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Back School The Back School Program is offered as part of your Physical Therapy prescription for Low Back Pain or Neck Pain. It is considered as part of Treatment plan if recommended by your Dr. you will be scheduled to attend the class for one of your PT sessions. What is the Back School Program? The program is an educational presentation of factors involved in care of the spine, including cervical, thoracic, and lumbar levels. Topics discussed are body mechanics posture, anatomy, flexibility, stress and nutrition. Where is it and how long does it last? The class is from 8:30am 10:15am and is always held in Coos Bay Office. If you are coming from out of town you will be provided with directions to the Thompson Road address. What will I be learning about? Is this like the programs Ive had at work? This class will focus on educating you about your anatomy, terminology of diagnosis, and explanation of the injury, aging and healing process. This class will give you more information to form better questions for you to take back to your Doctor. This is not like classes held at most work settings. We want to take you a step further in understanding your diagnosis and prognosis. What do I need to bring? Please bring the completed questionnaire on or before the day you are scheduled to attend. This information will help us customize the program content to your situation as much as possible. Bring your questions. You will be given handout material. Bring your reading glasses if needed. You will be sitting in this class but you need to feel free to get up and move about as much as needed. If you would like to lay down, arrangements can be made, but please let us know this ahead of time. What else do I need to know?

We will call you on Monday to confirm your Tuesday morning appointment for the class. We do have limited space so if you cant keep this time, let us know ASAP. Sometimes there is a waiting list.

2. Once a person has had an incidence of low back pain, their risk for recurrence is 10 times greater. Through back schools the goal is to provide information to reduce the risk factors that contribute to low back pain. Objectives address the role of responsibility of proper back care. All work settings are important to consider, whether it is at home, recreational activities or on the job

site. Postures and body mechanics are discussed and put into functional use through group participation in demonstrations. Nutrition and stress are also factors that contribute to back pain and are incorporated in the presentation as well as the elements of a balanced exercise program, with respect to the person who has already had an injury as well as preventative care. The presentation is given through, (1) lecture, (2) PowerPoint presentation, (3) group participation in stretching, body mechanic demonstrations, and sampling of stabilization testing, and (4) your questions. 3. Active Back School consisted of 20 sessions during a period of 13 weeks. There were two sessions per week for the first 7 weeks and one session per week for the last 6 weeks. Each session lasted 1 hour divided into a didactic part (20 minutes) and a practical training part (40 minutes). The didactic session dealt with anatomy, biomechanics, pathology, and basic ergonomic principles related to the spinal column and pelvis. The practical training session focused mainly on applying the basic ergonomic principles, which included bending the knee and hip joints while keeping the lumbar segments near midposition and using short lever arms during functional exercises and obstacle course simulations of home and work environments such as vacuum cleaning, floor washing, and lifting maneuvers. In addition, strength training of leg muscles and muscles between the upper body and pelvis was given. The training sessions were organized as circle training at six different stations using medical training therapy equipment. Intensity was regulated by different levels of difficulty chosen at each station. Two to three series of approximately 90 seconds work and 30 seconds rest at each station were performed. Approximately 5 to 10 minutes of stretching exercises for the calf muscles, hamstrings, rectus femoris, and hip flexors according to Evjenth and Hamberg ended the training session. The participants were instructed not to provoke any pain associated with earlier bad experiences, and were given individual instruction and encouragement to conduct home exercises. 4. The back school consisted of information on the anatomy of the back, biomechanics, optimal posture, ergonomics, and back exercises. Four small group sessions were scheduled during a 2-week period, each sesin lasting 45 minutes. Since the introduction of the Swedish back school, the content and length of back schools have changed and appear to vary widely today. 5. The original Swedish back school was introduced by Zachrisson-Forsell in 1969. It was intended to reduce the pain and prevent recurrences of episodes of LBP (Zachrisson 1980; Zachrisson 1981). The back school consisted of information on the anatomy of the back, biomechanics, optimal posture, ergonomics and back exercises. Four small group sessions were scheduled during a two-week period, each session lasting 45 minutes. Since the introduction of the Swedish back school, the content and length of back schools has changed and appears to vary widely today. 6. Back School (B.S) program is one of the programs applied for prevention and treatment of low back pain (9, 10 and 11). Back School Programs provide some useful information's about human body anatomy, performance of back, mechanical strain and careful recognition of body and its optimal posture at work (4, 11). Lynch

tried to expand the term B.S in south of France at 1825, and patients suffering from low back pain participated in his camp for 1- 2 years to correct their spine disorders. Recently, Swedish experts of corrective and therapeutic exercises have seriously applied B.S to ordinary peoples and workers of production departments of big factories (12-20). Japan and North American countries also apply these programs to their workers as well (13, 14, 17 and 18). The purpose for implementation of B.S programs is to help people know how to solve their problems, become aware of their body problems (4), learn proper exercises suitable for their problems (10, 4), enhance their information about anatomy and posture (4, 16) and learn the right principles for doing their jobs (picking up and pushing things and etc) (4, 12) and also to treat such diseases as low back pain as far as possible (13, 14, 16, 17). B.S programs are categorized in two groups: Health Care Professional Back School and Industrial Back School. Some of the goals for industrial B.S are: education, treatment of medical interferences, teaching the proper posture for working, ergonomic counseling, and giving a precise representation of body (4). To achieve the goals of B.S programs successfully, first we must teach the concepts of anatomy and posture to people thoroughly (11, 18, and 19), make them aware of their basic and occupational biomechanics (10, 26) and also teach them the right body positions for working (4). Generally, it must be said that the goal of industrial B.S programs is to decrease low back occupation associated pain (4). In order to do so, we must primarily, in cooperation with high level managers, explain the goals of B.S programs for the supervisors (4) and after achieving their complete agreement, then start the job (7, 4). Most of the researchers usually introduce the principles of B.S programs through showing slides and pictures of proper posture of the body (4, 25), instructing anatomy and the right method of doing jobs (4, 27, 20, 29), holding question and answer sessions with workers (4), and application of posters and pamphlets at workplace (4, 12). Applying B.S programs Richard (1993) reached to some useful results (4). Hartvigsen et.al (2005) found out that education of proper work principles and correct posture while working result in decrease of low back pain (40). 7. Canadian Back Education Unit (18), the California Back School (19) and the American Back School (17). 8. Educating patients should include a review of the basic anatomy and biomechanics of the spine and the cause of their complaints. The treatment plan should be discussed and should include a description of recommended imaging studies, medications, injections, and therapeutic exercises. Correct posture, biomechanics of the spine in activities of daily living, and simple methods to reduce symptoms should be reviewed. These early instructions will help patients become active participants in their treatment as they progress to a more comprehensive home exercise program. Patients must understand the lifelong commitment to the

program because the single most important risk factor for future episodes of back pain is a previous episode. In addition, patients must understand that their back pain will not be cured but will be managed and that, when they have pain, it does not mean they are causing themselves harm. Therefore, patient education must be considered an ongoing process that must be continually refined. Directed education should continue until patients are independent in their maintenance exercise program.