| Musculoskeletal disorders (MSDs), of which low | | | | vibration. Other associated factors include |
| back pain (LBP) is one, are among the most | | | | psychosocial issues such as low social support, low |
| common causes of sickness absence, long-term | | | | job satisfaction and work organisational factors |
| incapacity benefit (IB) for work, and ill health | | | | (Hermans 2000). |
| retirement: (Waddell 2006). MSDs account for | | | | Dillane et al (1996) pointed out that meaningful |
| 23% of sick certification, 21% of IB and 15-50% | | | | diagnosis of LBP is rare which is a situation that |
| of ill health retirement (in different occupational | | | | appears to have changed little in the intervening |
| settings).The annual incidence of LBD has been | | | | years with eighty fivepercent of chronic low back |
| reported to be approximately 5% (Andersson, | | | | pain (CLBP) disorders still having no known |
| 1999; Hoogendoorn et al., 1999). In the UK, the | | | | diagnosis leading to a classification of 'non-specific |
| annual incidence of low back pain in the general | | | | CLBP (O'Sullivan 2005). |
| population is reported to be 4.7%, with a point | | | | A diagnostic method of classification has been |
| prevalence of 19%, a twelve month of | | | | recently published, however, that is based on |
| prevalence of 39% and a lifetime prevalence of | | | | eliciting a pattern that reveals the diagnosis of |
| 59% (Hillman et al 1996). | | | | hitherto non-specific low back pain. This heralds an |
| When presenting as a musculoskeletal disorder, | | | | new era where in there is potentially a much |
| LBP is a major cause of business inefficiency | | | | clearer path towards prevention as there are now |
| accounting for half of the percentages presented | | | | a set of defined patterns that reveal the diagnosis |
| above and costing the economy £5bn per | | | | (Sweetman 2005). |
| annum with the loss of 4.9 million working days. | | | | There are seven patterns that Sweetman (2005) |
| From an economic point of view alone, therefore, | | | | has been identified: |
| the primary prevention of LBP appears to be | | | | - Facet Joint Pattern |
| quite an attractive prospect. | | | | - Rotation Back Strain Pattern |
| Porter (1993) outlined the following aspects to be | | | | - Two Disc Patterns |
| considered for the prevention of back pain: | | | | - Pelvi - spondylitis and sacro - iliitis pattern |
| - Changing the environment - ergonomics | | | | - No sign pattern |
| - Changing the individual - morphology | | | | It is reasonable to suppose that sub homogenous |
| - Changing attitudes - education | | | | groups of non-specific back pain that can be |
| - Deployment of individuals at work - screening | | | | diagnosed through establishing specific patterns will |
| There is little evidence that the application of | | | | respond to specific treatments, will have specific |
| Ergonomics within the work place has any | | | | aetiologies and specific means of prevention that |
| preventive affect (Wadell 1998). Changing | | | | may well vary. Of the above patterns, Sweetman |
| morphology is probably still a dream, and | | | | (2005) has been able to demonstrate that heavy |
| education has not demonstrated any benefit | | | | work exacerbates one pattern (Facet Joint |
| either (Burton et al 2004). The deployment of | | | | Pattern) whereas a different type of heavy work |
| individuals at work may hold merit with some | | | | protects against another pattern (Rotation Back |
| form of screening but is probably not practicable | | | | Strain). This finding illustrates why interventions |
| or ethical within the general world of work. | | | | that hitherto reduce loading (that are often |
| Little progress has been made into the primary | | | | contained within Ergonomics and Education Based |
| prevention of LBP but as the Government | | | | Training Interventions)may not facilitate a |
| struggles with the cost of increasing dependency | | | | reduction in the incidence of LBD as,whilst |
| ratios, the edict that prevention is better than | | | | protecting against one form of back pain, they |
| cure is moving up the political agenda and is being | | | | exacerbate another - potentially cancelling out any |
| applied to the health of the Nation in general as | | | | effect on incidence. |
| well as Occupational Health. | | | | Going forwards, Ergonomics based interventions |
| Factors that are associated with LBP in the | | | | should take account of the fact that loading spinal |
| workplace include the physical aspects of work | | | | tissues can be protective and that Ergonomics |
| such as heavy physical work, the lifting and | | | | interventions henceforth should include |
| handling of load, awkward and static postures, | | | | interventions that appropriately increase the |
| repetitive bending and twisting and whole body | | | | loading on spinal tissues. |