Low Back Pain Previous research has found over one hundred potential risk factors for LBP

(Bakker et al., 2009). A summary of the occupational risk factors of LBP are presented in table 1.

TABLE 1. Work-related risk factors of LBP Risk Factors Physical risk factors Manual material handling, including lifting, moving, carrying, and holding loads, as well as bending and twisting; whole-body vibration Patient handling, high level of physical activity Whole-body vibration, nursing tasks, heavy physical work, working with ones trunk in a bent and/or twisted position Occupational bending or twisting Low social support in workplace High job demands and low jod satisfaction

Reference (Hoogendoorn et al., 1999)

(Hoogendoorn et al., 2009)

(Bakker et al., 2009)

Psychosocial risk factors

(Wai et al., 2009) (Hoogendoorn et al., 2000) (Macfarlane et al., 2009)

According to a review of physical load during work as a risk factor for back pain (Hoogendoorn et al., 1999), there is a strong evidence that manual material handling, including lifting, moving, carrying, and holding loads, as well as bending and twisting are risk factors for back pain. The magnitude of the risk estimate (relative risk/odds ratio) ranged from 1.5 to 3.1 for manual handling. There is also strong evidence that whole-body vibration is a risk factor for back pain (effect estimate 4.8), and moderate evidence that patient handling and a high level of physical activity are risk factors for back pain with the magnitude of the risk estimates ranging from 1.7 to 2.7 (for patient handling) and from 1.5 to 9.8 (for heavy physical work). In the sensitivity analysis, however, no evidence was found for the effect of heavy physical load (Hoogendoorn et al., 1999). Five case-control studies and five prospective cohort studies were included in another recent systematic review on occupational bending or twisting and LBP. The conclusion was that the reviewed evidence was conflicting and not supportive of any clear causal relationship between occupational bending or twisting and LBP (Wai et al.. 2009). However, the results did suggest that bending activities

involving higher degrees of trunk flexion were associated with disabling types of LBP in certain working populations. In addition to physical load factors there is also evidence that psychosocial factors play a role in the aetiology of LBP. For symptom-free people, there is strong evidence that individual psychosocial findings are a risk factor for the incidence (onset) of LBP. However, the size of the effect is small (Waddell et al., 2001). A review of reviews has also been published on the associations between workplace psychosocial factors and musculoskeletal pain (Macfarlane et al.. 2009). This review claimed that out of the specific work-related psychosocial factors considered, the important factors were job demands, support, job autonomy and job satisfaction. With respect to back pain, the most consistent conclusions (4 reviews positive out of 6) were with high job demands and low job satisfaction. One of the included reviews (Hoogendoorn et al. 2000) found also strong evidence for low social support at work as a risk factor for LBP. However, this result was sensitive to changes in the rating system and the methodological quality of the studies. The authors considered also that the effect for low job satisfaction could be a possible result of insufficient adjustment for psychological work characteristics and physical load at work. They concluded that there seemed to be evidence for an effect of psychological factors at work but that the evidence for the role of specific work-related psychological factors has not been established yet (Hoogendoorn et al. 2000). Psychosocial risk factors seem to vary according to the type of LBP. In a Finnish prospective cohort study (Kaila-Kangas et al. 2004), low job control and low supervisor support at baseline were associated with increased risk of hospitalisation for back disorders in the 17 year follow-up. There was no similar association for intervertebral disc disorders. Instead, it has been shown in another Finnish study that physically demanding work was a risk factor for sciatica among men (Kaila-Kangas et al. 2009). The risk increased with the length of the exposure for the first 20 years, but decreased thereafter. This study found also a remarkably high prevalence of sciatica among those who were not working. In this group, sciatica was strongly associated with previous work exposures. These results indicate that premature health-related selection out of heavy work had occurred. The results of physical load exposures as risk factors for LBP in most reviews have been rather insensitive to slight changes in the assessment of the outcomes and the methodological quality of the

studies. This, however, does not apply to the results for psychological factors. This indicates that the body of evidence supporting the role of physical load as a risk factor for back pain is somewhat more consistent than that for the psychosocial factors.