Risk Factors For Low Back Pain Research Articles

Psychological Stress as a Risk Factor for Low Back Pain: a Review Article

Low back pain (LBP) is one of the most common complaints of pain in the settings of primary care. It affects the posterior region of the trunk that surrounds the first to fifth lumbar spine posteriorly. One of the most common mechanisms of LBP is excess muscle use in the posterior lumbar region that can promote the activation of nociceptors and cause pain. There are many risk factors that may lead to LBP which are classified into three types: individual, psychosocial, and occupational. One of the psychosocial risk factors of LBP is psychological stress. Based on the review over previous articles, psychological stress plays a role in the occurrence of LBP through excess cortisol and pain perception. There are also studies that stated a strong correlation between psychological stress and LBP.

What factors are associated with recovery from low back pain (LBP) in elite athletes? A Concept Mapping study of clinicians, coaches and elite athletes

Introduction: Despite being in peak physical fitness, 90% of Olympic athletes experiencing LBP in their career. Established risk factors for athlete LBP relate to training exposure variables, longer sporting career, and older age. It is well recognised in community patients with LBP that factors beyond physical load and age influence recovery. However, there is little evidence of what factors are associated with recovery from LBP in elite athlete populations. This concept mapping study aimed to identify factors that experienced clinicians, athletes, and coaches within elite sport associate with recovery from LBP in athletes.

Risk Factor of Low Back Pain in the Informal Sector Tailor in Solor Kupang City 2019

Tailor is a risky job that impact to low back pain. Low back pain (LBP) can cause a tailor to experience a decrease in the ability to perform daily activities and occupational health problems. One of the low back pain risk factors is individual factors include body mass index (BMI), exercise habits, and working period. This research was observational analytical research with a cross-sectional design conducted at Informal Sector tailor in Solor, Kupang City by filling questioner, body mass index measurement, and direct interview. The sampling technique used was total sampling with 48 samples that fulfilled inclusion and exclusion criteria. The data were analyzed by using the univariate, bivariate with chi-square, and multivariate with logistic regression as well. The bivariate analysis results showed that the results were significant on the variable of body mass index (p=0.012, OR=5.667) and work period (p=0.026). While there was no significant correlation between the variables of exercise habits with the incidence of low back pain (p=0.407).The multivariate analysis results found that the variable of the work period was the variable that had the biggest effect on the incidence of low back pain (OR=0.361). There are correlations between body mass index and work period with low back pain incidence at Informal Sector tailor in Solor, Kupang City in 2019.

Prevalence and risk factors analysis for low back pain among occupational groups in key industries of China

BackgroundWith the acceleration of industrialization and population aging, low back pain (LBP) has become the leading cause of life loss years caused by disability. Thus, it places a huge economic burden on society and is a global public health problem that needs urgent solution. This study aimed to conduct an epidemiological investigation and research on a large sample of workers in key industries in different regions of China, determine the incidence and distribution characteristics of LBP, explore the epidemic law, and provide a reference basis for alleviating global public health problems caused by LBP.MethodsWe adopted a modified epidemiological cross-sectional survey method and a stratified cluster sampling method. All on-duty workers who fulfill the inclusion criteria are taken as the research participants from the representative enterprises in key industries across seven regions: north, east, central, south, southwest, northwest, and northeast China. The Chinese version of the musculoskeletal disease questionnaire, modified by a standardized Nordic questionnaire, was used to collect information, and 57,501 valid questionnaires were received. Descriptive statistics were used, and multivariate logistic regression analysis (p < 0.05) was performed to explore the association between musculoskeletal disorders and potential risk factors.ResultsLBP annual incidence among workers in China’s key industries is 16.4%. There was a significant difference in LBP incidence among occupational groups across different industries (p < 0.05). The multivariate regression model showed the following as risk factors for LBP: frequent repetitive movements with the trunk, working in the same positions at a high pace, trunk position, frequently turning around with your trunk, often working overtime, lifting heavy loads (i.e., more than 20 kg), education level, staff shortage, working age (years), cigarette smoking, use of vibration tools at work, body mass index, lifting heavy loads (i.e., more than 5 kg), and age (years). Physical exercise, often standing at work, and absolute resting time were protective factors.ConclusionLBP incidence among key industries and workers in China is high. Thus, it is urgent to take relevant measures according to the individual, occupational, and psychosocial factors of LBP to reduce the adverse impact of LBP on workers’ health.

