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PubMed2005

Relationships between work-related factors and disorders in the neck-shoulder and low-back region among female and male ambulance personnel.

This cross-sectional study on a random sample of 1,500 ambulance personnel investigated the relationships between self-reported work-related physical and psychosocial factors, worry about work conditions, and musculoskeletal disorders among female and male ambulance personnel. Three different outcomes, complaints, activity limitation, and sick leave, for the neck-shoulder and low-back region, respectively, were chosen. Among the female personnel, physical demands was significantly associated with activity limitation in the neck-shoulder (OR 4.13) and low-back region (OR 2.17), and psychological demands with neck-shoulder (OR 2.37) and low-back (OR 2.28) complaints. Among the male personnel, physical demands was significantly associated with low-back complaints (OR 1.41) and activity limitation (OR 1.62). Psychological demands and lack of social support were significantly associated with neck-shoulder complaints (OR 1.86 and OR 1.58, respectively) and activity limitation (OR 3.46 and OR 1.71) as well as activity limitation due to low-back complaints (OR 2.22 and OR 1.63). Worry about work conditions was independently associated with activity limitation due to low-back complaints among the female (OR 5.28), and to both neck-shoulder and low-back complaints (OR 1.79 and OR 2.04, respectively) and activity limitation (OR 2.32 and OR 1.95) among the male personnel. In conclusion, the association patterns between physical and psychological demands and MSDs suggest opportunities for intervention.

Adult↗
PubMed2006

Neck/shoulder, low back, and arm pain in relation to computer use, physical activity, stress, and depression among Dutch adolescents.

OBJECTIVE: To examine among adolescents (1) the prevalence of neck/shoulder, low back, and arm pain within different sociodemographic groups and (2) the association of neck/shoulder, low back, and arm pain with computer use, physical activity, depression, and stress. METHODS: A school-based questionnaire survey in 2002 and 2003 of neck/shoulder, low back, and arm pain, computer use, physical activity, depression, and stress. The survey was given to 3485 adolescents aged 12 to 16 years who attended secondary schools in Amsterdam, Netherlands. RESULTS: The overall prevalence of neck/shoulder, low back, and arm pain was 11.5%, 7.5%, and 3.9%, respectively. The prevalence of neck/shoulder pain was higher among girls and adolescents not living with both parents. The prevalence of low back pain also was higher among girls. Depressive symptoms were associated with neck/shoulder pain, low back pain, and arm pain. The stress experienced was associated with neck/shoulder pain and with low back pain. CONCLUSIONS: This study strengthens the findings that musculoskeletal pain is common among adolescents and is associated with depression and stress but not with computer use and physical activity.

Adolescent↗
PubMed2002

Predictors of compliance with short-term treatment among patients with back pain.

OBJECTIVE: Great efforts have been made to find effective treatments for back pain. Nevertheless, the effectiveness of a particular treatment can depend on patient compliance. The objective of this study was to prospectively investigate whether patients' demographic factors, clinical factors, external barriers in following the treatment, and perceptions of disability, quality of life, depression, and control over health were predictive of compliance with a physical therapy program carried out with patients with low back pain. METHODS: This was an exploratory prospective cohort study that was carried out in New York City during 1999. All study participants answered a questionnaire at the initial clinical evaluation by a physical therapist and were followed during the treatment. The study assessed compliance with the three treatment regimens that were prescribed for every patient: attending scheduled physical therapy sessions, following a program of home exercises, and watching back-education videotapes. Depending on the individual patient, the planned treatment program could last from 2 to 6 weeks. The study employed a battery of instruments to measure patient characteristics that included perceived functional limitations, perceived quality of life, depression, and their beliefs about their health. Student's t tests and chi-square tests were used to determine if non- and low-compliant patients differed significantly from high-compliant patients. Logistic regression was used to estimate adjusted odds ratios expressing the association of selected variables with compliance. RESULTS: We found that 51% of the patients were either noncompliant or low-compliant overall with the low back pain treatment program. There were differences in compliance behavior among the three treatment regimens, with compliance being highest for watching the back-education videotapes and lowest for doing the home exercises. Poor compliance overall was positively associated with the expectation of barriers in following the proposed treatment, with comorbidity, and with longer duration of treatment in this program. CONCLUSIONS: The findings of our study indicate that patient compliance with back pain treatment is a serious and complex problem. Nevertheless, while this study was only an exploratory one, we believe that the results of this study can be used by care providers to identify patients likely to become noncompliant and also by researchers to plan specific studies on the effectiveness of treatment programs for patients with low back pain.

