Low Back Pain Problems Research Articles

The Functional and Economic Outcome of Lumber Discectomy: A Comparative Study of Fenestration Discectomy Versus Hemilaminectomy and Discectomy

Background: Lumber disc prolapse accounts for only 5% of all low back pain problems but is the most common cause of radiating nerve root pain which called sciatica. In the 20th century, techniques were developed to remove the herniated disc with minimal invasiveness, with these minimally invasive techniques; authors demonstrated decreased soft tissue manipulation, operative time, blood loss, and hospital stay, allowing early recovery. Patients and methods: This is a prospective study carried in Sulaimaniyah Teaching hospital for 111 patients (72 male and 39 female) complained from lumber disc prolapse from May 2010 till May 2015. Two different surgical discectomy procedures were done to these patients as follows: 1. Fenestration discectomy was performed to 53 patients through 2-5 cm skin incision. 2. Hemilaminectomy and discectomy had done to 58 patients through skin incision 4-7 cm. 3. The patients were evaluated preoperatively and 6 months postoperatively by PROLO score. Results: 111 patients (72 male and 39 females with ratio 1.8:1) underwent surgical discectomy. The mean age of the patient was 36.2 + 6.2 years. Fenestration discectomy group: 53 patients (47.7%) underwent fenestration discectomy. The operation time was ranging from 48–92 min with mean operative duration 69.13 ± 8.96 min. The mean hospital stay was 1.31 ± 0.73 days ranging from 16 hours to 3 days. According to PROLO score, fair results were reported in four (7%) patients while good result obtained in 12 patients (23%) and 37 patients (70%) showed excellent result. No patient expressed poor result. Hemilaminectomy and discectomy group: 58 patients (52.3%) underwent hemilaminectomy and discectomy. The operation time was ranging from 56–103 min with mean operative time 78.66 ± 10.31 min. The mean hospital stay was 2.46 ± 1.42 days ranging from 1 day to 10 days. According to PROLO score, 9 patients (16%) obtained fair results while reliable results obtained in 15 patients (26%) and excellent results founded in 34 patients (58%). No patient showed poor results. Discussion: Duration of the operation and hospital stay were significantly shorter in fenestration discectomy group than hemilaminectomy and discectomy one (p-value less than 0.001). Through PROLO score both procedures showed significant improvement postoperatively in both economic and functional assessments. Most of our patients gain excellent results according to PROLO score in both surgical procedures. In this series 92% of patients treated with fenestration discectomy improved postoperatively with good or excellent score, while 85% of the patients treated with hemilaminectomy have that improvement. Conclusion: Both fenestration discectomy and hemilaminectomy with discectomy showed the same final postoperative outcome but the fenestration discectomy is superior since the operation duration, hospital stay is less and overall improvement is relatively better.

Fatigue responses of the human cervical spine intervertebral discs

Numerous studies have been conducted since more than fifty years to understand the behavior of the human lumbar spine under fatigue loading. Applications have been largely driven by low back pain and human body vibration problems. The human neck also sustains fatigue loading in certain type of civilian occupational and military operational activities, and research is very limited in this area. Being a visco-elastic structure, it is important to determine the stress-relaxation properties of the human cervical spine intervertebral discs to enable accurate simulations of these structures in stress-analysis models. While finite element models have the ability to incorporate viscoelastic material definitions, data specific to the cervical spine are limited. The present study was conducted to determine these properties and understand the responses of the human lower cervical spine discs under large number of cyclic loads in the axial compression mode. Eight disc segments consisting of the adjacent vertebral bodies along with the longitudinal ligaments were subjected to compression, followed by 10,000 cycles of loading at 2 or 4Hz frequency by limiting the axial load to approximately 150 N, and subsequent to resting period, subjected to compression to extract the stress-relaxation properties using the quasi-linear viscoelastic (QLV) material model. The coefficients of the model and disc displacements as a function of cycles and loading frequency are presented. The disc responses demonstrated a plateauing effect after the first 2000 to 4000 cycles, which were highly nonlinear. The paper compares these responses with the “work hardening” phenomenon proposed in clinical literature for the lumbar spine to explain the fatigue behavior of the discs. The quantitative results in terms of QLV coefficients can serve as inputs to complex finite element models of the cervical spine to delineate the local and internal load-sharing responses of the disc segment.

Clinical guidelines for low back pain: A critical review of consensus and inconsistencies across three major guidelines.

