Lumbar spine
• Studies limited by the nature of back pain and diagnosis
• Life9me prevalence up to 80% • Ac9vity limi9ng pain has a 1 year recurrence of 24-‐80%
Lumbar spine
• Lumbar disc degenera9on is almost universal • Proposed (but not validated) as a cause of back pain
• Degenera9on largely based on gene9cs(1)
BaLe, videman.The twins spine study. 2009
Lumbar spine
• Pathology and disability do not appear to be related – Degenera9ve changes occur later in women, but cohort studies do not demonstrate a difference in back pain
Lumbar spine
• Work percep9on and psychosocial factors are predic9ve of acute low back pain(1)
(1) Bigos et al
Lumbar spine
• Heavy physical work – A number of studies report no sta9s9cally significant rela9onship with back pain.
– Some studies show a weak link – Sta9s9cally significant links in high manual handling of materials in scaffolders, and liUing and standing in smokers.
Lumbar spine
• Physical load not associated with occurrence of back pain, but was a risk factor for sickness absence(1)
(1) Burdorf, Jansen 2006
Lumbar spine
• SiLng – Strong evidence this is not associated with back pain
– Belief that siLng increases disc pressure is not founded in evidence(1)
(1) Claus, Hides 2006
Lumbar spine
• AGE – Strong evidence no associa9on with back pain
• Obesity – Conflic9ng evidence
• History of back pain
(1) Claus, Hides 2006
Lumbar spine
• Psychosocial – Weak associa9on with job sa9sfac9on
• Support – Strong evidence that a lack of social and supervisory support is a risk factor for absence with low back pain.
(1) Claus, Hides 2006
Cervical Spine
• Life9me incidence of neck pain: 14 – 71% • 1 year prevalence: 16 – 75% • “Heritability” 73%(1)
1. Macgregor 1999, 204
Cervical spine
– “insufficient evidence(1)” – LiUing >50kg/hr above shoulder height weakly associated with neck and/or shoulder pain
– Pushing and pulling not associated
(1) AMA guide to disease and injury causa9on 2014
Cervical spine
• Insufficient evidence(1) for: – Neck posture – Prolonged work in sedentary posi9on – Repe99ve and precision work
(1) AMA guide to disease and injury causa9on 2014
Cervical spine
• Age – Significant increase in neck pain with increasing age (>50 years)
• Gender – Strong data for increase in women > men
• BMI, smoking – Uncertain
• Past neck pain – significant
Whole body vibra9on
• No iden9fied associa9on or causal rela9onship between WBV and imaging findings
• No iden9fied discrete condi9on • No known dose response • Withdrawl from WBV has not been shown to stop symptoms, or alter aging degenera9on