The Validity and Inter-Rater Reliability of a Video-Based Posture-Matching Tool to Estimate Cumulative Loads on the Lower Back.

Background: Low back pain (LBP) is known as one of the most common work-related musculoskeletal disorders. Spinal cumulative loads (CLs) during manual material handling (MMH) tasks are the main risk factors for LBP. However, there is no valid and reliable quantitative lifting analysis tool available for quantifying CLs among Iranian workers performing MMH tasks.Objective: This study aimed to investigate the validity and inter-rater reliability of a posture-matching load assessment tool (PLAT) for estimating the L5-S1 static cumulative compression (CC) and shear (CS) loads based on predictive regression equations.Material and Methods: This experimental study was conducted among six participants performing four lifting tasks, each comprised of five trials during which their posture was recorded via a motion capture (Vicon) and simultaneously a three-camera system located at three different angles (0°, 45°, and 90°) to the sagittal plane.Results: There were no significant differences between the two CLs estimated by PLAT from the three-camera system and the gold-standard Vicon. In addition, ten raters estimated CLs of the tasks using PLAT in three sessions. The calculated intra-class correlation coefficients for the estimated CLs within each task revealed excellent inter-rater reliability (> 0.75), except for CS in the first and third tasks, which were good (0.6 to 0.75). Conclusion: The proposed posture-matching approach provides a valid and reliable ergonomic assessment tool suitable for assessing spinal CLs during various lifting activities.

Prevalence and associated risk factors of low back pain among users of a primary health care clinic serving semi-urban and rural settlements in KwaZulu-Natal, South Africa.

Low back pain (LBP) is one of the most frequent musculoskeletal conditions and a common work-related health problem. In South Africa, people from lower socio-economic strata are involved in physical labour and also have unequal access to health services. There is minimal data on the prevalence of LBP in these communities. This study determined the prevalence and associated risk factors of LBP among public sector health care users in a semi-urban/rural area of KwaZulu-Natal, South Africa. The study was conducted at a primary health care clinic in the Umdoni municipality, KwaZulu-Natal, South Africa. Convenience sequential sampling was used. An interviewer-administered questionnaire was utilized due to literacy constraints. Participants (n=400) answered the questionnaire in either English or isiZulu. The lifetime prevalence of LBP was 79.3%. Female gender and lifting heavy objects were associated with LBP. The direct impact of LBP was faced in the work place resulting in absenteeism, often followed by unemployment. In this setting, where the prevalence of LBP was high, specialized treatments for LBP were not available at the primary health care facility. Incorporation of such treatments will be useful, for people in lower socio-economic strata, to overcome the burden of LBP.

Prevalence and exposure to factors associated with low back pain (LBP) among commercial motorcycle riders in south eastern Nigeria

Introduction: LBP is the most common cause of activity restriction and work absence in much parts of the world, putting a heavy financial burden on people. This study aims at determining the prevalence and exposure to risk factors associated with low back pain (LBP) among commercial bike riders within Nnewi-North Local Government Area of Anambra state. Methodology: This was a cross-sectional study that involved commercial motorcycle riders that ply within the four major villages of Nnewi town in Nnewi-North local government area of Anambra state. An interviewer based semi-structured questionnaire was administered to the respondents at their muster points. Results: One hundred and fifty-four riders were recruited and all were male. The prevalence of LBP was 25%. LBP was highest among riders between ages of 26-36years. There was significant association linking age and marital status to low back pain (LBP) with p-values of 0.001 and 0.013 respectively. Conclusion: Our findings suggest that low back pain is very common among this population and has led to both mild, moderate and severe functional disabilities to the riders. This study also demonstrated the exposure of the riders to some risk factors of LBP. Adequate public awareness, education and use of ergonomics would help in the reduction of this problem.

A Study from a Highly Populated Country : Risk Factors Associated with Lower Back Pain in Middle-Aged Adults.

