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Back Injury and Work Loss: Biomechanical and Psychosocial Influences

Burton, A. Kim, PhD, DO, Eur Erg

Spine Update

The exponential increase in occupational low back pain disability is a problem that is not being addressed adequately in clinical practice. The notion of achieving primary control through ergonomic intervention, based on biomechanics principles, has so far been unhelpful. The traditional secondary prevention strategies of rest and return to restricted work duties are seemingly suboptimal. Biomechanics/ergonomic considerations may be related to the first onset of low back pain, but there is little evidence that secondary control based solely on these principles will influence the risk of recurrence or progression to chronic disability. More promising in this respect are programs that take account of the psychosocial influences surrounding disability. Work organizational issues are clearly important, but so also is the behavior of clinicians. The balance of the available evidence suggests that clinicians generally should adopt a proactive approach to rehabilitation by recommending, whenever possible, early return to normal rather than restricted duties as well as complementary psychosocial advice if the issue of chronic disability is to be successfully tackled.

From Spinal Research Unit, University of Huddersfield, Queensgate, Huddersfield, United Kingdom.

Acknowledgment date: April 22, 1997.

First revision date: June 19, 1997.

Acceptance date: June 19, 1997.

Device status category: 1.

Address reprint requests to: A. Kim Burton, PhD; Spinal Research Unit; University of Huddersfield; c/o 30 Queen Street; Huddersfield, HD1 2SP; United Kingdom; E-mail:

© Lippincott-Raven Publishers.