Given the scale and cost of the low back pain problem, it is imperative that healthcare professionals involved in the care of people with low back pain have access to up-to-date, evidence-based information to assist them in treatment decision-making. Clinical guidelines exist to promote the consistent best practice, to reduce unwarranted variation and to reduce the use of low-value interventions in patient care. Recent decades have witnessed the publication of a number of such guidelines. In this narrative review, we consider three selected international interdisciplinary guidelines for the management of low back pain. Guideline development methods, consistent recommendations and inconsistencies between these guidelines are critically discussed.

Pain-related factors associated with lost work days in nurses with low back pain: A cross-sectional study

Background and aimsChronic low back pain is known to contribute to lost work days (LWDs) in nurses. However, there is a limited understanding of the factors that moderate the impact of low back pain (LBP) on LWDs – in particular factors that are modifiable and that could therefore be the treatment targets of interventions designed to help nurses more effectively manage LBP.This study aims to identify pain-related factors that are associated with LWDs in nurses with LBP, in order to inform the development of interventions that could reduce LBP-related work dysfunction and improve patient care. MethodsA cross sectional study was conducted on 111 female nurses who were asked to answer questions regarding demographic information, work history, presence or absence of LBP, number of LWDs due to illness, and a number of factors that could potentially be related to LWDs including: (1) average and worst pain intensity; (2) the temporal pattern of LBP (constant versus intermittent); (3) pain aggravating factors (lifting, bending, walking, and standing); and (4) pain alleviating factors (medications, rest, exercise). ResultsSixty-five percent (n=72) of the sample reported LBP. Constancy of pain and having a LBP problem that was alleviated by rest were significantly associated with the number of LWDs, while maximum and average LBP intensity were only weakly associated. ConclusionThe findings provide important new information regarding what is (and of equal importance) what is not associated with LWDs in nurses with LBP. ImplicationsTo effectively reduce LBP-related work disability, interventions may need to teach nurses how to better manage constant pain and remain active despite pain, rather than focus on pain reduction. Research to examine the potential efficacy of such treatment approaches for nurses with LBP is warranted.

Risk assessment of musculoskeletal disorders by OVAKO Working posture Analysis System OWAS and evaluate the effect of ergonomic training on posture of farmers

Received: January 2016, Accepted: April 2016 Background: The agricultural sector is one of the most important sectors in production. The safety and health of farmers are important factors that can cause a significant increase in efficiency and productivity. The aim of this study was the assessment of musculoskeletal disorders (MSDs) using the OVAKO Working Posture Analysis System (OWAS) and evaluation of the effect of ergonomic training on posture of farmers. Materials and Methods: In this study, 400 farms were evaluated in 5 major activities including gathering of pistachios by men, gathering of pistachios by women, spading, gathering of pistachio waste, picking of wheat, and fertilizing regarding MSDs using the Nordic Musculoskeletal Questionnaire (NMQ) and OWAS. Then, the required ergonomic training was presented as face-toface to farmers and again evaluation was performed after the intervention. Results: Low back pain and knee problems had the highest frequency and can be caused by standin g or sitting for long periods of time, displacement and manual material handling, and undesirable workstations. A significant relationship was found between age and work experience, and MSDs (P ˂ 0.001). Risk level in pistachio and wheat gathering tasks wa s lowered significantly after the ergonomic interventions and required training compared to before the intervention (P ˂ 0.050). However, no significant change was observed in the spading and fertilizing tasks. Conclusions: The results showed that the prevalence of MSDs was relatively high in the studied farmers. Moreover, the level of risk that was obtained according to the OWAS indicated that the working conditions and environment in this industry are harmful. Therefore, t aking corrective actions in order to improve the working conditions is necessary.

A Study on Ergonomic Awareness among Workers Performing Manual Material Handling Activities

Manual material handling (MMH) is the most common cause of musculoskeletal disorders (MSDs) and low back pain (LBP). It involves manual lifting, lowering, carrying, pushing and pulling loads. This study has three main objectives, first: to identify ergonomics awareness towards MMH activities amongst the workers; second, to identify the body discomfort or body pain of the workers using Body Parts Symptom Survey (BPSS); and third to study the LBP and MSDs risk exposure in reference to MMH practiced by the workers using RULA. The respondents for the study were selected from the production area. There were 32 respondents who answered questionnaires regarding ergonomics awareness and reported their body pains through Body Parts Symptom Survey (BPSS) included in the 5-scale Likert questionnaires. Based on the self-reported survey, 7 subjects were chosen to be observed through Rapid Upper Limb Assessment (RULA). Evaluation of ergonomic awareness on MMH amongst workers on research area shows that they possess a moderate ergonomics awareness level (mean score 2.97). The BPSS used in this research provides the insight of discomfort issue amongst workers. Nine workers who are working at loading and collection bay were detected to have LBP and MSD problem symptoms. Based on RULA observations on work stations and MMH motions, it was found that the MMH methods used is on level 4. This means that the current method employed should be investigated and immediate changes should be applied. It is recommended that the management should put more effort to increase workers ergonomics awareness especially during MMH activities, to re-examine the MMH activities and redesign the work flow or the workstations.

