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Archived Comments for: Study protocol title: a prospective cohort study of low back pain

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  1. Different sorts of work activity cause different sorts of back pain.

    Brian Sweetman, NHS

    11 March 2013

    Garg et aaal (1) have published the protocol for their study of back pain in industry. Because it is a prospective study it may be able to distinguish cause and effect. In particular it may be able to tell whether heavy work causes back pain or whether back pain prevents the worker from doing heavy work. But there is another type of problem with such studies. Could it be that there are several sorts of heavy work each of which can provoke a different sort of back pain? In order to answer this the researchers need to measure multiple ergonomic aspects of work, and they also need an adequate classification of subgroups of back pain.
    Earlier work addressed these ergonomic and clinical problems and was summarized in a monograph (2).
    The most important findings were that heavy work in terms of much lateral flexion and rotation of the back was liable to provoke the facet joint syndrome. Heavy work in terms of using the large back muscles prior to accidents protected against the back strain syndrome whereas such heavy work could in an older age group provoke symmetrical back pain probably due to disc degeneration. With the latter process, progression to prolapse of the disc causing nerve root compression with lateralized sciatica may be more related to genetic influences within a specific age range than to type of work.
    The facet joint syndrome is identified when lateral flexion or rotation in one direction induces pain on the opposite side of the back. The back strain syndrome causes painful signs at the top and bottom of the lumbar spine. The symmetrical disc degeneration syndrome is best identified by sagittal plane tests inducing back pain in the midline or pain bilaterally such that it is equal on both sides. The monograph (2) gives more details and supplies references to other relevant literature.
    It is hoped that these details may assist in the much needed planned prospective study.

    Brian Sweetman FRCP, MD, PhD.

    Swansea, UK.

    1. Garg A, Hegmann KT, Moore JS, Kapellusch J, Thiese MS, Boda S, Bhoyr P, Bloswick D, Merryweather A, Sesek R, Deckow-Schaefer G, Foster J, Wood E, Sheng X, Holubkov R. A prospective cohort study of low back pa; a study protocol. BMC Musculoskeletal Disorders 2013, 14:84 (7 March 2013).

    2. Sweetman BJ. Low Back Pain: some real answers. tfm Publishing Ltd, Harley SY5 6LX, UK, 2005.

    Competing interests