This study investigated the efficacy of guidelines for a motivated class teacher to enhance the application of back care principles, taught by a physical therapist, in fifth-grade elementary schoolchildren. Testing consisted of a practical test before and a practical test, knowledge test and candid camera evaluation 11 weeks after the program. Three groups were compared: an intervention group of 38 pupils, with extra guidelines for the teacher, an intervention group of 48 pupils, without extra guidelines and 34 controls. The intervention plus guidelines group, compared to the intervention group without extra teacher guidelines, obtained significantly higher posttest-pretest gain scores for five of the seven practical test items and scored significantly higher for seven of the nine items of the candid camera evaluation. Knowledge test scores did not differ significantly between the two intervention groups. Study results indicate that guidelines to a motivated class teacher improve efficacy of back care education in elementary schoolchildren.