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
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 |