There was no reduction in the rate of low back injury; no reduction in the median cost per injury; no reduction in the time off from work, or in the rate of repeated injury after return to work.
"Back schools" are proliferating: those health programs developed to provide employees in industry and business with the knowledge of safe lifting and handling techniques, good posture, and basic back anatomy to help them prevent on-the-job back injuries. An employer signs on for a back program with the theory that such preventive measures will help save the company the costs of lost man hours and workers' compensation claims. What employers may not know is that low back injuries comprise 15-25 percent of workers' compensation claims, and 30-40 percent of workers' compensation payments.1
While lifting and handling techniques commonly taught in back schools have shown reductions in the number and severity of back symptoms,2,3 the results of controlled clinical trials on back schools have been inconclusive.4
A recently published, randomized, controlled trial5 on a program to prevent low back injuries has attempted to clarify the effectiveness of back schools. The study involved approximately 4,000 postal workers over a five-year period (Sept. 1985 to Sept 1990). Twelve staff PTs and two senior therapists trained the intervention groups (2,534 workers and 134 supervisors) in "primary prevention."
A survey of the subjects was done half way through the five year study, which found "significant increases in knowledge of safe behavior among workers in the intervention groups," compared to the control group, "but no significant improvements in actual behavior... or significant reductions in the proportion of workers with tired backs."
What was not expected was that injury rates were higher in the intervention group than in the control group. The authors suggested that this may have been due to "increased acceptability of reporting injuries" in the intervention group.
The study's authors concluded:
It would be interesting to see the outcome of an identical, randomized controlled trail that had a back school program designed and administered by DCs, instead of the PTs, as in this study.
References
Many relevant diagnostic signs are not performed deliberately by the examiner or by the patient at the examiner’s direction. They are observed as the patient reacts to their condition. Fortin’s finger sign, Minor’s sign, and Vanzetti’s sign are three examples of this principle.
On Feb. 1, 2024, two more legislators – John R. Carter (R-Texas) and Robert “Bob” Good (R-Va.) – co-sponsored the Chiropractic Medicare Coverage Modernization Act of 2023, bringing the co-sponsor total to 155, two more than the total achieved over the entire two-year congressional cycle in which identical legislation last appeared (2021-22).
While working at the Lovelace Medical Center in Albuquerque, N.M., one of the primary care physicians stated that imaging every patient prior to receiving chiropractic was not medically necessary. It was at that point I reconsidered the need for the imaging of every patient to avoid malpractice.
