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Spinal mechanical load as a risk factor for low back pain: a systematic review of prospective cohort studies

PainSci » bibliography » Bakker et al 2009
Tags: etiology, back pain, biomechanics, sedentariness, posture, prevention, pro, pain problems, spine

Four articles on PainSci cite Bakker 2009: 1. The Trouble with Chairs2. How to Treat Sciatic Nerve Pain3. The Complete Guide to Low Back Pain4. 6 Main Causes of Morning Back Pain

PainSci commentary on Bakker 2009: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

This review of 18 studies of risk factors for low back pain confirmed strong evidence of no link to sitting, standing, walking, or common amateur sports; “conflicting” evidence about leisure activitiues like gardening, whole body vibration, hard physical work, and even “working with ones trunk in a bent and/or twisted position”; and no evidence of any quality about sleeping.

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

STUDY DESIGN: Systematic review.

OBJECTIVE: To review and critically evaluate the past literature for spinal mechanical load as risk factor for low back pain (LBP).

SUMMARY OF BACKGROUND DATA: LBP is a costly health problem worldwide, and treatments are often unsuccessful. Therefore, prevention might be more beneficial in the management of LBP. With respect to prevention, the knowledge of risk factors is essential. From the literature, exposures involving spinal mechanical load is frequently discussed as a potential risk factor for LBP. For a better understanding of this risk factor, we performed a systematic review of the literature. Additionally, we evaluated exposures of spinal mechanical load for possible dose-response relations with LBP.

METHODS: We systematically searched Medline, Embase, PsycINFO, and CINAHL databases (without language restriction) for full-report publications of prospective cohort studies, evaluating spinal mechanical load during work and/or leisure time activities as risk factors for nonspecific LBP in patients >18 years of age) free of LBP at baseline. We assessed the methodology of each article and extracted information on population, response rates, characteristics of LBP, exposures, and estimated association(s), using standardized forms. We performed a best evidence synthesis of the obtained information.

RESULTS: In total, 18 studies were eligible (all rated as high methodologic quality) reporting on 24,315 subjects.

CONCLUSION: We found strong evidence that leisure time sport or exercises, sitting, and prolonged standing/walking are not associated with LBP. Evidence for associations in leisure time activities (e.g., do-it-yourself home repair, gardening), whole-body vibration, nursing tasks, heavy physical work, and working with ones trunk in a bent and/or twisted position and LBP was conflicting. We found no studies, thus no evidence, for an association between sleeping or sporting on a professional level and LBP.

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