Back School, ADL Training and Ergonomics
Back School
A critical component in the management of back pain is the education of patients regarding their pain and to provide them with general and specific protocols that they can use to minimize their pain and decrease the frequency of future flare-ups. The MBI back school protocol incorporates a variety of elements, including;
- Understanding your back pain
- Ergonomics training
- Training in Activities of Daily Living
- Exercises and stretching
- The home use of therapeutic modalities
- Developing a therapeutic management plan
Integrated Treatment & Back School Program
As part of the standard treatment protocol, an integrated Back School Program is provided to all patients.
- Industrial Back School Programs
Back school for low back pain
A back school is an educational program that teaches you practical information about back care, posture, body mechanics, back exercises, and preventing long-term back problems. Attending a back school gives you the tools for self-care, which may improve how well you manage low back pain.
Back school is only as effective as you make it by applying your back-care knowledge on a regular basis. Back school research has produced mixed results. While some studies have shown that back school can improve low back pain and speed recovery, other studies have shown no benefit or mixed results.1, 2 One study suggests that back school is as effective as manual treatments for relieving some low back pain.3
Researchers from the Netherlands suggest that people who are battling chronic back pain may need to return to school. Back patients may already have the reading and writing part down. But special back schools, the experts say, could be helpful by presenting a concentrated program that teaches how to manage pain and get on with life.
In their recent report, published in the Archives of Physical Medicine and Rehabilitation, the Dutch investigators showed that a back school program improves ability to do normal activities while enhancing patients' overall sense of health and diminishing their sense of being disabled.
Study author Audy Hodselmans says these patients often fear that any exertion might bring a return of that all-too-familiar (and excruciating) pain that makes the ailment such a ... pain. So while back pain itself is undeniably real, the limitations it imposes are at least partly a matter of perception, he tells WebMD.
At a back school at the Rehabilitation Center Beatrixoord, in the Netherlands, patients with chronic pain are taught to recognize and pay attention to their body's signals so that they have a better idea of what they can and can't do.
"You have to learn when you can stop and when you can go on," Hodselmans says. "We teach people to perceive when the light is green and when it is red."
In the study, 14 patients received instruction in the back school for an average of three-and a half months. Endurance, ability to function and lift things, and self-perceptions of disability were compared with 10 patients who did not receive the back school instruction.
The results: The patients in school improved significantly compared with the others. "The patients dare to go on longer and knew their physical limitations better, and they improve in physical capacity because they know how to prevent chronic overloading," Hodselmans tells WebMD.
One expert who reviewed the study for WebMD, however, cautioned that this report is based on a very small number of participants and does not measure long-term improvement. It also suffers from the same limitations that other studies on back schools do: It is very hard to know what exactly it is about back school that helps patients improve, says Steven J. Atlas, MD. Atlas is a physician at Massachusetts General Hospital and an instructor in medicine at Harvard Medical School in Boston.
The problem is compounded by the fact that back schools vary markedly in what they teach and how they teach it. Back schools exist in the U.S., sometimes as part of disability insurance plans, sometimes as freestanding clinics, and sometimes as part of a hospital.
"There are multiple things that are done," Atlas tells WebMD. "It may be very simple things such as good education about how to take care of your back, which many doctors do as part of routine practice."
Still, Atlas says there is a body of research that appears to support the effectiveness of back school instruction. So should you go back to school for your back? Atlas says people should have realistic expectations.
"I tell my patients that just because they have had pain for many years doesn't mean they are going to have it forever," Atlas says. "There are important things they can do to live with the pain. A lot of these [back school] programs help them do that. But many patients want a magic cure because they have had the pain for so long. I would love to find it for them, but it's not likely."
Ergonomics
Ergonomics and back pain in the work place
Back pain is one of the most common work-related injuries and is often caused by ordinary work activities such as sitting in an office chair or heavy lifting. Applying ergonomic principles—the study of the workplace as it relates to the worker—can help prevent work-related back pain and back injury and help maintain a healthy back.
The goal of an ergonomics program is to adapt the workplace to a specific worker, dependent on the job description, required tasks and physical make up of the employee performing those tasks. Two types of situations typically cause people to begin having back pain or to sustain a back injury while on the job.
Non-accidental injury occurs when pain arises as a result of normal activities and requirements of the task. Poor body mechanics, prolonged activity, repetitive motions, and fatigue are major contributors to these injuries. This may occur from sitting in an office chair or standing for too long in one position.
Accidental injury results when an unexpected event triggers injury during the task. A load that slips or shifts as it is being lifted, and a slip and fall or hitting one’s head on a cabinet door are typical examples.
As early as the 18th century, doctors noticed that workers whose jobs required them to maintain certain body positions for long periods of time developed musculoskeletal problems. In the last 20 years, research has clearly established the connection between certain job tasks and repetitive stress injuries, or RSI’s.
Two elements are at work here: “static work” and “force.” “Static work” refers to the musculoskeletal effort required to hold a certain position, even a comfortable one. For example, when we sit and work at computers, keeping our head and torso upright requires either small or great amounts of static work depending upon the efficiency of the body positions we choose. “Force” refers to the amount of tension our muscles generate. For example, tilting your head forward or backward from a neutral, vertical position quadruples the amount of force acting on your lower neck vertebra. This increase of force is due to the increase in muscular tension necessary to support your head in a tilted position.
The term “ergonomics” is derived from two Greek words: “erg,” meaning work and “nomoi,” meaning natural laws. Ergonomists study human capabilities in relationship to work demands. In recent years, ergonomists have attempted to define postures which minimize unnecessary static work and reduce the forces acting on the body. All of us could significantly reduce our risk of injury if we could adhere to the following ergonomic principles:
1. All work activities should permit the worker to adopt several different, but equally healthy and safe postures
2. Where muscular force has to be exerted it should be done by the largest appropriate muscle groups available.
3. Work activities should be performed with the joints at about mid-point of their range of movement. This applies particularly to the head, trunk, and upper limbs. (Cortlett, 1983)
References
- Van Tulder M, Koes B (2004). Low back pain (acute). Clinical Evidence (12): 1643–1658.
- Van Tulder M, Koes B (2004). Low back pain (chronic). Clinical Evidence (12): 1657–1682.
- Hseih C, et al. (2002). Effectiveness of four conservative treatments for subacute low back pain. Spine, 27(11): 1142–1148.
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