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Neuromuscular Exercise and Counseling Decrease Absenteeism Due to Low Back Pain in Young Conscripts: A Randomized, Population-Based Primary Prevention Study

Suni, Jaana H. PT, PhD*; Taanila, Henri BM†,‡,§; Mattila, Ville M. MD, PhD‡,§; Ohrankämmen, Olli MSc; Vuorinen, Petteri Captain; Pihlajamäki, Harri MD, PhD; Parkkari, Jari MD, PhD†,§

doi: 10.1097/BRS.0b013e318270a12d
Randomized Trial

Study Design. Controlled intervention with group randomization.

Objective. To investigate the effectiveness of a 6-month neuromuscular exercise and counseling program for reducing the incidence of low back pain (LBP) and disability in young conscripts, with a healthy back at the beginning of their compulsory military service.

Summary of Background Data. Basic military training is physically demanding on the back and requires adequate physical fitness. LBP causes significant morbidity and absence from military service.

Methods. Participants were conscripts of 4 successive age cohorts (n = 1409). In the prestudy year, before adoption of the intervention, 2 successive cohorts of conscripts of 4 companies (n = 719) were followed prospectively for 6 months to study the baseline incidence of different categories of LBP. In the intervention year, conscripts (n = 690) of 2 new cohorts of the same companies (intervention group: antitank, engineer; control group: signal, mortar) were followed for 6 months. The intervention program aimed to improve conscripts' control of their lumbar neutral zone and specifically to avoid full lumbar flexion in all daily tasks.

Results. Total number and incidence of off-duty days due to LBP were significantly decreased in the intervention companies compared with controls (adjusted hazard ratio = 0.42, 95% confidence interval = 0.18–0.94, P = 0.035). The number of LBP cases, number of health clinic visits due to LBP, and number of the most severe cases showed a similar decreasing trend but without statistical significance.

Conclusion. These findings provide evidence that exercise and education to improve control of the lumbar neutral zone have a prophylactic effect on LPB-related off-duty service days in the military environment when implemented as part of military service among young healthy men.

Effectiveness of a 6-month neuromuscular exercise and counseling program for reducing the incidence of low back pain and disability was studied in a randomized controlled intervention study of healthy conscripts. The number of off-duty days was reduced by 58% in intervention companies compared with controls.

*UKK Institute for Health Promotion Research, Tampere, Finland

Tampere Research Centre of Sports Medicine, UKK Institute, Tampere, Finland

Research Department, Centre for Military Medicine, Lahti, Finland

§Department of Trauma, Musculoskeletal Surgery and Rehabilitation, Research Unit of Pirkanmaa Hospital District and Division of Orthopedics and Traumatology, Tampere University Hospital, Tampere, Finland

General Headquarters of Finnish Defence Forces, Helsinki, Finland; and

Staff Department, Pori Brigade, Säkylä, Finland.

Address correspondence and reprint requests to Jaana H. Suni, PT, PhD, UKK Institute for Health Promotion Research, Box 30, 33501 Tampere, Finland; E-mail:

Acknowledgment date: April 17, 2012. Revision date: July 18, 2012. Acceptance date: August 18, 2012.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Research Unit of Pirkanmaa Hospital District, Ministry of Culture and Education, and Finnish Defence Forces funds were received to support this work.

No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

© 2013 Lippincott Williams & Wilkins, Inc.