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PubMed1991

Postural load and back pain of workers in the manufacturing of prefabricated concrete elements.

In a population of male workers in a concrete manufacturing plant (n = 114), the occurrence of back pain was studied in relation to a control group of maintenance engineers (n = 52). The prevalence of back pain in the 12 months preceding the investigation was 59% among the concrete workers, and 31% among the controls. After excluding persons with existing back pain before starting work in the present factory, a comparison between concrete workers and maintenance engineers showed an aged-adjusted odds ratio for back pain of 2.80 (1.31-6.01). Postural load of workers in both plants were measured using the Ovako Working posture Analysis System. During 4009 observations working postures concerning the back, lower limbs, and lifting activities were recorded. The average time spent working with a bent and/or twisted position of the back was found to contribute to the prevalence of back pain. The results of this study also suggest that exposure to whole-body vibration, due to operating vibrotables, is a second risk factor for back pain.

Adult↗
PubMed1994

Sources of variation in back and leg dynamometry.

Three investigations were carried out to examine the concurrent validity and the reliability of a portable dynamometer (Takei Kiki Kogyo) for the measurement of back and leg strength. First, leg extension strength of 19 subjects was measured using the Takei dynamometer and compared to the isometric knee extension strength of the dominant (right) leg measured using a computer-controlled dynamometer (Lido Active, Davis, CA). The back extension strength of 18 subjects was also compared between the two dynamometers. Second, back and leg strengths of 36 subjects, aged 19-30 years, were measured twice using the Takei dynamometer. Six days separated the test and retest. Third, back and leg strengths of four subjects, aged 21-30 years, were measured at six different times of the solar day. Significant relations (p < 0.001) were obtained between the Takei and Lido dynamometers for leg strength (r = 0.90) and back strength (r = 0.79). Significant test-retest correlations (p < 0.001) were found for leg strength (r = 0.80) and back strength (r = 0.91). Group mean (+/- SD) leg strength values of test (1450.4 +/- 428.6 N) and retest (1432.8 +/- 449.1 N) did not differ ((p > 0.05). A small (4.5%) but significant difference was found between the test (1057.2 +/- 309.9 N) and retest (1106.2 +/- 334.4 N) mean values for back strength (p < 0.05). A time of day effect was evident for back and leg strength (p < 0.05); on average the peak times occurred at 16:53 h and 18:20 h, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Back pain in the working population: prevalence rates in Dutch trades and professions.

An analysis of three health surveys in the Dutch working population is described, aimed at the identification of Dutch trades and professions with relative high and low prevalence rates of back pain. The sample was representative of the working population in the Netherlands and consisted of 5840 men and 2908 women. The analysis included 33 trades and 34 professions, with at least 50 respondents for each. A total of 26.6% of the workers reported back pain quite often. Almost 2% reported absence from work in the last two months, and 4% considered their back pain to be a chronic disabling disease. There was a substantial variation in prevalence rate of low-back pain between trades and professions ranging from 12% to 41%. Trades with relatively high prevalence rates were found to be the building materials industry, the construction industry and road transportation, and the wholesale industry. Trades with relatively low prevalence rates were found to be banking, public administration and commercial services. Workers in the construction industry and supervisory production workers, plumbers, drivers and cleaners have a relatively high prevalence rate of back pain. Chemists, scientists, bookkeepers, secretaries and administrative professions have a relatively low prevalence rate of back pain. It is concluded that high prevalence rates of back pain are found in particular in non-sedentary professions. Priorities in prevention of back pain should be directed towards the group with relatively high prevalence rates identified above.

Adolescent↗
PubMed1999

Association between peridural scar and persistent low back pain after lumbar discectomy.

The purpose of this study was to investigate the correlation between low back pain persisting six months after first surgery for herniated lumbar intervertebral disc and the extent of peridural fibrosis present at the surgical site, as defined by magnetic resonance imaging (MRI). The 298 patients who underwent first-time, single-level unilateral discectomy for lumbar disc herniation were evaluated in a controlled, randomized, double-blind multicenter clinical trial to test the effectiveness of the scar-inhibiting device ADCON-L. Clinical assessments were conducted pre-operatively and at 1, 3, and 6-month intervals post-operatively, and included MRI scar assessment and the assessment of low back pain by visual analog scales. There were 267 patients available for low back pain assessments. The data obtained at the 6-month follow-up visit were statistically analyzed for the association between the presence of peridural scar and the persistence of low back pain. Those patients treated with ADCON-L at surgery had significantly less scar than did control patients (p = 0.007), and had less low back pain than did control patients when the pain was most severe (p = 0.047) and when the pain was assessed at the end of the day (p = 0.044). Patients with extensive scar reported continuing and debilitating low back pain more frequently than those with no or minimal scar. These findings demonstrate a direct correlation between persistent low back pain and extensive scar, since patients with increased amounts of scar had increased low back pain, regardless of their treatment group (p = 0.0003).