Does provocative discography cause clinically important injury to the lumbar intervertebral disc? A 10-year matched cohort study

Background contextProvocative discography, an invasive diagnostic procedure involving disc puncture with pressurization, is a test for presumptive discogenic pain in the lumbar spine. The clinical validity of this test is unproven. Data from multiple animal studies confirm that disc puncture causes early disc degeneration. A recent study identified radiographic disc degeneration on magnetic resonance imaging (MRI) performed 10 years later in human subjects exposed to provocative discography. The clinical effect of this disc degeneration after provocative discography is unknown. PurposeThe aim of this study was to investigate the clinical effects of lumbar provocative discography on patients subjected to this evaluation method. Study design/settingA prospective, 10-year matched cohort study. Patient sampleSubjects (n=75) without current low back pain (LBP) problems were recruited to participate in a study of provocative discography at the L3–S1 discs. A closely matched control cohort was simultaneously recruited to undergo a similar evaluation except for discography injections. Outcome measuresThe primary outcome variables were diagnostic imaging events and lumbar disc surgery events. The secondary outcome variables were serious LBP events, disability events, and medical visits. MethodsThe discography subjects and control subjects were followed by serial protocol evaluations at 1, 2, 5, and 10 years after enrollment. The lumbar disc surgery events and diagnostic imaging (computed tomography (CT) or MRI) events were recorded. In addition, the interval and cumulative lumbar spine events were recorded. ResultsOf the 150 subjects enrolled, 71 discography subjects and 72 control subjects completed the baseline evaluation. At 10-year follow-up, 57 discography and 53 control subjects completed all interval surveillance evaluations. There were 16 lumbar surgeries in the discography group, compared with four in the control group. Medical visits, CT/MRI examinations, work loss, and prolonged back pain episodes were all more frequent in the discography group compared with control subjects. ConclusionThe disc puncture and pressurized injection performed during provocative discography can increase the risk of clinical disc problems in exposed patients.

Constructions of crisis: the social interactional functions of catastrophising in accounts of acute and persisting low back pain

Background: Identifying psychosocial risk factors in patients with low back pain has become an important focus to help prevent persistent pain and disability. Catastrophising is seen as displays of magnification, rumination and helplessness which have become considered as obstacles to recovery and linked with poor outcomes. There has been increasing encouragement to adopt a more psychologically informed practice. This aims to improve the identification of psychological risk factors, such as catastrophising, to support more skilled assessment and achieve better outcomes by applying psychologically targeted interventions. Yet in both research and clinical contexts, preventing or reducing persistent problems through psychologically orientated interventions has proved less successful and more challenging than expected. Of interest, most literature proposing catastrophising as a risk for poor outcome comes from evidence collating responses to self-report scales, commonly the Pain Catastrophising Scale and the ‘Catastrophising’ component of the Coping Strategies Questionnaire. Little research has examined catastrophising in interaction contexts. Purpose: The study aimed to explore the personal accounts of patients experiencing acute and persisting low back pain problems to informunderstandings of psychosocial risk factors when expressed during clinical interactions. Methods: Nineteen participants experiencing acute low back pain (< 6weeks) were interviewed from close to onset until recovery, or throughout persisting problems. Repeated interviewswere undertaken generating 37 accounts of resolving, resolved and persisting problems followed up to three months to the timeframe considered the transition to chronicity. The accounts were analysed using discourse analysis strategies drawn from Discursive Psychology, Social Psychology and Sociolinguistics. Developing findings were considered against observations of accounts within clinical interactions. Results: Analysis found that catastrophising talk was performing several important interactional functions: Characterising personal circumstances to be appreciated as a problem; Indexing personal and moral significance into circumstances to be appreciated as unwanted, unjust and deserving of help; Managing issues concerning personal conduct and accountability; Enhancing listener engagement, compassion and emotional appeal; Creating emphasis and intensifying information to support persuasion and credibility. These interactional functions remained evident in accounts of persisting problems yet were hardly present in accounts conveying positive circumstances. Conclusion(s):Features in talk seen as catastrophising are ways to help to characterise and emphasise circumstances as bad, unwanted, undeserved and warranting care. The findings help explain the expression of catastrophising talk and its link with persisting problems.Catastrophising appears a common feature of ‘problem-talk’ and thus may remain a feature when reporting persisting problems or unwanted circumstances, and becomes interactionally unnecessary and absent in accounts of positive circumstances and recovery. Appreciating the social interactional function of the verbal expression of psychosocial factors is important in the interpretation of accounts. Implications: Undertaking sociologically-informed and psychologically informed research and practice seems an important step in advancing our interpretation or patient responses and approaches to patient care. Further research exploring interaction-based versus self-report strategies seems important for informing more effective clinical practice and patient management.

