10
Back pain: Prevention and management in the workplace

https://doi.org/10.1016/j.berh.2015.04.028Get rights and content

Abstract

Despite all the efforts in studying work-related risk factors for low back pain (LBP), interventions targeting these risk factors to prevent LBP have no proven cost-effectiveness. Even with adequate implementation strategies for these interventions on group level, these did not result in the reduction of incident LBP. Physical exercise, however, does have a primary preventive effect on LBP. For secondary prevention, it seems that there are more opportunities to cost-effectively intervene in reducing the risk of long-term sickness absence due to LBP. Starting at the earliest moment possible with proper assessment of risk factors for long-term sickness absence related to the individual, the underlying mechanisms of the LBP, and also factors related to the workplace by a well-trained clinician, may increase the potential of effective return to work (RTW) management. More research on how to overcome barriers in the uptake of these effective interventions in relation to policy-specific environments, and with regard to proper financing of RTW management is necessary.

Section snippets

The burden of back pain and scope of this review

Back pain may be considered a symptom that is usually not attributable to a specific pathology such as infection, tumour, osteoporosis, fracture, structural deformity, inflammatory disorder, radicular syndrome or cauda equina syndrome [1]. In about 90% of cases of back pain, the pathogenesis is unknown, and it is considered non-specific back pain. Because the pain is mostly felt in the lower part of the back, it is also termed ‘low back pain (LBP)’. However, there is no specific additional

Prevention of back pain in the workplace: what are the work-related risk factors?

In general, the aetiology of LBP is multifactorial: genetic, environmental and biological determinants probably all play a role [23], [24]. Regarding environmental factors, it has been estimated that worldwide 37% of LBP may be attributable to work-related risk factors. This fraction varies among different regions in the world, and it is higher in areas with lower health status in general, mostly due to the relatively high proportion of physical labour [25]. Overall, the attributable risk

Prevention of back pain in the workplace: what are the effective interventions?

If manual lifting at work is an important risk factor for LBP, then it makes sense to try to reduce spinal load by setting maximum permissible limits [3]. The National Institute of Occupational Safety and Health (NIOSH) in the USA has developed a risk assessment tool that can be used to assess a ‘recommended weight limit’. The maximum recommended weight limit is 23 kg. The lifting conditions, such as the vertical and horizontal distances of the load from the body and the degree of trunk

Management of back pain

It is customary to distinguish between acute LBP with a duration up to 6 weeks, subacute LBP with a duration between 6 and 12 weeks and chronic LBP with a duration of >12 weeks [14]. However, in this article, we will particularly focus on risk factors and the management of LBP with and without sickness absence to prevent long-term work disability.

Working-age patients with an episode of LBP often consult different types of health-care providers, such as the general practitioner, chiropractor,

Management of back pain in the workplace: what are the risk factors for sickness absence?

Not all workers with an episode of LBP will also have sickness absence. Whether someone does call in sick will depend on many factors related to the individual and to the workplace. First of all, it is generally known that a previous episode of sickness absence is the strongest predictor for future sick listing [68]. This also holds true for sickness absence due to LBP. Personal factors, such as older age and an individual's beliefs about back pain, play a major role in reporting sick or

Management of back pain in the workplace: what are the effective interventions?

Interventions to limit work disability or being on sickness-absence benefits should follow a similar strategy for chronic or recurrent LBP as for more acute episodes of LBP [75]. Based on a proper assessment of physical, psychosocial and workplace factors by appropriately trained clinicians, an effective strategy for RTW should be developed and coordinated. Research on effective RTW strategies for chronic or recurrent LBP has focused on interventions directed to the worker using either

Recommendations for future research

Most benefit in terms of improved care and reduction of costs can be expected from reducing chronic or recurrent LBP with sickness absence. Already more than a decade ago, it was shown that persons with acute LBP receiving therapy stratified according to their psychosocial risk factors showed greater effects on pain-related measures, and they were more likely to return to full-duty work after 4 weeks compared to those receiving an approach based on clinical practice guidelines [86]. More recent

Summary

LBP remains an enormous burden for workers, employers and society as a whole. Despite all efforts in studying work-related risk factors for developing LBP, interventions targeting these risk factors to prevent LBP have not been cost-effective. Even with adequate implementation strategies for these interventions, no effect in the reduction of incident LBP on group level could be detected. Genetic and biological determinants probably also play a major role in the aetiology of LBP, next to

Conflicts of interest statement

No conflicts of interest to declare.