Chronic Disease↗
PubMed1996

An assessment of lower back pain in young adults: implications for college health education.

A convenience sample of 243 undergraduates completed a 36-item questionnaire on their knowledge about back care and exercise patterns before they attended lectures and a workshop on back mechanics. At the workshop, the students were individually evaluated for posture, hamstring flexibility, hip flexor flexibility, back and abdominal strength, and lifting technique. Twenty-nine percent of the students reported that they experienced no back pain; 71% experienced lower back pain 1 to 5 days a week. The majority were neglectful of their posture, lifting and carrying techniques, and scored fair-to-poor on the hamstring flexibility test, possibly foreshadowing back problems in later life. The majority of respondents were unsure of what exercises to do for back care. Within the subgroup of students who claimed they were knowledgeable about exercise, more than 50% were performing ineffective and potentially harmful exercises. The results underscored the potential worth of health education on back care offered through didactic instruction and experiential workshops.

Adult↗
PubMed2002

Risk factors of back pain frequency in schoolchildren: a search for explanations to a public health problem.

UNLABELLED: This study examined physical, behavioral and social factors associated with schoolchildren's back pain. Factors associated with back pain were also identified using a stepwise regression method. The study was based on a self-administered questionnaire survey of a random national sample of 2173 Icelandic 11-12 and 15-16-y-old schoolchildren. It found that older subjects tended to report back pain more frequently than younger children. Back pain showed significant associations with different aspects of physical condition such as chronic health conditions, tiredness and physical fitness. A number of behavioral factors including participation in sports, television viewing, eating habits and smoking also had a relationship with back pain. Finally, children with lower social support were more likely to experience back pain. CONCLUSION: Overall, four major factors (age, morning tiredness, eating habits and parental support) emerged as factors associated with back pain in the study subjects. These results highlighted the roles of lifestyle and social factors in the experience of back pain in schoolchildren.

Adolescent↗
PubMedDate not supplied

Trunk muscular strength in pre-pubertal children with and without back pain.

OBJECTIVE: While in adulthood there is no proven relationship between back pain and trunk muscle strength, in pre-pubertal subjects this topic has been poorly studied. The aim of the study was to evaluate isometric and isokinetic trunk muscle strength in children with or without previous back pain. METHODS: The recent occurrence of back pain (last 6 months) among 144 children (77 males, 67 females, age 11.9 +/- 0.3 years) was assessed using a questionnaire. Extensor and flexor trunk muscle strength was measured through isometric and isokinetic (60, 90, 120 degrees/s) tests. Peak torque (PT), PT angle, PT flexor/PT extensor ratio and intra-session coefficient of variation (COV) were determined. RESULTS: Flexor and extensor muscle PT, but not PT angle, were significantly higher in males than in females, irrespective of back pain occurrence. PT flexor/PT extensor ratio at 90 degrees angular velocities increased significantly only in males with back pain, compared with males without back pain. The COV trend was similar for flexor and extensor muscles. CONCLUSIONS: Isometric and isokinetic trunk muscle strength probably play a minor role in back pain occurrence in children. The isokinetic testing velocity may be important in determining trunk strength differences between children with and without back pain.

Abdominal Muscles↗
PubMed2003

Are the "myths" of low back pain alive in the general Norwegian population?

AIM: The aim of this study was to examine the perception of low back pain care and consequences according to what Deyo refers to as seven "myths" about back pain, in the Norwegian population. METHODS: In spring 2001, seven questions, corresponding to Deyo's myths, were included in an opinion poll (telephone interviews) of a representative sample (n=1015) of the Norwegian population. RESULTS: In total, 41% of the population held that 'If you have a slipped disc you must have surgery'. Approximately 50% believed that 'X-ray and newer imaging tests can always identify the cause of pain' and 'Most back pain is caused by injury and heavy lifting'. Almost 60% agreed that 'Everyone with back pain should have a spine X-ray'. However, only one-quarter believed that 'If your back hurts, you should take it easy until the pain goes away', and approximately one-fifth believed that 'Back pain is usually disabling'. Only 12% believed that 'Bed rest is the mainstay of therapy'. More individuals in the lower- compared with the higher-educated groups believed in the myths. CONCLUSION: Information concerning current knowledge on healthcare and health consequences of low back pain had reached only a small part of the general population. The most important factor for lack of knowledge was education. Developing effective methods to promote adequate self-care and treatment and reduce the risk of chronicity of low back pain in the lower-educated groups should be a top priority.