Adolescent↗
PubMed2005

The need to legislate the health-care industry in the state of Washington to protect health-care workers from back injury.

There is an epidemic of health-care worker back injury in the State of Washington. Voluntary programs are not keeping pace with the increasing back injury rates to health-care workers. Adding all the health-care industry SIC codes, hospitals, nursing homes, home health and residential care puts health-care as the leading industry in the State of Washington for back injury. Licensed practical nurses, nurses aides, and registered nurses account for the majority of all claims in the health-care industry. Self-insured hospitals led the state for lost time compensable back injuries between 1993 and 2001, and combined Washington State Fund and self-insured health-care hospitals and nursing homes led all other industries for compensable soft-tissue disorders of the neck, back, and upper extremities. Legislation is needed to protect this group of workers in this type of industry. A bill will be re-introduced in the 2006 session that calls for hospitals to implement back injury prevention programs through either the Zero-Lift model, with nursing staff use of lift equipment, or the Lift-Team model, with a specially trained team using lift equipment, or a combination of the two, for all shifts. The State of Washington should provide funding, through savings created by back injury prevention programs, for small rural health-care institutions to assist them in compliance with the legislation.

Back Injuries↗
PubMed2001

The value of magnetic resonance imaging of the lumbar spine to predict low-back pain in asymptomatic subjects : a seven-year follow-up study.

BACKGROUND: In 1989, a group of sixty-seven asymptomatic individuals with no history of back pain underwent magnetic resonance imaging of the lumbar spine. Twenty-one subjects (31%) had an identifiable abnormality of a disc or of the spinal canal. In the current study, we investigated whether the findings on the scans of the lumbar spine that had been made in 1989 predicted the development of low-back pain in these asymptomatic subjects. METHODS: A questionnaire concerning the development and duration of low-back pain over a seven-year period was sent to the sixty-seven asymptomatic individuals from the 1989 study. A total of fifty subjects completed and returned the questionnaire. A repeat magnetic resonance scan was made for thirty-one of these subjects. Two neuroradiologists and one orthopaedic spine surgeon interpreted the original and repeat scans in a blinded fashion, independent of clinical information. At each disc level, any radiographic abnormality, including bulging or degeneration of the disc, was identified. Radiographic progression was defined as increasing severity of an abnormality at a specific disc level or the involvement of additional levels. RESULTS: Of the fifty subjects who returned the questionnaire, twenty-nine (58%) had no back pain. Low-back pain developed in twenty-one subjects during the seven-year study period. The 1989 scans of these subjects demonstrated normal findings in twelve, a herniated disc in five, stenosis in three, and moderate disc degeneration in one. Eight individuals had radiating leg pain; four of them had had normal findings on the original scans, two had had spinal stenosis, one had had a disc protrusion, and one had had a disc extrusion. In general, repeat magnetic resonance imaging scans revealed a greater frequency of disc herniation, bulging, degeneration, and spinal stenosis than did the original scans. CONCLUSIONS: The findings on magnetic resonance scans were not predictive of the development or duration of low-back pain. Individuals with the longest duration of low-back pain did not have the greatest degree of anatomical abnormality on the original, 1989 scans. Clinical correlation is essential to determine the importance of abnormalities on magnetic resonance images.

Adult↗
PubMed1996

Management of back pain in athletes.

