[Guidelines for the prevention of low back pain]

About 60%-85% of the population will suffer from low back pain during their lifetime and in 5%-10% of cases this will become a chronic problem. This also has economic implications since it has been found that each year 20-50 billion dollars are spent in America for the treatment and compensation of those suffering from back pain. Based on the literature search performed, Dr. Lahad and Mrs. Sarig-Bahat present their conclusions on the prevention of low back pain in the publication of the "Israeli Guidelines for prevention of low back pain". Their conclusions, ranked according to level of scientific foundation, that are based on the Cochrane database group and on other high quality articles, can be divided into "what should be done" and "what should be avoided". Only the recommendation for physical exercise was found to be a level A conclusion (highest quality level) for the prevention of low back pain. The use of lumbar supports, shoe insoles and "back schools" were not found to be effective for the prevention of low back pain. These recommendations should be given with much caution, since most of them only have slight statistical significance and are directed at patients with non-specific low back pain, and non-specific pain is not a single disease. Genetic, psychological, environmental and morphometric conditions as well as physical effort have been found to be associated with an increased risk for recurrent attacks of back pain. Questions still exist concerning the amount, duration, frequency and kind of physical exercises, and whether or not the same exercises should be given to a healthy young man and to an old woman with osteoporosis and congestive heart failure. In summary, a patient with low back pain should be informed of all the scientifically proven data on what might and what might not prevent a future attack of low back pain. He/she should be advised to try and find out, from the known risk factors, the one that is applicable in his/her case and to avoid those activities that cause him/ her pain.