Vibration exposure characteristics and health risk prevention strategies associated with vibration exposure during mining applications

Occupational exposure to vibration can lead to health problems and is typically classified as whole-body vibration (WBV), hand-arm vibration (HAV), or foot-transmitted vibration (FTV). Vibration exposure characteristics are typically measured and compared to standards (ISO 2631-1; ISO 5349-1; EU Directive 2002/44/EC) in an effort to determine the probability of adverse health effects including: low-back pain, spinal degeneration, and gastrointestinal tract problems linked with exposure to WBV; decreased grip strength, tingling/numbness in the fingers/hands, and blanching of the fingers associated with exposure to HAV; and numbness/tingling in the feet/toes, and cold induced blanching of the toes stemming from exposure to FTV. The presentation will summarize vibration exposure data collected by the research team over a 10-year period which suggests operators of load-haul-dump vehicles, haulage trucks, and dozers are exposed to WBV above recommended guidelines, while operators of jack-legs are exposed to HAV above guidelines. Our data also suggest miners exposed to FTV associated with drilling off of raise platforms and operating bolters and jumbo drills are at risk of developing a vibration-induced injury. The presentation will also review the effectiveness of control strategies evaluated by the research team including seating, isolation platforms, “anti-vibration” drills, cab interventions, road maintenance, and operating speeds.

Assessment of Vitamin D status In Patients of Chronic Low Back Pain of Unknown Etiology

Low back pain is very disabling and dispiriting because of the physical impediment it causes and its psychological effects. Innumerable factors have been implicated in its etiology. In spite of improvements in diagnostic modalities, a considerable number of such cases fall in the ambiguous zone of unknown etiology or 'idiopathic.'Early diagnosis of low back pain will allow effective prevention and treatment to be offered. This study was conducted to assess the contribution of vitamin D levels and other biochemical factors to chronic low back pain in such cases. All patients attending the orthopedics OPD for low back pain in whom a precise anatomical cause could not be localized, were prospectively enrolled in this study. We measured serum levels of glucose, calcium, phosphorus, uric acid, rheumatoid factor, C reactive protein, alkaline phosphatase, total protein, albumin and 25 (OH) D concentrations in 200 cases and 200 control samples. The patients showed significantly lower vitamin D levels compared to controls with p value<0.0001. The maximum number of low back pain patients were in the age group of 31-50years (42%).The average BMI was 23.27±5.17kg/sq m, 73% of total patient population were females and 27% were known case of type 2 diabetes mellitus. Calcium, alkaline phosphatase, was positively correlated with vitamin D and glucose showed a negative correlation with vitamin D in the patient population. The problem of low back pain provides a challenge to health care providers. The problem in developing countries is compounded by ignorance to report for early treatment and occupational compulsions in rural areas and sedentary lifestyle in urban youth. The authors strongly recommend early frequent screening for vitamin D along with glucose, protein, albumin, calcium, phosphorus, CRP as part of general health checkup for non-specific body pain, especially low back pain.

TPLUFIB-WEB: A fuzzy linguistic Web system to help in the treatment of low back pain problems

Low back pain affects a large proportion of the adult population at some point in their lives and has a major economic and social impact. To soften this impact, one possible solution is to make use of Information and Communication Technologies. Recommender systems, which exploit past behaviors and user similarities to predict possible user needs, have already been introduced in several health fields. In this paper, we present TPLUFIB-WEB, a fuzzy linguistic Web system that uses a recommender system to provide personalized exercises to patients with low back pain problems and to offer recommendations for their prevention. This system may be useful to reduce the economic impact of low back pain, help professionals to assist patients, and inform users on low back pain prevention measures. TPLUFIB-WEB satisfies the Web quality standards proposed by the Health On the Net Foundation (HON), Official College of Physicians of Barcelona, and Health Quality Agency of the Andalusian Regional Government, endorsing the health information provided and warranting the trust of users.