Low back pain (LBP) is a global health problem that affects the productivity of the patients. Several factors such as individual, occupational, and psychosocial factors increase the risk of LBP. However, only a few studies investigated those factors, especially in middle adulthood in Indonesia. Indonesia is a country with a young population that has been rapidly developing in recent years. This study was conducted to find out the factors associated with LBP in middle adulthood. This study is a cross-sectional observational analytic study using a convenience sampling method with a total sample of 3005 respondents. Data were collected using a questionnaire which was then analyzed using the chi-square test, Kolmogorovsmirnov, Spearman's Rank, and logistic regression test. From the result of this study, it was found that the 12-month prevalence of LBP in middle-aged adults was 44,29%. Female (odds ratio [OR], 1.3; 95% confidence interval [Cl], 1.098-1.545; p=0.002), lack of physical exercises (OR, 0.87; 95% Cl, 0.794-0.959; p=0.005), high body mass index (OR, 1.09; 95% Cl, 1.009-1.187; p=0.002), stress level (OR, 1.26; 95% Cl, 1.088-1.458; p=0.002), and years of work experience (OR, 1.1; 95% Cl, 1.001-1.225; p=0.047) were determined as risk factors that significantly associated with LBP. LBP is quite common among middle-aged adults in Indonesia. Female gender, higher body mass index, lack of physical activity, stress level, and years of work experience were all potential risk factors for LBP in middle-aged adults. Middle-aged adults in Indonesia should be aware of LBP and avoid disabilities by identifying risk factors that may worsen LBP in the future.

Low back pain and associated risk factors among medical students in Bangladesh: a cross-sectional study.

Background: Low back pain (LBP) is one of the leading causes of disability worldwide. Different studies showed the high prevalence of LBP among medical students. However, no study has been conducted on Bangladeshi medical students to estimate the prevalence of LBP. This study determined the prevalence, characteristics, and associated risk factors of LBP among medical students in Bangladesh. Methods: A cross-sectional study was conducted from October to December 2020 among randomly selected 270 medical students and medical interns in Faridpur Medical College, Bangladesh, using an online questionnaire. In data analysis, chi-square test and binary logistic regression were performed, and a p-value of < 0.05 was regarded as statistically significant. Results: A total of 207 participants responded fully to the survey, and were included in the analysis. The mean age of the participants was 22.4 ± 1.9 years. The point, 6-month, and 12-month prevalence of LBP was 25.6%, 46.9%, and 63.3%, respectively. In most participants, LBP was localized (53.2%), recurrent (64.9%), non-specific (70.8%), affected for a short period (55%), and relieved without receiving any treatment (60.4%). Participants who had a significantly higher 12-month prevalence of LBP included females (72.2% vs 52.2%), with BMI >25 kg/m 2 (73.2% vs 56.7%), those who performed physical activity at low to moderate frequency (72.4% vs 29.5%), those who spent > 6 hours/day by sitting (71.3% vs 45.3%), and those who did not have enough rest time (92.7% vs 56%). Ergonomic features of chairs, such as having back support, adjustable back support, and adjustable sitting surface, significantly (p < 0.05) influenced the outcomes. Conclusion: The prevalence of LBP among medical students in Bangladesh was high, and most of the risk factors associated with the high prevalence of LBP were modifiable. Hence, LBP can be prevented by implementing preventive strategies and providing ergonomic training and physical activity facilities.

The impact of lumbosacral alignment on lumbar mobility, functional disability and psychological wellbeing in office workers with chronic low back pain

Background/aims The lumbosacral curvature of the spine has a special role in its mobility during weight-bearing activities. Office work is a sedentary role, which requires sitting for long durations, having a negative effect on spinal posture. Therefore, low back pain risk factors in office workers are different from other populations. The aim of this study was to examine the effect of lumbosacral joint angle on the lumbar mobility, functional disability, pain intensity and overall health in office workers with chronic low back pain. Methods A total of 116 male office workers with chronic low back pain (aged between 30–59 years) participated in this cross-sectional study. The lumbosacral radiography was used to divide the participants into two groups, according to the value of their lumbosacral joint angle: group A (lumbosacral joint angle &lt;20°, n=61) and group B (lumbosacral joint angle group &gt;20°, n=55). The lumbar mobility, functional disability, pain intensity and overall health issues of participants were measured. Results The functional disability and pain intensity of individuals in group A were significantly higher than group B (P&lt;0.05). There was a significant decrease in the lumbar flexion and extension range of motion and activities of daily living of those in group A compared to group B (P&lt;0.05). There was a significant increase in emotional health problems and impaired social activity of individuals in group A compared to group B (P&lt;0.05). There were fair positive correlations between lumbosacral joint angle values and functional disability, pain intensity and social activity in office workers in group B (r=0.292, 0.036, 0.333 respectively). Conclusions A decreased lumbosacral joint angle increases functional disability and pain intensity, decreasing lumbar mobility and level of functionality. Furthermore, it reduces emotional health and social activity in participants with low back pain. Therefore, measuring the lumbosacral joint angle of patients with chronic low back pain during treatment may be useful to decrease their pain intensity and improve their functional disability and quality of life.