Back pain affects millions of people. It affects 80% of the population and up to 52% at any given time. Back pain is not limited to sedentary individuals; it has significant effects on athletes as well. Depending upon the sport, incidence rates of back pain occur in athletes from 1.1% to as high as 30%. Athletes differ from the non-athletic population in that their incentives to return to activity are considerably different than non-athletes. The reasons may vary from the will to win through to significant financial considerations. Although reasons for recovery are different, the physiology and mechanics of repair of injured soft tissue in the athlete is the same as for the non-athlete. Proper management of the athlete requires ruling out emergent causes of back pain such as tumour, infection, acute fracture, progressive neurological deficit, visceral sources (e.g. pancreatitis, abdominal aortic aneurysm), and rheumatoid variants. Once a good history and physical is performed, a simple classification system can be utilised to manage the athlete presenting with back pain. This system can be expressed as: (a) regional back pain; (b) radicular leg pain; (c) radicular leg pain with progressive neurological deficit; and (d) cauda equina syndrome. Each of these categories needs to be managed in a specific manner and can provide the healthcare professional with simple, straightforward guidelines for handling the athlete with lower back pain. The key is to return the athlete to the field of play in a safe and timely manner.

Athletic Injuries↗
PubMed1992

The relationship between back pain and lead apron use in radiologists.

Anecdotal experience has suggested that back pain in radiologists may result from extensive wearing of lead aprons. To investigate this possibility, we sent questionnaires to 688 radiologists in various subspecialties whose use of lead aprons varied from none to moderate to extensive. The questionnaire included both objective items that quantitated apron use and back pain and subjective items that asked, for example, if the respondent believed that lead aprons were responsible for his or her back pain. We received 236 responses (34% response rate). Objective data from those radiologists who had experienced no back pain before wearing a lead apron (179 radiologists, 26% of those surveyed) were tabulated; respondents were grouped according to age, time spent wearing a lead apron, and degree of back pain. Odds ratios were calculated. Answers to subjective questions for all respondents were tabulated. Back pain was reported by 52% of those who estimated their lead apron use at greater than or equal to 10 hr per week, the mean response, as opposed to 46% of those who wore lead aprons fewer than 10 hr a week. These and related results were not statistically significant. Our study does not prove that wearing a lead apron is a significant risk factor for the development of back pain.

Adult↗
PubMed1990

Effects of chronic back pain on the perception of experimental heat pain.

19 patients between 23 and 65 yr. of age whose chronic back pain was caused by lumbosacral disk disease and 19 healthy volunteers matched for age and sex were studied. Pain thresholds under phasic and tonic heat stimulation and thermal thresholds for warmth and cold were measured on the right hand. The patients rated any current back pain on a visual analog scale. There was a significant negative correlation between current back pain and the threshold for tonic pain, but there was no correlation between current back pain and either the threshold for phasic pain or temperature sensitivity. Hence, current back pain and experimental tonic pain seem to have an additive effect on pain perception because perceptual qualities are similar. Reduced somatosensory perception of chronic back pain patients could be demonstrated for temperature sensitivity and to a lesser degree for phasic pain, but as a consequence of the "opposing" effect of current back pain, not for tonic pain perception.

Arousal↗
PubMed1998

Effects of a three-month active rehabilitation program on psychomotor performance of lower limbs in subjects with low back pain: a controlled study with a nine-month follow-up.