Effects of Core Strengthening on Cardiovascular Fitness, Flexibility and Strength on Patients with Low Back Pain

Background: Back pain is a common complaint for people of all ages. Chronic back pain sufferers have been estimated to constitute ¼ of the population. People who sit for prolonged periods of time are predisposed to have low back pain problem frequently. Methodology: In this study, 30 patients were selected according to inclusion and exclusion criteria and were assigned into two groups: experimental group and control group. The experimental group was given core strengthening exercises and control group was given conventional exercises. The intervention was followed daily for 4 weeks. Prior to the exercise and after every week VO2max, flexibility and strength were evaluated as outcome measure. Results: Both the groups had significant effect on VO2max, flexibility and strength at the end of 4th week (p<0.05). Cardiovascular fitness, flexibility and strength improved more in the experimental group. Conclusion: Core strengthening exercise improves muscle imbalances, posture and enhances cardiovascular fitness, flexibility and strength in patients with low back pain.

An Overview of Ergonomics Problems Related to CNC Machining Operations

In the new era of advanced manufacturing technology, machine tool design plays an important role in maximizing productivity and occupational health of industrial workers. However, the machine tool manufacturers face difficulty in designing an ergonomic machine tool that can be suited to Malaysian industrial workers because almost all machine tools were designed according to physical dimensions, capabilities and limitations of European or American populations. This mismatch between machine design and worker abilities may eventually lead to occupational injuries. Therefore, the purpose of this paper is to disseminate information on ergonomics problem, assessment methods, and control measures associated with CNC machining operation. Published articles related to CNC machining operation have been reviewed. Based on published researches, work-related musculoskeletal disorders such as low-back pain, neck and shoulder problem have been identified as common health problems associated with the machine operation. Engineering and administrative controls have been proposed to minimize the health problems.

Management of Low Back Pain

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Low back pain: tackling a common problem

Margaret Perry discusses the common problem of low back pain and how to address and treat it

A Study of Musculoskeletal Injuries in Greek Male and Female Swimmers

An epidemiological survey was conducted to collect data relating to the prevalence and frequency of musculoskeletal injuries in male and female Greek swimmers. A questionnaire was administered on site thus ensuring that the response rate was 100 percent. Analysis of results revealed that of the 149 respondents there were 76 male (51%) and 73 female subjects (49%). A total of 48 athletes (32.21%) indicated that they had musculoskeletal injuries, and mainly shoulderproblems (62.41%; N=50 males and N=43 females), followed in descending order by knee injuries and low back pain problems. The prevalence of musculoskeletal injuries ranked highest among freestyle swimmers (N=26) followed by breaststroke (N=11), butterfly (N=7) and finally backstroke (N=4) swimmers. Musculoskeletal injuries are common in Greek under aged elite swimmers and thus care must be taken for their prevention and early safe return to play.

Urban-rural differences in physical performance and health status among older Japanese community-dwelling women

Background/PurposeAssessment of physical performance allows the identification of health and functional independence among older adults. Several factors, such as environmental conditions, influence the results; therefore our objective was to compare the physical performance and the health status between older Japanese women living in urban and rural communities. MethodsThe Japanese women were aged ≥65 years, and recruited in urban (n = 41, age = 73.8 ± 3.92 years) and rural (n = 54, age = 73.8 ± 4.15 years) locations through the local press. Physical performance was assessed by the Timed Up and Go (TUG), one leg stand (OLS), repeated chair stands (CS) and handgrip strength (HGS) tests. Health status was investigated using socio-demographic characteristics; anthropometric measures and body composition; physical activity, a pedometer, Life-Space Assessment (LSA); Geriatric Depression Scale; incidence of falls, fear of falling; and medical information. Variables were compared by χ2 test, Independent-Samples t test and Mann Whitney U-test. ResultsRural individuals presented a better performance in the HGS test (p = 0.01) than urban individuals, who had a better performance in the CS test (p < 0.001). No statistical differences were found in the TUG or OLS tests. Rural women also had a higher body mass index (p = 0.04), waist circumference (p < 0.01), and body fat percentage (p = 0.014) than urban women, who showed higher scores in LSA (p < 0.001). Concerning medical information, more rural women complained of low back pain (p = 0.01) and gastrointestinal problems (p = 0.02). ConclusionOur findings showed that the physical performance and health status varied according to the place. Rural individuals had worse results in the CS test, but a better performance in the HGS test than urban individuals. We emphasize that health interventions should address the specific demand of each location.

