There is no question but that the most important single element of spine care is prevention and that the most important element of prevention is education.  The key to effective education regarding prevention and self-care is to start it at the earliest age possible, ideally at the elementary school level.  Without this basic knowledge and understanding the individual starts life with a serious educational void.  Without this basic knowledge how can an incapacitated individual act intelligently in making good choices for themselves?

While formal education is considered important to success in life by most individuals it is truly amazing how little attention has been paid to the subject of health education later in life.  Managed care has been particularly disrespectful to "education" as an important and necessary component of a treatment programs.  The phrase "we don't pay for education" has become one of their many inappropriate mantras.  And, for the most part the public has let them get away with this absurdity.

A productive step forward, which could be taken by employers in industries in which low back problems are an occupational disease (i.e. trucking, airline Pilot Seating, etc.) would be to require a "Low Back Health Certification" before a individual could be hired or continued to be employed.  This would mean having successfully completed a low back education program.  Questionnaires and imaging studies probably could not be performed because of concern and resistance from unions who fear that this information will be used to discriminate against workers.  The education certification does not have this onus and could thereby be supported by all parties.

There are some individuals who have endeavored mightily to champion patient's interests in regard to initiating low back education in North America  and they deserve special recognition for their efforts.  They have, until recently, received little support or acknowledgement for their efforts.  Also deserving of praise are the many patients who have recognized the value of this education and have gone to great efforts to avail themselves of it despite denials of coverage by their third party payors.