References (93)

  • I. Pehkonen et al.

    Evaluation of a participatory ergonomic intervention process in kitchen work

    Appl Ergon

    (2009 Jan)
  • S.J. Bigos et al.

    High-quality controlled trials on preventing episodes of back problems: systematic literature review in working-age adults

    Spine J

    (2009 Feb)
  • S. Dagenais et al.

    Synthesis of recommendations for the assessment and management of low back pain from recent clinical practice guidelines

    Spine J

    (2010 Jun)
  • N.E. Foster et al.

    Stratified models of care

    Best Pract Res Clin Rheumatol

    (2013 Oct)
  • R. Haskins et al.

    Clinical prediction rules in the physiotherapy management of low back pain: a systematic review

    Man Ther

    (2012)
  • J.M. Beneciuk et al.

    Subgrouping for patients with low back pain: a Multidimensional approach incorporating cluster analysis and the STarT back screening tool

    J Pain

    (2015 Jan)
  • S.J. Kamper et al.

    Treatment-based subgroups of low back pain: a guide to appraisal of research studies and a summary of current evidence

    Best Pract Res Clin Rheumatol

    (2010)
  • J.C. Hill et al.

    Comparison of stratified primary care management for low back pain with current best practice (STarT Back): a randomised controlled trial

    Lancet

    (2011)
  • R. Baril et al.

    Management of return-to-work programs for workers with musculoskeletal disorders: a qualitative study in three Canadian provinces

    Soc Sci Med

    (2003 Dec)
  • F. Balasgué et al.

    Non-specific low back pain

    Lancet

    (2012)
  • R. Niemelainen et al.

    Prevalence and characteristics of upper or mid-back pain in Finnish men

    Spine (Phila Pa 1976)

    (2006)
  • Verbeek JH, Schaafsma FG. Occupational back pain. In: Baxter PJ, ed. Hunter's diseases of occupations, 10th ed.. Hodder...
  • H.S. Picavet et al.

    Utilization of health resources due to low back pain: survey and registered data compared

    Spine (Phila Pa 1976)

    (2008)
  • J.H. van Dieën et al.

    Work-related low-back pain: biomechanical factors and primary prevention

  • L. Axén et al.

    Trajectories of low back pain

    Best Pract Res Clin Rheumatol

    (2013 Oct)
  • F. Pellisé et al.

    Prevalence of low back pain and its effect on health-related quality of life in adolescents

    Arch Pediatr Adolesc Med

    (2009 Jan)
  • J.R. Anema et al.

    Medically certified sickness absence

    Br Med J

    (2008)
  • D. Hoy et al.

    The global burden of low back pain: estimates from the global Burden of disease 2010 study

    Ann Rheum Dis

    (2014 Jun)
  • A. Ozguler et al.

    Individual and occupational determinants of low back pain according to various definitions of low back pain

    J Epidemiol Community Health

    (2000 Mar)
  • H.C. de Vet et al.

    Episodes of low back pain: a proposal for uniform definitions to be used in research

    Spine (Phila Pa 1976)

    (2002 Nov 1)
  • G. Wynne-Jones et al.

    Absence from work and return to work in people with back pain: a systematic review and meta-analysis

    Occup Environ Med

    (2014 Jun)
  • S. Schandelmaier et al.

    Return to work coordination programmes for work disability: a meta-analysis of randomised controlled trials

    PLoS One

    (2012)
  • K.G. Stigmar et al.

    Promoting work ability in a structured national rehabilitation program in patients with musculoskeletal disorders: outcomes and predictors in a prospective cohort study

    BMC Musculoskelet Disord

    (2013 Feb 6)
  • L.C. Lambeek et al.

    The trend in total cost of back pain in The Netherlands in the period 2002 to 2007

    Spine (Phila Pa 1976)

    (2011 Jun)
  • S.V. Srinivas et al.

