Contemporary understanding of prevention of spinal pain

Spinal pain, including low back pain and neck pain, are among the leading causes of disability, affecting over half a billion people around the world. Despite much research over the past three decades devoted to increasing understanding of spinal pain, the burden associated with this condition has failed to reduce. Effective strategies to prevent spinal pain are important to reducing the global burden. Given the recurrent nature of spinal pain, interventions that can reduce recurrence in those who have previously experienced an episode are particularly important. The broad aims of the work presented in this thesis were to, (1) investigate the effectiveness of a McKenzie-based self-management exercise and education program, following the Mechanical Diagnosis and Therapy principles, in preventing a recurrence of low back pain (Chapter Two and Chapter Three) and (2) to synthesise the available literature investigating prevention strategies aiming to reduce future impact of low back pain (Chapter Four); as well as, the literature investigating prevention strategies aiming to reduce the risk of neck pain episodes (Chapter Five). The studies presented in Chapter Two and Chapter Three outline the design and results of a randomised controlled trial evaluating the effectiveness of the McKenzie-based self management exercise and education program as secondary prevention for a recurrence of low back pain. Findings from this randomised controlled trial suggest that the intervention did not produce a substantial reduction on the risk of a new episode of activity-limiting low back pain when compared to the control group; however, this intervention program may reduce the risk of episodes of low back pain that result in a person seeking care. Although the effect on episodes resulting in care seeking looks promising, the confidence intervals include no effect so caution is required. We found no substantial effect between groups when assessing the overall personal impact of low back pain over 12-months. In Chapter Four, we systematically reviewed the literature evaluating the effectiveness of prevention strategies to reduce future impact of low back pain. The results of this study indicated that exercise programs can reduce future low back pain intensity, and that exercise combined with education can reduce future disability due to low back pain. In Chapter Five, the effectiveness of intervention strategies to prevent an episode of neck pain was investigated through a systematic review of the literature. This review showed that exercise programs may be effective in preventing a new episode of neck pain. In conclusion, findings from the randomised controlled trial (Chapter Three) provided evidence that a McKenzie-based self-management exercise and education program was no more effective than minimal intervention in reducing recurrences of low back pain; however, it may produce a substantial reduction in recurrences resulting in healthcare-seeking. In contrast, the systematic reviews presented in this thesis provided promising results. The evidence from the study in Chapter Four suggests that exercise-based and education interventions may reduce future low back pain intensity and associated disability, while the study in Chapter Five provides evidence that exercise-based programs may be effective in preventing a new episode of neck pain -- abstract.