Adult↗
PubMed2006

Chronic low back pain in individuals with chronic neck pain of traumatic and non-traumatic origin: a population-based study.

BACKGROUND: It is unclear whether the prevalence of chronic low back pain is higher in chronic whiplash patients than in the general population. In a population-based study, we evaluated the prevalence of chronic low back pain in individuals with chronic neck pain of traumatic and non-traumatic origin, with special emphasis on whiplash injury. SUBJECTS AND METHODS: Additional questions concerning the patient's experience of neck and low back pain were added to the questionnaire of the MONICA health survey. 4,415 subjects aged 25-64 years were randomly selected from a geographically well-defined area in northern Sweden. RESULTS: The prevalences of chronic low back pain and chronic neck pain were 16% and 17%, respectively. 51% of subjects had both back and neck pain. Of the patients with neck pain, one quarter had a history of neck injury, which was related to whiplash injury in almost one-half of the cases. The prevalence of chronic low back pain in individuals with chronic non-traumatic neck pain was 53%, and it was 48% in those with chronic neck pain and a history of neck trauma. There was no difference in the prevalence of chronic low back pain between whiplash injury and other types of neck trauma. Confounding factors such as sex, age, marital status, BMI, smoking status and level of education were not significantly different between traumatic and non-traumatic groups. INTERPRETATION: Independently of traumatic or non-traumatic origin of the symptoms, the prevalence of chronic low back pain is 3 times higher in individuals with chronic neck pain than in the general population. Causes other than a history of neck trauma, such as chronic muskuloskeletal pain syndromes, may be important in evaluation of these cases.

Adult↗
PubMed2006

Does back pain prevalence really decrease with increasing age? A systematic review.

BACKGROUND: It is believed that the prevalence of back pain decreases around the middle of the sixth decade. However, back pain is still among the most commonly reported symptoms in the elderly and osteoarthritis, disc degeneration, osteoporosis and spinal stenosis all increase with age. In light of this, it is difficult to understand why the prevalence of back pain would decrease with increasing age. OBJECTIVE: This study aimed at summarising the scientific evidence on the trends of back pain prevalence with age. METHODS: Population-based studies reporting the prevalence of back pain, including people aged 65 years and over, were systematically retrieved from several bibliographic databases. These were read and assessed by two reviewers, and papers retained ('good quality studies') were aggregated according to specific criteria. RESULTS: Good quality studies showed a large heterogeneity as to their methods and prevalence figures. No specific patterns were detected by country nor outcome measure. However, most studies that considered severe forms of back pain found an increase of prevalence with increasing age. The curvilinear association between age and back pain prevalence that is widely mentioned in the literature was found only for benign and mixed problems. CONCLUSIONS: The evidence concerning the association of back pain prevalence with age is more sparse than currently believed and this association seems to be modified by the severity of the problem. This knowledge could have important public health implications, as the proportion of older people will increase considerably in the coming years in most industrialised societies.

Age Distribution↗
PubMed2001

Risk factors for the development of low back pain in adolescence.

A previous history and earlier onset of low back pain are associated with chronic low back pain in adults, implying that prevention in adolescence may have a positive impact in adulthood. The study objectives were to determine the incidence of low back pain in a cohort of adolescents and to ascertain risk factors. A cohort of 502 high school students in Montreal, Canada, was evaluated during 1995-1996 at three separate times, 6 months apart. The outcome was low back pain occurrence at a frequency of at least once a week in the previous 6 months. Of the 377 adolescents who did not complain of low back pain at the initial evaluation, 65 developed low back pain over the year (cumulative incidence, 17 percent). Risk factors associated with development of low back pain were high growth (odds ratio = 3.09; 95 percent confidence interval (CI): 1.53, 6.01), smoking (odds ratio = 2.20; 95% CI: 1.38, 3.50), tight quadriceps femoris (odds ratio = 1.02; 95% CI: 1.00, 1.05), tight hamstrings (odds ratio = 1.04; 95% CI: 1.01, 1.06), and working during the school year (odds ratio = 1.33; 95% CI: 1.03, 1.71). Modifying such risk factors as smoking and poor leg flexibility may potentially serve to prevent the development of low back pain in adolescents.

