Does  a  heavy  job  wear  out  your  back?  

Dr  Angus  Forbes  Occupa9onal  Physician  

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  

•  Heavy  work  •  Prospec9ve  studies  

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  

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