Proper psychomotor performance is needed in work and in activities of daily living, but among subjects with low back pain this area has been studied little. The present purpose was to evaluate the effect and permanence of a 3-mo. physical exercise program on the psychomotor performance of lower limbs in subjects with low back pain. The associations between psychomotor performance and intensity of low back pain and subjective disability were also evaluated. 90 subjects with nonspecific, subacute low back pain were assigned to one of the three groups: one given three months intensive training, one home exercise, or the control group. Four measurement sessions were made during the 1-yr. study. Psychomotor speed of lower limbs was analyzed with Choice Reaction Time, Movement Time, and Total Response Time. Flight Time of a vertical static jump was also measured. Muscle strength was assessed with conventional methods from trunk, lower limbs, and hand. Intensity of Current Back Pain was analyzed with the Borg scale. Subjective disability was evaluated with the Oswestry Index. Analysis showed that muscle strength and back pain intensity had associations with psychomotor performance but subjective disability or physical activity did not affect it noticeably. There were no changes in Choice Reaction Time, but Total Response Time and Movement Time decreased and Flight Time increased for all subjects. In the first postintervention measurement the home exercise group had significantly lower Movement Time than the intensively trained group. Back Pain Intensity decreased in both exercise groups for those subjects whose psychomotor performance values were below the mean value for the sample.

Adult↗
PubMed1997

Low back pain among cooks in nursery schools.

A cross-sectional questionnaire study was conducted on cooks working for nursery schools in N city in order to verify epidemiological evidence of the work-relatedness of low back pain among them. After female workers aged 30 or more were selected from a study base of 2,799 workers in social welfare facilities, low back pain prevalence of cooks (n = 240) was compared with nursery school teachers (n = 955). Age-standardized prevalence ratios (PRs) of low back pain were 1.9 (95% CI: 1.5-2.5) in cooks compared with nursery school teachers. Among cooks, relative risks of low back pain increased with the increase in the number of lunches to be prepared and decreased with the increase in the number of cooks making lunches in a logistic regression model controlling age and body length. Low back pain was also found to be associated with self-estimated job stressors/ work load by logistic regression models. Multifactorial effects from ergonomic and psychosocial factors, and individual factors on the low back were suggested. From the viewpoint of epidemiological criteria for work-relatedness, it was concluded that the work-relatedness of low back pain among cooks in nursery schools was partially supported.

Adult↗
PubMed2005

The influence of head and neck position on kinematics of the back in riding horses at the walk and trot.

REASONS FOR PERFORMING STUDY: A common opinion among riders and in the literature is that the positioning of the head and neck influences the back of the horse, but this has not yet been measured objectively. OBJECTIVES: To evaluate the effect of head and neck position on the kinematics of the back in riding horses. METHODS: Eight Warmblood riding horses in regular work were studied on a treadmill at walk and trot with the head and neck in 3 different predetermined positions achieved by side reins attached to the bit and to an anticast roller. The 3-dimensional movement of the thoracolumbar spine was measured from the position of skin-fixed markers recorded by infrared videocameras. RESULTS: Head and neck position influenced the movements of the back, especially at the walk. When the head was fixed in a high position at the walk, the flexion-extension movement and lateral bending of the lumbar back, as well as the axial rotation, were significantly reduced when compared to movements with the head free or in a low position. At walk, head and neck position also significantly influenced stride length, which was shortest with the head in a high position. At trot, the stride length was independent of head position. CONCLUSIONS: Restricting and restraining the position and movement of the head and neck alters the movement of the back and stride characteristics. With the head and neck in a high position stride length and flexion and extension of the caudal back were significantly reduced. POTENTIAL RELEVANCE: Use of side reins in training and rehabilitation programmes should be used with an understanding of the possible effects on the horse's back.

Acceleration↗
PubMed1991

The impact of low back and pelvic pain in pregnancy on the pregnancy outcome.

The prevalence and characteristics of back pain were recorded in 855 women on nine occasions during pregnancy from the 12th to the 36th week of gestation. Data on delivery and pain relief were recorded. At 12 months post partum the women were reassessed regarding the presence of back pain. Women with a history of back pain had more intense pain (p less than 0.05). No correlation was observed between back pain (a) during pregnancy and (b) after pregnancy and delivery, nor between (a) the need for pain relief in labor and (b) birthweight, length and Apgar score. Back pain usually disappeared in the first 6 months post partum, except in women with recurrent back pain from previous pregnancies. Eighty-two percent of these women continued to have back pain at 18 months post partum, compared with 45% of all other multi-parous women (p less than 0.001).

