To determine the effects of a postoperative exercise program on pain , disability , psychological status , and spinal function . Summary of Background Data . Microdiscectomy is often used successfully to treat prolapsed lumbar intervertebral disc . However , some patients do not have a good outcome and many continue to have low back pain . The reasons for this are unclear but impairment of back muscle function due to months of inactivity before surgery may be a contributing factor . A postoperative exercise program may improve outcome in such patients . Methods . Twenty patients who underwent lumbar microdiscectomy  were r and omized into EXERCISE and CONTROL groups . After surgery , all patients received normal postoperative care that included advice from a physiotherapist about exercise and a return to normal activities . Six weeks after surgery , patients in the EXERCISE group undertook a 4-week exercise program that concentrated on improving strength and endurance of the back and abdominal muscles and mobility of the spine and hips . Assessment s of spinal function were performed in all patients during the week before surgery and at 6 , 10 , 26 , and 52 weeks after . The assessment included measures of posture , hip and lumbar mobility , back muscle endurance capacity and electromyographic measures of back muscle fatigue . On each occasion , patients completed question naires inquiring about pain , disability and psychological status . Results . Surgery improved pain , disability , back muscle endurance capacity and hip and lumbar mobility in both groups of patients . After the exercise program , the EXERCISE group showed further improvements in these measures and also in electromyographic measures of back muscle fatigability . All these improvements were maintained 12 months after surgery . The only further improvement showed by the CONTROL group between 6 and 52 weeks was an increase in back muscle endurance capacity . Conclusion . A 4-week postoperative exercise program can improve pain , disability , and spinal function in patients who undergo microdiscectomy STUDY DESIGN A prospect i ve double-blind r and omized trial in 31 patients . OBJECTIVES To assess the clinical efficacy of percutaneous radiofrequency denervation of the lumbar zygapophysial joints in reducing pain , functional disability , and physical impairment in patients with back pain originating from the lumbar zygapophysial joints . SUMMARY OF BACKGROUND DATA Chronic low back pain is a major health problem in the industrialized world . A treatment option is percutaneous radiofrequency denervation of the lumbar zygapophysial joints . Its clinical efficacy has never been formally tested in a controlled trial . METHODS Thirty-one patients with a history of at least 1 year of chronic low back pain were selected on the basis of a positive response to a diagnostic nerve blockade and subsequently r and omly assigned to one of two treatment groups . Each patient in the radiofrequency treatment group ( 15 patients ) received an 80 C radiofrequency lesion of the dorsal ramus of the segmental nerve roots L3 , L4 , and L5 . Patients in the  control group ( n = 16 ) underwent an the same procedure but without use of a radiofrequency current . Both the treating physician and the patients were blinded to the group assignment . Before treatment , physical impairment , rating of pain , the degree of disability , and quality of life were assessed by a blinded investigator . RESULTS Eight weeks after treatment , there were 10 success patients in the radiofrequency group ( n = 15 ) and 6 in the sham group ( n = 16 ) . The unadjusted odds ratio was 3.3 ( P = 0.05 , not significant ) , and the adjusted odds ratio was 4.8 ( P < 0.05 , significant ) . The differences in effect on the visual analog scale scores , global perceived effect , and the Oswestry disability scale were statistically significant . Three , 6 , and 12 months after treatment , there were significantly more success patients in the radiofrequency group compared with the sham group . CONCLUSIONS Radiofrequency lumbar zygapophysial joint denervation results in a significant alleviation of pain and functional disability in a select group of patients with chronic low back pain , both on a short-term and a long-term basis OBJECTIVES Risk factors for low-back pain are known to co-occur , but their joint effect has not often been studied . Little is also known about the variation of the risk factors or their effects with age . METHODS This prospect i ve study assessed the 1-year incidence of low-back pain by age group in a Finnish industrial population . The effects of the baseline variables on the risk of low-back pain in the follow-up were estimated with a log-binomial regression . RESULTS Among 2256 blue- and white-collar workers free of low-back pain 12 months preceding the baseline , 21 % reported low-back pain after 1-year of follow-up . Physical work load ( sum of heavy lifting , awkward postures , and whole-body vibration ) predicted low-back pain among those younger than 50 years [ highest relative risk ( RR ) 2.4 , 95 % confidence interval ( 95 % CI ) 1.4 - 4.2 ] , whereas health behavior ( sum of smoking , overweight , and lack of physical exercise ) increased the risk only among those 50 years or older ( RR up to 2.8 , 95 % CI 1.4 - 5.4 ) . Mental stress , dissatisfaction with life , and sleep problems were significant predictors in the group of 40- to 49-year-old workers . Work-related psychosocial factors were not associated with the outcome . CONCLUSIONS In this study , workers of different ages were affected