Adolescent↗
PubMed2005

Childhood and early adult predictors of risk of incident back pain: Ontario Child Health Study 2001 follow-up.

Musculoskeletal disorders of the back and spine are a leading cause of disability in working-age populations. There is limited information on the potential consequences of childhood socioeconomic and health status on the risk of incident back pain in early adulthood. The authors describe factors associated with having had a first episode of back pain during the past year in the Ontario Child Health Study, a prospective cohort study of children who were aged 4-16 years at the time of enrollment in 1983 and were resurveyed in 2001. Respondents reporting a first episode of back pain (n=143) were compared with respondents who had never experienced back pain (n=896). The annual incidence of a first episode of back pain in this sample of young adults was 74.7/1,000. Following adjustment for age, sex, childhood conditions, childhood health status, and measures of early adult health, behavior, socioeconomic status, and work environment, the risk of incident back pain was associated with both low (odds ratio (OR)=1.86, 95% confidence interval (CI): 1.14, 3.03) and moderate/high (OR=1.85, 95% CI: 1.07, 3.02) levels of psychological distress, current heavy smoking (OR=1.85, 95% CI: 1.10, 3.10), lower levels of parental education in childhood (OR=1.72, 95% CI: 1.06, 2.80), and emotional or behavioral disorders in childhood (OR=1.87, 95% CI: 1.02, 3.41). The associations of low childhood socioeconomic status and childhood emotional and behavioral disorders with risk of incident back pain in early adulthood are important findings with implications for better understanding the etiology of soft-tissue disorders.

Adolescent↗
PubMed2002

Development of a systematic observation protocol of physical exposure of the back: a preliminary study.

OBJECTIVE: At present there is no systematic observation protocol for the assessment of the multi-factorial aspects of physical exposure related to the back used within the constraints of occupational epidemiological research. In this context, a new preliminary systematic observation protocol is proposed to assess exposure to physical loading of the back using nine categories of physical risk factors: the SOPE back protocol. The objective of this study was to investigate whether the new protocol can correctly identify the level of exposure related to measured physical loading of the back. METHODS: The subjects of this closed cohort study were 451 manual workers at a natural gas distribution company. The assessment of exposure was made with the protocol using groups with different job titles. The workers were followed for a 2 yr period to establish the risk of a new occurrence of complete disability related to the back (NOCD back injury) in each job grouping. RESULTS: Based on the median of the total scores derived from the protocol, two levels of exposure were identified (high and low). CONCLUSION: Taking into account the limitations of this study, the protocol in development may be a good tool to establish two levels of exposure to physical loading of the back in large epidemiological studies of occupational low back pain. Further research is needed to replicate these results with larger samples and to test the reliability and predictive validity of the protocol.

Adult↗
PubMed1998

Chronic low back pain in primary care: a prospective study on the management and course.

BACKGROUND: There is little evidence about the management and course of chronic low back pain in primary care. OBJECTIVES: Our aim was to describe the course of chronic low back pain and the performed diagnostic and therapeutic procedures for patients with chronic low back pain in general practice. METHODS: Twenty-six GPs involved in the Registration Network Family Practices participated in this prospective follow-up study. All patients and GPs were asked to complete questionnaires at baseline and at 4, 8 and 12 months follow-up. RESULTS: The GPs provided information about diagnostic and therapeutic procedures concerning 524 patients with chronic low back pain. Diagnostic tests other than history-taking and physical examination were not frequently used. Medication, mostly NSAIDs, was the most frequently used type of treatment (21.6%). The most frequent referrals concerned physiotherapy (16.3%) and neurology or neurologic surgery (6.3%). Information about the course of their chronic low back pain was provided by 368 patients participating in our study. The course of chronic low back pain appeared to be quite stable, as there was only a slight improvement in pain intensity and physical functioning over the 12 months of follow-up. CONCLUSIONS: A variety of options for the treatment and referral of chronic low back pain patients is available for and used by GPs. Efforts should be made to establish which diagnostic and therapeutic procedures are the most effective for chronic low back pain.

Adult↗
PubMed1999

Low back pain and disability in older women: independent association with difficulty but not inability to perform daily activities.