    Application of “less is more” to low back pain

    Arch Intern Med

    (2012 Jul 9)
  • L.C. Lambeek et al.

    Randomised controlled trial of integrated care to reduce disability from chronic low back pain in working and private life

    BMJ

    (2010 Mar 16)
  • G. Livshits et al.

    Lumbar disc degeneration and genetic factors are the main risk factors for low back pain in women: the UK twin spine Study

    Ann Rheum Dis

    (2011 Oct)
  • L. Punnett et al.

    Estimating the global burden of low back pain attributable to combined occupational exposures

    Am J Ind Med

    (2005 Dec)
  • W.E. Hoogendoorn et al.

    Physical load during work and leisure time as risk factors for back pain

    Scand J Work Environ Health

    (1999)
  • P. Coenen et al.

    The effect of lifting during work on low back pain: a health impact assessment based on a meta-analysis

    Occup Environ Med

    (2014)
  • B.K. Kwon et al.

    Systematic review: occupational physical activity and low back pain

    Occup Med (Lond)

    (2011 Dec)
  • J. Hartvigsen et al.

    Is sitting-while-at-work associated with low back pain? A systematic, critical literature review

    Scand J Public Health

    (2000)
  • W.E. Hoogendoorn et al.

    Systematic review of psychosocial factors at work and private life as risk factors for back pain

    Spine (Phila Pa 1976)

    (2000 Aug 15)
  • J. Hartvigsen et al.

    Psychosocial factors at work in relation to low back pain and consequences of low back pain; a systematic, critical review of prospective cohort studies

    Occup Environ Med

    (2004 Jan)
  • A. Burdorf et al.

    Positive and negative evidence of risk factors for back disorders

    Scand J Work Environ Health

    (1997)
  • B.P. Bernard

    Musculoskeletal disorders and workplace factors. A critical review of epidemiologic evidence for work-related musculoskeletal disorders of the neck, upper extremity, and low back

    (1997)

    • Cited by (36)

    • Adding a back care package to the primary healthcare; a community-based cluster-randomized trial

      2023, Brain and Spine

    • Real-time feedback to reduce low-back load in lifting and lowering

      2020, Journal of Biomechanics
      Citation Excerpt :

      One frequently mentioned cause is work-related lifting, for which an exposure-response relationship of intensity and duration of lifting with LBP has been established (Bergmann et al., 2017; Coenen et al., 2014). Numerous studies have attempted to develop effective preventive interventions, but according to a recent review, the effectiveness of such interventions is very limited (Schaafsma et al., 2015). More specifically, also evidence on effects of ergonomic interventions and assistive devices aiming to reduce exposure remains inconclusive (Ammendolia et al., 2005; Sahar et al., 2008; van Duijvenbode et al., 2007).

    • Correlation between nursing supervision and low back pain preventive behavior among nursing staff in hospital

      2019, Enfermeria Clinica
      Citation Excerpt :

      LBP among nurses may be avoided through systems and individual approaches. Prevention of LBP through individual approaches includes improving posture, proper methods of lifting and moving patients, and muscle exercises.9 LBP can also be prevented through systems such as nursing supervision and training, which are the two variables that ensure nurses’ safety.10

    • Special situations: Performance of endoscopy while pregnant

      2019, Techniques in Gastrointestinal Endoscopy
      Citation Excerpt :

      The individual worker interventions include increasing physical exercise as primary prevention for overuse injuries. No studies have shown that efforts to improve an employees’ physical health decreases the rates of LBP although low back flexor strength has been shown as a risk factor for development of pain [87]. During pregnancy, at least 150 minutes per week of moderate intensity exercise is recommended for most women, although certain high-risk populations are excluded [90].

    • Persistence of Low Back Pain and Predictive Ability of Pain Intensity and Disability in Daily Life among Nursery School Workers in Japan: A Five-Year Panel Study

      2024, Healthcare (Switzerland)

    • Diaphragmatic breathing exercises in recovery from fatigue-induced changes in spinal mobility and postural stability: a study protocol

      2023, Frontiers in Physiology
    View all citing articles on Scopus
    View full text
    Copyright © 2015 Elsevier Ltd. All rights reserved.