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Low Back Pain.  A Progressive Etiology?

Low back pain is a commonly occurring complaint within the general population.  The background prevalence rate is often quoted as 80% or higher.  However, perhaps a more realistic view of the situation would suggest that notable back trouble (i.e. that which results in care seeking or a period of disability and not just the transient twinges suffered by most) occurs with a prevalence rate of approximately 60%.1  Recent research has suggested that low back pain can be as prevalent in sedentary workers as in manual workers.2  Some studies have found a dose response relationship between severe low back pain and stooping and kneeling but back pain in general was associated more with a range of psychosocial factors.3

Given the high background prevalence rate and the multifactorial nature of low back pain, it is exceedingly difficult to be certain that a particular job is involved in causation in individual cases when no specific significant injury is reported.4  Research by Troup et al suggested that the current episode of low back pain arose in over 50% of individuals with no specific "injury".5  Furthermore, in approximately 85% of cases, no tissue specific diagnosis is possible and low back pain remains primarily a symptomatic complaint.  Therefore, determining the cause of low back pain in the absence of a specific injury or incident is exceedingly difficult.

According to NIOSH (National Institute for Occupational Safety & Health), strong evidence of an association between workplace factors and back pain is present for daily, whole shift exposures to lifting/forceful movements and/or whole body vibration.6  Some evidence is present to support an association with awkward postures and/or heavy physical work.  Insufficient evidence is present to confirm a relationship between static postures and back pain.  Additionally, it should be pointed out that NIOSH suggested that the strongest associations were present with intense, prolonged exposures particularly when a combination of risk factors were present.

Given the above, it appears reasonable to state that back pain occurs frequently in a non-work related setting, and in the absence of a specific injury, a work relationship can only be reasonably established when there is a relatively intensive, preferably daily, exposure to heavy physical work, lifting/forceful movements, whole body vibration or sustained awkward postures.  In the absence of significant exposures to the above risk factors or a specific injury, postulating a work relationship with respect to low back pain would be highly speculative given the high background prevalence of the condition.

References

  1. Papageorgiou et al.  Estimating the prevalence of low back pain in the general population:  Evidence from the South Manchester Back Pain Survey.  Spine 20: 1889-1894
  2. Hemmingway et al.  Society of Back Pain Research, Leeds: November 11
  3. Holmstrom et al. 1992.  Low back and neck/shoulder pain in construction workers:  Occupational workload and psychosocial risk factors.  Part 2: Relationship to neck and shoulder pain.  Spine 17: 672-677
  4. Burton, Kim et al.  The relative importance of biomechanical and psychosocial factors in low back injuries:  presented to The University of Alberta, Management of Low Back Pain conference September 9, 1997
  5. Troup et al.  Back pain in industry – a prospective survey.  Spine 6: 61-69
  6. NIOSH, Musculoskeletal Disorders and Workplace Factors.  US Department of Health and Human Services, July 1997

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