BACKGROUND: Low back pain is a highly prevalent chronic condition, yet little is known about the disabling effects of this common problem in older adults. This study examines the relationship between the presence and severity of low back pain and disability in older women. METHODS: The study population was 1,002 disabled older women participating in a population-based prospective study of disablement. Key outcome measures of disability included level of difficulty and inability to perform the following daily activities: light housework, shopping, walking one-quarter mile, climbing stairs, lifting, and activities of daily living (ADLs). RESULTS: Forty-two percent of participants reported they had low back pain for at least one month in the year before baseline. The prevalence of severe back pain decreased markedly with age (10% of those > or = 85 yr versus 23% in each of the two younger 10 yr age groups). After multivariate adjustments, women with severe back pain were 3 to 4 times more likely than other women to have a lot of difficulty with light housework or shopping. There was also an increased likelihood of difficulty with mobility tasks and basic ADLs among those with severe back pain. No associations were found between back pain and being unable to perform any of the daily activities studied, indicating possible differences in disablement processes leading to functional difficulties versus functional incapacity. CONCLUSIONS: There was a strong association between back pain and functional difficulties in older women, pointing to the need for further research using longitudinal methods.

Activities of Daily Living↗
PubMed1994

Attitudes towards prevention of low back disorders in industry.

The attitudes of employees in the metal industry towards possibilities for preventing the occurrence of low back pain were studied. Of 170 clerical employees and 504 manual workers, 86 per cent (n = 146) and 63 per cent (n = 315), respectively, responded to the questionnaire. Opinions were positive in both groups, even among those who reported experience of recurrent or continuous low back pain. Measures requiring their own activity, such as daily training of back and abdominal muscles, straightening the back during awkward postures, increasing physical exercise during leisure time, and increased information about the structure and loading of the back, were considered effective more often than measures involving changes at work or passive rehabilitation. Attitudes towards possibilities for promoting health in general by their own behaviour were more positive among the clerical employees than the manual workers. The attitudes became more negative with increasing age, as well as with reported experience of low back pain in both groups. Thus, it is important that an active approach is taken in occupational health care to motivate subjects to take action themselves in the prevention of low back pain at a younger age, and, at the latest, when the first episodes of low back pain occur.

Adult↗
PubMed2000

Prevalence of low back pain among staff in a rural hospital in Nigeria.

A cross-sectional study was carried out in a rural hospital in south-western Nigeria to determine the prevalence of low back pain among its staff. The questionnaire administered to staff sought information on social and demographic characteristics, job history, smoking status, frequency and severity of low back pain and factors predisposing to low back pain. Seventy-four out of a total of 80 workers participated in the study. The prevalence of low back pain among staff was 46%. The highest prevalence of back pain (69%) was recorded among nursing staff, followed by secretaries/administrative staff (55%) and cleaners/aides (47%). Heavy physical work (45%), poor posture (20%) and prolonged standing or sitting (20%) were the most frequent activities reported to be associated with low back pain among these workers. The prevalence of low back pain among these workers is comparable to that of workers in high income countries. Health education on posture and correct lifting techniques can be introduced to reduce the burden of low back pain among these workers.

Adult↗
PubMed2004

Risk factors for first-ever low back pain among workers in their first employment.

BACKGROUND: Low back pain has been estimated to be the most costly ailment of people of working age. Both work characteristics and individual factors have been identified as risk factors. The first interaction between work characteristics and individual factors occurs when workers start in their first job. AIMS: To investigate work-related risk factors for first-ever low back pain in young workers in their first employment. METHODS: A cross-sectional analysis was performed on 278 young workers in their first employment and without a history of low back pain prior to working. Work-related physical factors, psychosocial work characteristics, individual variables and first-ever low back pain were queried by means of a questionnaire. RESULTS: About half of the workers who developed low back pain after job start did so in the first year of employment. An increased risk was observed for (i) long periods of seated work [relative risk (RR) = 3.2, 95% confidence interval (CI) = 1.6-6.4]; (ii) more than 12 flexion or rotation movements of the trunk per hour (RR = 3.0, 95%CI = 1.4-6.4); and (iii) more than 3 years seniority in a job involving lifting more than 25 kg at least once an hour (RR = 3.7, 95%CI = 1.4-9.4). As to psychosocial work characteristics, first-ever low back pain was associated with a combination of low psychological job demands and low supervisor support. CONCLUSION: Work-related physical factors and psychosocial work characteristics should be considered as risk factors for first-ever low back pain. First-ever episodes of low back pain are common in the first year of employment. This may reflect a lack of work experience or training.

Adult↗