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Chiropractic Research Review

Occupational LBP: Biomechanical and Psychosocial Causes

Low back pain (LBP) is the number-one occupational health problem in the industrialized world; up to 30% of all workers' compensation claims and up to half of all compensation costs are based on LBP.

Although numerous studies have assessed occupational LBP, the specific biomechanical and psychosocial factors that have the greatest association with the reporting of LBP are unclear; investigating these relationships was the goal of this study.

A case-control research strategy was applied in this comprehensive study. In this design, biomechanical and psychosocial aspects of workers in an automobile factory were compared across three groups. One group consisted of 137 workers with a new episode of LBP; these workers were called "cases." The second group of 179 workers did not have LBP complaints and were called controls. The third group of 65 workers did not have a LBP complaint and, additionally, they were matched to the cases by job duties; they were called matched controls. Researchers collected data by means of in-home interviews and worksite assessments of the physical demands of each job.

Results: The biomechanical risk factors found to be most associated with the cases were peak lumbar shear force, peak hand force, and accumulated lumbar disc compression over full shifts. Peak hand force and peak lumbar shear force are thought to be related since typically a worker will lean forward with a load in the hands, or lean forward to pull an object. This type of loading is believed to be primarily resisted by the facet joints, which have numerous pain receptors. Significant self-reported psychosocial risk factors for the cases included perceptions of a physically demanding job, a poor social environment at work, and a higher level of education than others in the same position. Perceived exertion showed the highest odds ratio of LBP.

"By using direct measurements of biomechanical demands rather than relying solely on the use of self-reported loads or group-level measures such as those based on job title, this study provides robust estimates of the relationships between these potentially modifiable demands and reporting of low back pain at work," the authors write. They conclude that preventing workplace LBP will be most effective if focused on both psychosocial and biomechanical factors.

Kerr MS, Frank JW, Shannon HS, et al. Biomechanical and psychosocial risk factors for low back pain at work. American Journal of Public Health, July 2001:91(7), pp. 1069-1075.

Chiropractic Research Review

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