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Table 3 Overview of the key messages, educational themes and performance objectives for the person with low back pain and the exercise components of the GLA:D Back intervention. The Table is constructed from the literature and consensus discussions about the content of the intervention

From: GLA:D® Back group-based patient education integrated with exercises to support self-management of back pain - development, theories and scientific evidence -

Key Messages Educational theme/activity Self-Management
Performance objectives
A healthy back requires a balance between demands and capacity Behavioural pain control The person with back pain achieves an increased sense of control and an ability to manage everyday life through being able to reduce demands and increase capacity, through:
 insights into social, physical and mental factors affecting pain
 reducing monotonous loads by varied motion
 increased physical capacity
Pain = Alarm
Pain ≠ Harm
The brain can turn pain up and down
Pain mechanisms Exercise The person with back pain achieves increased understanding of pain and reduced fear and concerns through:
 knowledge about pain mechanisms
 knowledge about how thoughts, fear and beliefs influence the pain experience
 knowledge that pain can be influenced by distraction, exercise and physical activity
 positive non-fearful experience with movement and exercise
Bad posture and deformations of the spine are common Imaging
Structural pain sources
The person with back pain has fewer structural beliefs from understanding that spinal curves, posture and imaging findings relate poorly to pain through:
 knowledge about common findings on MRI and their lack of association with back pain
 knowledge that there is a wide variation in the appearance of healthy and strong spines
Action comes before improvement
Natural movements inhibit pain
Exercise strengthens the back
Treatment The person with back pain achieves improved expectation through:
 understanding that engaging in physical activity and work is part of the cure, rather than something to wait for until cured
 experiencing that movement reduces pain
 enhanced awareness of muscle function and perceptions of bodily control
The back is made for movement
The back is strong
Exercises
Physical activity
The person with back pain obtains physical skills with variation in movement through:
 positive experiences with movement
 exploring variation in movement
 knowledge about how exercises improve back capacity and decrease pain