Welcome to Chiropractic OnLine Today's Journal Corner's Literature Review of
the Month.
This month's topic centers on Prevention of Low Back Pain. Welcome to Chiropractic OnLine Today's Journal Corner's Literature Review of
the Month.
This month's topic centers on Prevention of Low Back Pain.
2. Ciriello VM, Snook SH. The effect of back belts on lumbar fatigue. Spine 1995; 20(11):1271-1278.
3. Lahad A, Malter AD, Berg AO, Deyo RA.The effectiveness of four interventions for the prevention of low back pain. JAMA 1994; 272:1286-1291.
4. Troup JDG. The perception of musculoskeletal pain and incapacity for work: Prevention and early treatment. Physiotherapy 1988; 78(9):435-439.
The first and second papers report on studies that have examined the use of support belts by people involved in occupations which involve heavy lifting. The use of these belts has grown tremendously in the past few years and arose in an attempt to provide support for the lower back during vigorous activities. Many employers have made it mandatory that their employees make use of these devices at all times. But the question remains, are they effective in preventing injury to the lower back? According to these studies, perhaps not. The first study looked at 22 subjects and tested their ability to engage in isometric and dynamic (progressively lifting cannisters to various heights) lifting activities. The results showed no difference in strength between groups wearing a belt and those not. This does not necessarily mean that the belts do not prevent injury, but only that they do not increase strength.
The second study looked at 13 male industrial workers who engaged in lifting tasks 2 days per week for 4 weeks for 1-4 hours each session. Endurance tests and median frequency EMG evaluation was used to assess the difference in endurance capacity between days in which they wore a support belt and those in which they did not. The results showed no difference in fatigue after wearing a belt or not wearing one.
The third paper reviewed the literature that had been published up to the time the paper was written on the effectiveness of exercise, education, mechanical supports and behavior modification for risk factors and showed that there is some evidence, though limited, of the role of exercise, although it is not clear whether there is a difference between aerobic and trunk strengthening exercise. There is minimal evidence to support education and no support for mechanical supports. There is no evidence for risk factor modification. Thus it appeared that there is very little known that can be done to prevent episodes of acute low back pain. There is some evidence that people who are physically fit in general tend to have fewer episodes of LBP, though this may not be considered a specific prevention strategy.
Finally, the fourth paper by Troup was published in 1988 and discusses the concepts of musculoskeletal injuries in the workplace and their prevention. Traditionally, there have been 4 approaches to this:
Ergonomics, which at the time of this paper had only just started to gather evidence of cost savings.
Troup also discusses the issue of preventing the acute injury from becoming chronic. The majority of costs for LBP disability are incurred by the small percentage (approximately 10%) that become chronic. Probably the most important factor in the progression to chronic stages in the fear of pain, which leads to avoidance behavior and disuse. Pain in the back has a different effect on a person than other types of pain, such as toothache. Studies have shown that people who consult doctors for LBP have a higher rate of consultation for other complaints. One study showed that people with LBP had a higher likelihood of passive coping strategies (ie rest, medications), than people with other types of pain, who were more likely to take active coping strategies (run it off, ignore the pain).
So perhaps the best form of prevention is not one that is aimed so much at preventing the initial injury, but preventing it from becoming chronic - this is where the majority of cost savings would be seen. As the methods that have been used for preventing initial episodes have not held up very well to scrutiny, perhaps this is the direction we need to head in our attempt to gain control over the increasingly costly problem of chronic LBP.