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Education, not core exercise, reduces back pain incidence in soldiers

PainSci » bibliography » George et al 2011
Tags: etiology, treatment, exercise, mind, structuralism, back pain, pro, self-treatment, biomechanical vulnerability, pain problems, spine

One page on PainSci cites George 2011: The Complete Guide to Low Back Pain

PainSci commentary on George 2011: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

Despite good general fitness, soldiers get back pain: do they get less if they train their “core” muscles more in basic training? They should! As the authors note, “Core stabilization has been advocated as preventative.” However, core training “offered no such benefit when compared to traditional lumbar exercise in this trial” — none at all. Although the results might be better with civilians, a good prevention method for us shouldn’t fail completely with soldiers. And although a different, more perfect training program might have worked, even a suboptimal one should have worked at least a little. The null result is therefore significant.

Headlines about the study have focused on the fact that soldiers who got a little extra back pain education reported less back pain over the next two years. (They measured the number of medical follow-ups.) However, it was a minor effect (17% relative risk reduction), and might be due to a fairly obvious (and acknowledged) limitation of the study — the education was “designed to reduce … threat and fear” and may have persuaded soldiers to seek less medical care. Of course, that is a win-win situation, good news either way, whether it was actually preventing back pain, or merely reassuring people and reducing the load on the health care system.

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

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 randomized 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 randomly 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 resulting 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 resulting 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, resulting 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 resulting 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 populations.

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