Adult↗
PubMed1990

Back pain and spinal pathology in patients with functional upper abdominal pain.

Thirty-nine hospital outpatients with upper abdominal pain without demonstrable organic abdominal abnormalities and 28 healthy controls were compared blindly with regard to back pain and back abnormalities when subjected to a standardized physical examination of the spine. Seventy-two per cent of the patients versus 17% of the controls were troubled with back pain (P less than 0.001). Seventy-five per cent of the patients with back pain actually had abnormalities revealed at the physical examination, indicating that some organic mechanisms are involved in back pain. Most of the findings were localized to the lower thoracic and thoracolumbar segments, the same segments that innervate the upper gastrointestinal tract. This suggests the existence of a connection between abdominal pain and back pain. Viscerosomatic or somatovisceral reflexes with trigger zones either in the viscera or in the skin, muscles, tendons, or ligaments could be part of the pathophysiology in this syndrome. Fifty-one per cent of the patients had symptoms of irritable bowel syndrome, and 41% had heartburn, which was significantly related to the experience of back pain.

Abdominal Pain↗
PubMed1989

Risk factors for low back pain and sciatica.

So far, eight prospective studies and 50 cross-sectional or retrospective studies have focused on risk factors for low back syndromes. Half of these have been published during the 1980s. Hard physical work and, in particular, frequent lifting and postural stress are likely to result in disc degeneration, low back pain and sciatica. Physical strain may also have prophylactic effects, as physical leisure activity and muscular strength are negatively associated with the risk of low back pain. Much evidence points to driving motor vehicles being causally associated with low back pain and sciatica. A probably causal relationship exists between body height and risk of sciatica, but height is not necessarily predictive of other types of low back pain. Obesity, smoking, psychological distress and poor general health also carry increased risk of low back pain, but their causal role is questionable. Although none of the suspected risk factors can be described as having been conclusively investigated epidemiologically, the results of published studies show that there are modifiable factors contributing to low back pain. The overall potential of primary prevention is great if adequate tools for intervention can be developed.

Back Pain↗
PubMed1989

Descriptive epidemiology and public health aspects of low back pain.

The prevalence of low back syndrome and its consequences in terms of disability, handicap, and need for medical care were studied as part of "the Mini-Finland Health Survey". A sample of 8000 persons representative of the Finnish population aged 30 or over was invited for examination, and 7217 (90%) participated. At interview 75% of the participants reported that they had experienced at least one episode of low back pain. Six or more episodes were reported by half of the population, and about 20% had suffered from pain during the previous month. On the basis of a standardised clinical examination, a physician diagnosed low back syndrome in 17.5% of men and 16.3% of women. The prevalence was highest in those aged 55-64 years. The use of health services was frequent among those suffering from low back pain. Nevertheless, their need for care was commonly unmet. Some disability was found in almost 60% of the subjects with low back pain, although severe functional limitations were rare. It was estimated that of the work disability the reduced capacity for everyday duties apart from work, and the reduced capacity for leisure time activities, in the population 18%, 16%, and 17%, respectively, were attributable to the low back syndrome. Thus low back syndrome has a strong impact on individuals and on society as a whole.

Adult↗
PubMed1989

Risk indicators in low back pain.

Injuries leading to low back pain can occur by direct trauma, overexertion or repetitive trauma. Overexertion is claimed by 60% of low back pain patients as the cause of injury. Of these patients with overexertion injuries, 66% implicated lifting and 20% pushing or pulling. It is, however, difficult to relate the workplace to the complaint of low back pain in a specific worker, and low back pain is found quite often in those with sedentary occupations. The incidence, severity and potential disability are all related to the demands on the individual in the workplace. Among the factors implicated are the requirements for lifting (particularly when compared to the worker's lifting capacity), pushing and pulling, posture, and cyclic loading. Drivers of heavy vehicles have two to four times the average incidence of serious low back pain. This is probably due to the cyclic loading environment. The general psychosocial environment (including that at work) is an important risk factor. The first attack of low back pain occurs in the teens or twenties. Low back pain is as frequent in females as males, although women in manual materials handling jobs are at greater risk. Posture, anthropometry and mobility measures have limited prognostic value. Muscle strength and physical fitness probably have some value. Radiographic findings have little pragmatic value.