Evaluation of Acceptable Weight of Bag For Students in School: A Fuzzy Logic Approach

Overweight schools bags will bring additional stress and fatigue to primary and junior secondary students. The Department of Health recommends that, as a precautionary measure, students should avoid carrying school bags which exceed 15% of their body weight for long periods of time. Around 60 per cent of Indian schoolchildren may suffer back pain by carrying schoolbags. For example, a heavy bag that’s slung over one shoulder can, over the 12 years of schooling, cause chronic back problems that linger into adulthood. Risks include muscle strain, distortion of the natural ‘S’ curve of the spine and rounding of the shoulders. The low back pain as a result of carrying of school bag by students has necessitated the attention given to the determination of limits of weight of school bag carrying by students in the school. It was however noted by that no Occupational Safety and Health organization exist regarding what constitutes the maximum acceptable or safe weight of school bag. After this observation, several researchers have worked on the subject of weight of school bag using three main approaches namely: Physiological, Psychophysical and Biomechanical. Author has applied the Fuzzy logic approaches for setting weight limit (WL) of school bag to be carried by students in school in the analysis the strengths and the weaknesses with the height are taken in to consideration. The approach may probably lead to reduce the problem of low back pain of students caused by heavy weight of school bag.

Quantitative Paraspinal Muscle Measurements: Inter-Software Reliability and Agreement Using OsiriX and ImageJ

Variations in paraspinal muscle cross-sectional area (CSA) and composition, particularly of the multifidus muscle, have been of interest with respect to risk of, and recovery from, low back pain problems. Several investigators have reported on the reliability of such muscle measurements using various protocols and image analysis programs. However, there is no standard protocol for tissue segmentation, nor has there been an investigation of reliability or agreement of measurements using different software. The purpose of this study was to provide a detailed muscle measurement protocol and determine the reliability and agreement of associated paraspinal muscle composition measurements obtained with 2 commonly used image analysis programs: OsiriX and ImageJ. This was a measurement reliability study. Lumbar magnetic resonance images of 30 individuals were randomly selected from a cohort of patients with various low back conditions. Muscle CSA and composition measurements were acquired from axial T2-weighted magnetic resonance images of the multifidus muscle, the erector spinae muscle, and the 2 muscles combined at L4-L5 and S1 for each participant. All measurements were repeated twice using each software program, at least 5 days apart. The assessor was blinded to all earlier measurements. The intrarater reliability and standard error of measurement (SEM) were comparable for most measurements obtained using OsiriX or ImageJ, with reliability coefficients (intraclass correlation coefficients [ICCs]) varying between .77 and .99 for OsiriX and .78 and .99 for ImageJ. There was similarly excellent agreement between muscle composition measurements using the 2 software applications (inter-software ICCs = .81-.99). The high degree of inter-software measurement reliability may not generalize to protocols using other commercial or custom-made software. The proposed method to investigate paraspinal muscle CSA, composition, and side-to-side asymmetry was highly reliable, with excellent agreement between the 2 software programs.

Ten-year survey reveals differences in GP management of neck and back pain

Clinical guidelines provide similar recommendations for the management of new neck pain and low back pain (LBP) but it is unclear if general practitioner's (GP) care is similar. While GP's management of LBP is well documented, little is known about GP's management of neck pain. We aimed to describe GP's management of new neck pain and compare this to GP's management of new LBP in Australia between April 2000 and March 2010. All GP-patient encounters for a new (i.e. first visit to any medical practitioner) neck pain or LBP problem were compared in terms of treatment delivered, referral patterns and requests for laboratory and imaging investigations. General practitioners in Australia have managed new neck pain and LBP problems at a rate of 3.1 and 5.8 per 1,000 GP-patient encounters, respectively. GP's primarily utilised medications, in particular non-steroidal anti-inflammatory drugs, to manage new neck and LBP problems and referred approximately 25% of all patients for imaging. Patients with new neck pain are more frequently managed using physical treatments and were referred more often to allied health professionals and specialists. In comparison, patients with new LBP were managed more frequently with medication, advice, provision of a sickness certificate and ordering of pathology tests. This is the first time GP management of a new episode of neck pain has been documented using a nationally representative sample and it is also the first time that the management of back and neck pain has been compared. Despite guidelines endorsing a similar approach for the management of new neck pain and LBP, in actual clinical practice Australian GPs manage these two conditions differently.