From The Ergoweb® Learning Center

Refocusing Back Pain

For every five people who read this article, four of them will do it with back pain.  And there’s not a lot ergonomics can do to stop it.


It’s a well-accepted fact that no matter how hard engineers and ergonomists try, 80 percent of all humans will still face low back pain at some point in their lives.  And this inevitable back pain has a good chance of affecting the sufferer’s ability to perform well at work and in play. But, as unmoving as this statistic might seems, for ergonomists, an 80 percent failure rate at attempting to prevent back pain shouldn’t indicate time to throw in the towel. It just means it’s time to change the goal of ergonomics from prevention to accommodation.


Ergonomics can’t stop back pain. Period.  But ergonomics can keep work from exacerbating the condition.


At Some Point, It Will Happen to Almost Everyone

The idea is nothing new.  Stover Snook, Ph.D., CPE, a Lecturer on Ergonomics in the Department of Environmental Health at the Harvard School of Public Health, first started looking into the concept of working with back pain rather than attempting to prevent it in the late 1970s and early 1980s when he noticed that the epidemiological data was indicating that regardless of intervention, low back pain would probably still exist.


“We can’t control aging and genetics,” says Snook.  “We can control the occupation and personal behavior, but how can we control low back pain if we can’t control aging?”


“It gets down to an old ergonomics principal,” Snook said.  “Yet we continue to design jobs for young strong people.  The job doesn’t change throughout the years but the person does. We have to begin designing for older people.”


Snook points out that age is one of the contributing factors to developing back pain.  In a paper entitled Work-Related Low Back Pain:  Secondary Intervention presented at the 2003 State-of-the-Art (STAR) Symposium, Snook notes that “non-specific low back pain is basically an age-related disorder that is affected by differences in occupation, genetics, and personal behavior.”


Snook details the stages of back pain, starting usually when a person is in his or her 20s and changing in severity until later in life. “People in their twenties and early thirties usually suffer from sudden acute attacks of short duration.  During the mid to late thirties, the pain often becomes more localized to one side or the other, listing to one side becomes evident, and there may be some residual, mild backache between attacks.  During the forties, radiation of pain into the buttocks, the thigh, and even down to the foot occurs more frequently.  And in the fifties, the pain often becomes more constant, but less severe,” Snook wrote.


In addition to age, genetics and lifestyle choices (smokers, for example, report higher rates of back pain) all affect the chances that a person will experience low back pain.  As for occupation as a contributor, Snook indicates that studies on the topic aren’t in agreement, mostly because sedentary workers experience back pain, too.


If It Can’t Be Fixed, Why Bother?

Even though back pain might not be preventable, treatment for, compensation and disability  payments related to low back pain are expensive.  It’s the second most common cause of missed work-days in the U.S. following only the common cold.  And that’s where ergonomics can help.


A Swedish study involving workers between the ages of 20 and 59 reporting low back pain reaffirmed the fact that treatment or not, back pain remains.  While treatment improved pain and disability somewhat during the first three months, very little benefit was shown after that period.  According to the study, no predictive factors for recovery were found.


Snook points to the Swedish study to indicate that, while the workers were reporting back pain, most of the workers (95 percent) still continued to work in some capacity with their back pain.  However, depending upon the workplace and the job design, that capacity may have been limited to some degree or even placed the worker at a different task.


The key, then, is to focus on designing jobs for those people who will experience the back pain, says Snook.  If a work area is designed so that it accommodates the person with back pain, it only follows that those who don’t have back pain should be comfortable as well.  More workers can do the job successfully and with minimal pain.  Workers can keep working at their jobs without being moved to different positions or put at a reduced capacity. The key for industry is to remember that some workers will experience back pain no matter what, but the severity of it can probably be diminished along with disability rates.


“It starts with recognition,” says Snook.  “Management should recognize that it will happen with most workers.  We need to put some compassion in here.”


Addressing the workplace with this in mind is just the start, and Snook admits that ergonomics interventions will probably prevent some of the back pain.  “Perhaps even more important is that it permits people to continue working,” he says.  “If you can minimize the bending, you’re preventing pain or preventing the aggravation of an underlying condition, [the worker] can still continue to work.”


For the desk-bound worker, sitting is the big problem.  Snook’s answer?  “Design a workstation that doesn’t require sitting.  One of the things you can do is provide a high based workstation.  The workstation is about elbow height, and allows for standing or sitting.  The worker can vary [his or her] posture. One of the problem [with office work] is that a person can’t tolerate one position for a long time.  This allows a person to change posture.”


The Bottom Line

And if worker health and possibly lower disability rates don’t convince an employer to start looking at ergonomics as a management tool for low back pain, Snook offers one last bit of advice, taken from a previously written manuscript.


“Henry Ford offered good advice in the early 1900s when he said:

This article originally appeared in The Ergonomics Report™ on 2003-09-01.