gms | German Medical Science

Physical training and biopsychosocial education constitute central elements in primary and secondary prevention of back pain. Because of the high lifetime prevalence of back pain, both approaches primarily aim to prevent the occurrence of recurrent back pain and the chronification of the condition (Lühmann et al. 2007).

Systematic reviews have shown evidence of the preventive effectiveness of physical training. The occurrence and duration of recurrent back pain and back pain induced work absenteeism is successfully addressed (Bigos et al. 2009, Linton & van Tulder 2001, Vuori, 2001). With regard to acute back pain, physical training makes no difference compared to applying any other conservative approach or even no treatment. In view of subacute back pain, there is evidence that graded-activity- programs are effective in reducing times absent from work. Concerning chronic back pain, physical training is slightly more effective than other conservative treatments. That holds true for reductions in pain and improvements in functional impairments in both the short and long-term (Hayden et al. 2005). Effects are small to moderate. So far, it is not proven that there is a predominant type of physical training regarding its comparative effectiveness. Further, the optimal mode of training (duration, frequency, intensity, progression and mode of delivery) for achieving preventive effects is not yet clarified by existing primary studies.

Systematic reviews have demonstrated that biopsychosocial education, applied as the only intervention, does not bring about primary and secondary preventive effects with reference to recurrent back pain and back pain induced work absenteeism (Bigos et al. 2009, van Poppel et al. 2004). In contrast, there is strong evidence that an intensive individual education leads to reduction of pain episodes and return to work in acute and subacute back pain. Regarding chronic back pain, the current state of research is unclear. Moreover, the predominance of a specific type of educational intervention is not proven (Engers et al. 2010). In general, combining physical training and biopsychosocial education appears to be most effective in the prevention of recurrent and chronic back pain (Airaksinen et al. 2006). However, only a few studies on that issue do exist. Therefore, the ideal approach of combining biopsychosocial education, cognitive-behavioral and movement-related strategies and modes of delivery is not yet determined. There is a lack of high-quality studies which encompass a homogeneous sample and investigate specific dose-response relationships, underlying mechanisms, differential effects and the cost-effectiveness related to interventions comprising behavioral and movement-related approaches in the prevention of back pain.