Age Factors↗
PubMed2002

Impact of repetitive manual materials handling and psychosocial work factors on the future prevalence of chronic low-back pain among construction workers.

OBJECTIVES: This study investigated the influence of manual stone and brick handling and psychosocial work factors on the risk of chronic low-back pain and describes the impact in terms of risk advancement period. METHODS: The Hamburg Construction Worker Study included a longitudinal study among 488 male construction workers. Adjusted prevalence ratios (PR) of chronic low-back pain (>3 months during the last 12 months) according to self-reported worktasks in the baseline survey were estimated with the Cox proportional hazards model. RESULTS: The 1-year prevalence of chronic low-back pain was 15.4%. Workers with chronic low-back pain in the baseline survey had a higher risk of such pain during the follow-up (PR4.07,95% CI 2.18-7.59). The prevalence in association with laying large lime sandstones for >2 hours per shift (PR 1.80, 95% CI 1.04-3.14) further increased after adjustment for job category (PR 2.69, 95% CI 1.25-5.78), and it advanced the risk by a risk advancement period of 18 years (95% CI 4-39). Workers with low satisfaction with their work achievements had a higher prevalence of chronic low-back pain (PR 2.07, 95% CI 1.10-3.88). Similar risk estimates were observed in the subgroup without chronic low-back pain in the baseline survey. A strong effect of time pressure wasonly present for these workers (high: P R 6.30,95% CI 1.41-28.21). CONCLUSIONS: The results suggest that repetitive work involving bent positions and the manual manipulation of heavy stones increases the risk of future chronic low-back pain. For risk communication, the notion that a 40-year-old construction worker laying large sandstones has the same risk as an unexposed 58-year-old construction worker may be more informative.

Achievement↗
PubMed2006

Disability associated with low back pain in Mulago Hospital, Kampala Uganda.

BACKGROUND: Low back pain is sufficiently disabling and a common cause of disability particularly during the productive middle years of adult life. Disability implies interference with daily activities. OBJECTIVE: To assess and document the disability associated with low back pain in terms of sick leave days, interference with daily activities and some pain characteristics. METHODS: This study was carried out in the Orthopaedic out patient clinic of Mulago Hospital, a tertiary national referral hospital in Kampala, Uganda. It was a descriptive cross sectional study over a period of seven months. 204 patients with mechanical back pain were enrolled in the study, after screening all consecutive new adult patients referred with low back pain as the major complaint. A validated modified Oswestry instrument was used to collect data. Nine daily activities: sleep, sex, lifting, traveling, social and recreational activities, dressing, sitting, walking and running activities were investigated. Data was analyzed using SPSS for windows version 10. Mean and Standard deviations were used to summarize continuous variables. P value was considered statistically significant if it was equal or less than 0.05. RESULTS: 87% of the respondents reported a mean of 14 days off work during the 4 weeks prior to the interview because of back problems. The mean duration of a current low back pain episode was 5 months. All activities were interfered with; with lifting as the most affected with a mean score of 4.5, walking and running was 3.6, standing was 3.3, sex life was 2.9, traveling was 2.9, sitting was 2.7, social and recreational activities was 2.7, getting dressed was 2.1 and sleeping was 1.8. CONCLUSION: Our results confirm that low back pain is a significant cause of disability affecting the productive middle years of adult life and causes significant disruption of daily activities including sleep and sex. The cost of lost work time, compensation and treatment for our setting is a knowledge gap that should be filled by further study. There is need for a community-based study to ascertain extent of the problem in at a wider population level.

Activities of Daily Living↗