by slightly different risk factors . The results support the provision of health promotion and stress management as part of programs to prevent work-related low-back pain . In particular , aging workers may benefit from such an integrated approach . More prospect i ve studies on the joint effects of age-specific risk factors of low-back pain are warranted BACKGROUND Hamstring tightness induces posterior pelvic tilt and decreased lumbar lordosis , which can result in low back pain OBJECTIVE : We investigated effects of hamstring stretch with pelvic control on pain and work ability in st and ing workers . METHODS One hundred adult volunteers from a st and ing workers were r and omly assigned to pelvic control hamstring stretching ( PCHS ) ( n = 34 ) , general hamstring stretching ( GHS ) ( n = 34 ) , control ( n = 32 ) groups . The control group was performed self-home exercise . All interventions were conducted 3 days per week for 6 weeks , and included in the hamstring stretching and lumbopelvic muscle strengthening . Outcomes were evaluated through the visual analog scale ( VAS ) , straight leg raise test ( SLR ) , sit and reach test ( SRT ) , Oswestry disability index ( ODI ) , and work ability index ( WAI ) . RESULTS Significant difference in VAS , SLR , SRT , ODI , and WAI were found in the PCHS and GHS groups . The control group was a significant difference only in ODI . The PCHS group showed a greater difference than the GHS group and control group in VAS , SLR , SRT , and ODI . CONCLUSIONS The pelvic control hamstring stretch exercise would be more helpful in back pain reduction and improvement of work ability in an industrial setting BACKGROUND AND PURPOSE Exercise and education is a common physiotherapy approach in the prevention of low back pain . A Mensendieck exercise programme consisting of exercises and ergonomical education has , in a previous study , been shown to be effective in preventing recurrent low back pain during one-year follow-up . The purpose of the present study was to evaluate the long-term effect of the Mensendieck exercise programme on people with recurrent episodes of low back pain who , when entering the study , had finished treatment for their last episode of low back pain . METHOD A r and omized controlled clinical trial in which 41 women and 36 men were allocated to either a Mensendieck or control group . The Mensendieck subjects received 20 group sessions of exercises and ergonomical education over 13 weeks . The control subjects were not offered any prophylactic therapy , but were free to receive treatment or exercises . Outcome measures were the number of recurrences of low back pain , sick leave , low back function and general functional status . RESULTS At three-year follow-up , 11 subjects had been lost to the study . Survival analysis showed a significant reduction ( p = 0.02 ) in subjects experiencing recurrent low back pain in the Mensendieck group compared to the control group . Significant improvements in pain and function scores were reported in both groups . There was no significant difference between the groups in pain , function or sick leave . CONCLUSION A Mensendieck exercise programme seems efficient in reducing recurrent episodes of low back pain at three-year follow-up , but it did not influence sick leave , pain or function scores Objective To compare the effects of lumbar stabilization exercises and lumbar dynamic strengthening exercises on the maximal isometric strength of the lumbar extensors , pain severity and functional disability in patients with chronic low back pain ( LBP ) . Methods Patients suffering nonspecific LBP for more than 3 months were included prospect ively and r and omized into lumbar stabilization exercise group ( n=11 ) or lumbar dynamic strengthening exercise group ( n=10 ) . Exercises were performed for 1 hour , twice weekly , for 8 weeks . The strength of the lumbar extensors was measured at various angles ranging from 0 ° to 72 ° at intervals of 12 ° , using a MedX. The visual analog scale ( VAS ) and the Oswestry Low Back Pain Disability Question naire ( ODQ ) were used to measure the severity of LBP and functional disability before and after the exercise . Results Compared with the baseline , lumbar extension strength at all angles improved significantly in both groups after 8 weeks . The improvements were significantly greater in the lumbar stabilization exercise group at 0 ° and 12 ° of lumbar flexion . VAS decreased significantly after treatment ; however , the changes were not significantly different between the groups . ODQ scores improved significantly in the stabilization exercise group only . Conclusion Both lumbar stabilization and dynamic strengthening exercise strengthened the lumbar extensors and reduced LBP . However , the lumbar stabilization exercise was more effective in lumbar extensor strengthening and functional improvement in patients with nonspecific chronic LBP
There was no evidence for the effectiveness of lumbar supports due to contradictory outcomes of the studies .
Thus there is limited evidence that education does not help to prevent back pain .
All three studies on exercise reported a positive result , indicating limited evidence for the effectiveness of exercise .
The review showed that there is limited evidence that exercise has some effect in the prevention of back pain and that education is not effective .
No conclusive evidence was found for or against the effectiveness of lumbar supports .
OBJECTIVE : To assess the effectiveness of lumbar supports , education , and exercise in the prevention of back pain in industry .