Low-back pain in adolescents with an osteopathic component

Low-back pain (LBP) is a common symptom presenting in adolescents. Most back pain in adolescents is benign and musculoskeletal in nature, due to trauma or congenital anomalies. Other less common causes include infection, inflammatory conditions or neoplasm. A comprehensive history and physical focusing on posture, muscle tenderness, range of motion, muscle strength and neurological function is essential in understanding the cause of low-back pain. Identification of risk factors for low-back pain will help the clinician in managing their patient. Treatment includes rest, avoiding activities that cause pain, physical therapy, osteopathic manipulative treatment, limited use of non-steroidal anti-inflammatory drugs and family and patient education. Assessing for warning signs or red flags of serious causes of LBP is a fundamental part of the clinical assessment. Pain that awakens from sleep, pain lasting longer than 4 weeks, sudden onset pain, systemic findings such as fever or weight loss and abnormal neurological findings should warrant immediate evaluation as these may suggest serious infectious conditions, malignancy or fracture. This article presents a comprehensive review of the epidemiology, relevant anatomy, biomechanics, causes and major risk factors for adolescent low-back pain. A diagnostic algorithm utilizing a step-by-step approach is also introduced to aid the clinician in management of the patient. Finally, the article presents guidelines for management of the adolescent with low-back pain including conservative, pharmacologic, as well as the osteopathic approach to treatment. Evidence-based recommendations on osteopathic approach to treatment has been reviewed from meta-analysis data and randomized controlled trials.

Cortical function and sensorimotor plasticity are prognostic factors associated with future low back pain after an acute episode: the Understanding persistent Pain Where it ResiDes prospective cohort study.

Predicting the development of chronic low back pain (LBP) at the time of an acute episode remains challenging. The Understanding persistent Pain Where it ResiDes study aimed to identify neurobiological and psychological risk factors for chronic LBP. Individuals with acute LBP (N = 120) participated in a prospective cohort study with 6-month follow-up. Candidate predictors were selected from the neurobiological (eg, sensorimotor cortical excitability assessed by sensory and motor-evoked potentials and brain-derived neurotrophic factor genotype), psychological (eg, depression and anxiety), symptom-related (eg, LBP history), and demographic domains. Analyses involved multivariable linear regression models with pain intensity or disability degree as continuous variables. Secondary analyses involved a multivariable logistic model with the presence of LBP at 6 months (thresholding pain intensity and disability degree) as a dichotomous variable. Lower sensory cortex and corticomotor excitability, higher baseline pain intensity, higher depression, stress, and pain catastrophizing were the strongest predictors ( R2 = 0.47) of pain intensity at 6 months. Older age and higher pain catastrophizing were the strongest predictors ( R2 = 0.30) of disability at 6 months. When the LBP outcome was dichotomised, sensory cortex and corticomotor excitability, brain-derived neurotrophic factor genotype, depression and anxiety, LBP history and baseline pain intensity, discriminated between those who did and did not report LBP at 6 months (C-statistic 0.91). This study identifies novel risk factors for the development of future LBP. Neurobiological risk factors, when added to a multivariable linear regression model, explained a further 15% of the variance in the 6-month pain intensity.

Delivery of Multimodal Analgesia to Effectively Treat Acute Pain: A Review From Roma Pain Days.

