Comparison of Different Approaches for the Prevention of Low Back Pain

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Abstract
Three major approaches have been used to reduce the problem of low back pain: training and education, job design (ergonomics), and job placement (selection). Training is the oldest and most common approach. Teaching the worker to lift with a straight back and bent knees is one of the oldest types of training found in industry. Unfortunately, it has been difficult to prove the effectiveness of this approach in reducing compensable low back pain. More effective results have come from training the worker in strength and physical fitness and in training management on how to respond to low back pain when it does occur. The training of practitioners in treating low back pain is also important since many long-term disability cases result from inappropriate treatment and/or the prolonged use of ineffective treatment. The ergonomic approach of designing the job to fit the capabilities of the worker has received greater attention in recent years. Unnecessary bending, twisting, and reaching are risk factors to be avoided in good job design. Criteria for determining excessive loads have been developed for use in evaluating and designing jobs. Studies have shown that good job design can reduce up to one-third of compensable low back pain. The use of ergonomic principles in job design can reduce the probability of initial and recurring episodes, allow the worker with moderate symptoms to stay on the job longer, and permit the disabled worker to return to the job sooner. The third approach to controlling low back pain is job placement, or the selection of the worker to fit the job. This approach is particularly useful for jobs that are difficult to design or control such as firefighters, police, and certain construction and delivery operations. The use of medical criteria in job placement can identify up to 10 percent of young workers susceptible to low back pain. Studies on strength testing indicate that the probability of a musculoskeletal disorder is up to three times greater when job lifting requirements approach or exceed the worker's isometric strength capability. It is concluded that there is no simple solution to low back pain and that all three approaches are necessary for the best possible control of the disorder. However, some approaches are more effective than others and should be considered first in any program to reduce low back pain. Although knowledge about low back pain is limited, enough is already known to adequately control the problem. Instead of waiting for a major medical breakthrough to occur, emphasis should be placed on applying the knowledge that is already available.

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