It is crucial that acute pain be promptly and adequately treated in order to prevent it from transitioning to chronic pain, a devastating and sometimes permanent condition that is challenging to treat and associated with disability, reduced quality of life, and depression. Guidelines for the treatment of acute low-back pain (LBP) are predicated on assumptions that all acute LBP is benign, temporary, and traditionally treated with a “wait and see” approach. LBP is far from a monolithic condition: etiology, the presence of underlying conditions, mental health status, social situation, patient’s age and occupation, and comorbidities all present different risk factors for chronic LBP that should be considered in treating acute LBP or other forms of acute pain. A multimodal approach to acute pain has been shown to be safe and effective. In particular, the combination product of oral dexketoprofen and tramadol has been shown effective in controlling acute pain, which spares the use of opioids and is well tolerated. Chronic pain must be viewed as a global health crisis, and the timely and adequate control of acute painful conditions is a good strategy to reduce its prevalence. Experts at Roma Pain Days discussed this important topic which is the foundation of this review.

Low back pain and associated risk factors among medical students in Bangladesh: a cross-sectional study.

Background: Low back pain (LBP) is one of the leading causes of disability worldwide. Different studies showed the high prevalence of LBP among medical students. However, no study has been conducted on Bangladeshi medical students to estimate the prevalence of LBP. This study determined the prevalence, characteristics, and associated risk factors of LBP among medical students in Bangladesh. Methods: A cross-sectional study was conducted from October to December 2020 among randomly selected 270 medical students and medical interns in Faridpur Medical College, Bangladesh, using an online questionnaire. In data analysis, chi-square test and binary logistic regression were performed, and a p-value of < 0.05 was regarded as statistically significant. Results: A total of 207 participants responded fully to the survey, and were included in the analysis. The mean age of the participants was 22.4 ± 1.9 years. The point, 6-month, and 12-month prevalence of LBP was 25.6%, 46.9%, and 63.3%, respectively. In most participants, LBP was localized (53.2%), recurrent (64.9%), non-specific (70.8%), affected for a short period (55%), and relieved without receiving any treatment (60.4%). Participants who had a significantly higher 12-month prevalence of LBP included females (72.2% vs 52.2%), with BMI >25 kg/m 2 (73.2% vs 56.7%), those who performed physical activity at low to moderate frequency (72.4% vs 29.5%), those who spent > 6 hours/day by sitting (71.3% vs 45.3%), and those who did not have enough rest time (92.7% vs 56%). Ergonomic features of chairs, such as having back support, adjustable back support, and adjustable sitting surface, significantly (p < 0.05) influenced the outcomes. Conclusion: The prevalence of LBP among medical students in Bangladesh was high, and most of the risk factors associated with the high prevalence of LBP were modifiable. Hence, LBP can be prevented by implementing preventive strategies and providing ergonomic training and physical activity facilities.

Ergonomic Risk Factors for Low Back Pain among Three-Wheel Drivers in Ethiopia: A Community-Based Cross-Sectional Study

Background Driving a three-wheel car is an emerging job opportunity in most parts of developing countries. Drivers are at risk for developing low back pain (LBP). However, very little is known about the association between ergonomics factors and LBP among three-wheel drivers. Objective This study was aimed to identify ergonomic risk factors of LBP among three-wheel drivers. Methods A community-based cross-sectional study on 396 participants was conducted in the Jimma city on all selected public three-wheel drivers in March, 2020. The data were collected using a standard questionnaire adapted from the Nordic Musculoskeletal questionnaire, anthropometric measurements, and observation checklist. The collected data were entered into Epi Data and exported to SPSS version 21.0. Logistic regression analysis was used for analysis based on the p value less than 0.05, 95% C.I. Results. Among 422 planned respondents, 396 (93.8%) have given the complete response. The mean age of the study population was 27.94 (±5.45). One hundred four (26.26%) out of 396 participants had experienced low back pain in the last 12 months. Driving in sitting upright position OR = 0.32 (95% CI = 0.12–0.86), steer wheel handling OR = 3.02 (95% CI = 1.58–5.77), not holding extra passengers OR = 0.35 (95% CI = 0.21, 0.60), rest breaks, and brand of the three-wheel vehicles were significantly associated with LBP. Conclusion Nearly more than one-fourth of three-wheel drivers in our study had LBP. The finding implies a significant number of three-wheel drivers are at risk of developing reduced well-being. An appropriate health visit, lifestyle modification, and adequate policy should be established in the study area.

Low back pain and associated risk factors among medical students in Bangladesh: a cross-sectional study

Background: Low back pain (LBP) is one of the leading causes of disability worldwide. Different studies showed the high prevalence of LBP among medical students. However, no study has been conducted on Bangladeshi medical students to estimate the prevalence of LBP. This study determined the prevalence, characteristics, and associated risk factors of LBP among medical students in Bangladesh. Methods: A cross-sectional study was conducted from October to December 2020 among randomly selected 270 medical students and medical interns in Faridpur Medical College, Bangladesh, using an online questionnaire. In data analysis, chi-square test and binary logistic regression were performed, and a p-value of < 0.05 was regarded as statistically significant. Results: A total of 207 participants responded fully to the survey, and were included in the analysis. The mean age of the participants was 22.4 ± 1.9 years. The point, 6-month, and 12-month prevalence of LBP was 25.6%, 46.9%, and 63.3%, respectively. In most participants, LBP was localized (53.2%), recurrent (64.9%), non-specific (70.8%), affected for a short period (55%), and relieved without receiving any treatment (60.4%). Participants who had a significantly higher 12-month prevalence of LBP included females (72.2% vs 52.2%), with BMI >25 kg/m 2 (73.2% vs 56.7%), those who performed physical activity at low to moderate frequency (72.4% vs 29.5%), those who spent > 6 hours/day by sitting (71.3% vs 45.3%), and those who did not have enough rest time (92.7% vs 56%). Ergonomic features of chairs, such as having back support, adjustable back support, and adjustable sitting surface, significantly (p < 0.05) influenced the outcomes. Conclusion: The prevalence of LBP among medical students in Bangladesh was high, and most of the risk factors associated with the high prevalence of LBP were modifiable. Hence, LBP can be prevented by implementing preventive strategies and providing ergonomic training and physical activity facilities.

Prevalence and Potential Risk Factors for Occupational Low Back Pain Among Male Military Pilots: A Study Based on Questionnaire and Physical Function Assessment.

Objectives: Low back pain (LBP) has negative implications for the military's combat effectiveness. This study was conducted to determine the prevalence and risk factors of LBP among pilots through a questionnaire and physical function assessments.Methods: Data on the demographic and occupational characteristics, health habits, physical activity, and musculoskeletal injuries of 217 male pilots (114 fighter, 48 helicopter, and 55 transport pilots) were collected using a self-reported questionnaire and physical function assessments.Results: LBP prevalence was 37.8% in the total cohort and 36.0, 45.8, and 34.5% among fighter, helicopter, and transport pilots, respectively. Multivariate regression analysis revealed that the risk factors significantly associated with LBP were neck pain [odds ratio (OR): 3.559, 95% confidence interval (CI): 1.827–6.934], transversus abdominis activation (OR: 0.346, 95% CI: 0.172–0.698), and hip external rotator strength (OR: 0.001, 95% CI: 0.000–0.563) in the total cohort; neck pain (OR: 3.586, 95% CI: 1.365–9.418), transversus abdominis activation (OR: 0.268, 95% CI: 0.094–0.765), hip external rotator strength (OR: 0.000, 95% CI: 0.000–0.949), and weekly flying hours (OR: 3.889, 95% CI: 1.490–10.149) in fighter pilots; irregular strength training (OR: 0.036, 95% CI: 0.003–0.507) and hip external rotator strength (OR: 0.000, 95% CI: 0.000–0.042) in helicopter pilots; and neck pain (OR: 6.417, 95% CI: 1.424–28.909) in transport pilots.Conclusions: High volume flight schedules and weak core muscle functions have significant negative effects on pilots' back health. LBP is commonly associated with high weekly flying hours, worsening neck pain, transversus abdominis insufficient activation, and reduced hip extensor/rotator strength. Risk factors vary among pilots of different aircraft. Thus, specific core muscle training would be especially important for military pilots.

Lifting Techniques: Why Are We Not Using Evidence To Optimize Movement?

Lifting something off the ground is an essential task and lifting is a documented risk factor for low back pain (LBP). The standard lifting techniques are stoop (lifting with your back), squat (lifting with your legs), and semi-squat (midway between stoop and squat). Most clinicians believe the squat technique is optimal; however, training on squat lifting does not prevent LBP and utilizing greater lumbar flexion (i.e. stoop) when lifting is not a risk factor for LBP. The disconnect between what occurs in clinical practice and what the evidence suggests has resulted in ongoing debate. Clinicians must ask the right questions in order to apply the evidence appropriately. A proposed clinical framework of calm tissue down, build tissue up, improve work capacity can be used to determine which lifting technique is optimal for a patient at any given time. When applying this clinical framework, clinicians should consider metabolic, biomechanical, physical stress tolerance, and pain factors in order to address the movement system. For example, stoop lifting is more metabolically efficient and less challenging to the cardiopulmonary system. There may be few biomechanical differences in spinal postures and gross loads on the lumbar spine between stoop, squat, and semi-squat lifting; however, each lift has distinct kinematic patterns that affects muscle activation patterns, and ultimately the movement system. Clinicians must find the optimal dosage of physical stress to address all aspects of the movement system to minimize the risk of injury. There is no universal consensus on the optimal lifting technique which will satisfy every situation; however, there may be a lifting technique that optimizes movement to achieve a specific outcome. The calm tissue down, build tissue up, improve work capacity framework offers an approach to determine the best lifting technique for an individual patient at any give time.Level of Evidence5

The burden of low back pain, rheumatoid arthritis, osteoarthritis, and gout and their respective attributable risk factors in Brazil: results of the GBD 2017 study.

INTRODUCTION: Musculoskeletal (MSK) disorders are a major cause of disability worldwide. Different modifiable risk factors are associated to these disorders. The objective of this study was to analyze the burden of low back pain (LBP), rheumatoid arthritis (RA), osteoarthritis (OA), and gout, attributable to risk factors, in 2017. METHODS: The burden of LBP, RA, OA, and gout, and attributable risk factors were analyzed using data extracted from the Global Burden of Disease (GBD) Brasil-2017 study. Descriptive analysis was conducted to compare disability-adjusted life years (DALY) rates between sexes and age groups (15-49 and 50-69 years), in 2017. RESULTS: The highest rates of DALY due to LBP were attributed to occupational ergonomic factors in the 15-49-year group, regardless of sex and males aged 50-69 years, whereas smoking was the major contributor in the 50-69-year female group. RA-related DALY rates were attributed to smoking and were higher among women aged 50-69 years. High body mass index (BMI) was the most relevant risk factor for the burden of OA, with higher rates detected in the 50-69-year group, and it was the most significant risk factor for DALY rate attributed to gout, regardless of sex or age group. CONCLUSIONS: Occupational surveillance measures are indicated to prevent LBP. Actions to decrease smoking and overweight, and the surveillance of weight gain are warranted to decrease the burden of LBP, RA and OA, and gout, respectively. These actions will be more effective if age and sex differentials are considered in planning.

Does group-based cognitive therapy improve functional ability, pain, catastrophic thoughts and quality of life in patients with persistent low back pain and psychological risk factors? A randomised controlled trial in a secondary care setting

Objective To investigate the effects of a group-based cognitive behavioural intervention for patients with persistent low back pain (LBP) and psychological risk factors referred to secondary care. Design A randomised controlled trial. Setting Silkeborg Regional Hospital, Denmark. Subjects A total of 136 participants with chronic LBP and psychological risk factors. Interventions Participants were randomised to the standard care group, including examination by a rheumatologist and/or a physiotherapist, or the intervention group, including standard care plus a multidisciplinary group-based pain management programme. Main measures Patient-reported outcomes were collected at baseline and after 6 and 12 months. The primary outcome was disability (Roland Morris Disability Questionnaire). Secondary outcomes included low back pain intensity, pain catastrophising, health-related quality of life, and sick leave. Results Among 136 participants, 68 (mean age: 41.7 years (SD 11.8)) were randomised to standard care and 68 (mean age: 46.0 years (SD 10.8)) were randomised to the intervention group. Except for age, baseline characteristics were comparable between groups. 12-month follow-up was completed by 92.6% in the intervention group and 80.9% in the standard care group. Both groups achieved significant improvements on disability, with a reduction of −4.8 points (SD 6.1) in the intervention group compared to −3.7 points (SD 5.2), resulting in an insignificant difference between groups. No significant differences were found in the secondary outcomes. Conclusion A group-based pain management programme was no more effective than standard care for patients with persistent LBP and psychological risk factors.