How Do I Know If I Need Surgery For My Back Pain?

How Do I Know If I Need Surgery For My Back Pain?

Low back pain has become a major health problem in the Western World with 1-year prevalence ranging from 22 to 65% (Walker 2000). 

In certain cases where back pain becomes chronic (lasting 12 weeks or longer) or when there are symptoms of severe nerve root compression secondary to a disc herniation, many people will end up having an orthopaedic referral. In some cases, this leads to the recommendation that back surgery is required.

I frequently see people who have been advised to undergo surgery for a disc herniation but are unsure as to whether they should or not. When it comes to a decision regarding whether spinal surgery is necessary, there are published guidelines to guide this decision-making process which we will highlight below.

In many cases however, the reality is that whether surgery is undertaken or not, is often a decision undertaken by the back pain sufferer themselves and is often based on whether they can cope with the pain or not. Generally speaking, since the 1980’s, the pendulum has swung in favour of non-surgical rehabilitation in the vast majority of back pain presentations.

There are some symptoms that indicate a significant compression of the spinal cord and necessitate surgery; however, these symptoms are extremely rare.

Risks from Spinal Surgery - Naas Physio & Chiropractor

Criteria that necessitate the performance of immediate surgery include the following:

  • Loss of bowel or bladder control eg incontinence or constipation
  • Lack of sensation around the bum or genital region
  • Instability while walking

What Does the Research Say About Back Surgery?

The most respected research group in healthcare are the Cochrane research group.
A Cochrane research review (Gibson et al. 1999) found no evidence that fusion surgery was effective for low back pain or degenerative disc disease.

Despite this, rates of lumbar spinal fusion increased 220% from 1990 to 2001 in the United States (Deyo et al. 2005)

Do I Need Surgery If I Have Sciatica?

Peul WC, van Houwelingen HC, van den Hout WB, Brand R, Eekhof JA, Tans JT, Thomeer RT, Koes BW; Leiden-The Hague Spine Intervention Prognostic Study Group. Surgery versus prolonged conservative treatment for sciatica. N Engl J Med. 2007 May 31;356(22):2245-56. doi: 10.1056/NEJMoa064039. PMID: 17538084.

In this study they randomly assigned 283 patients who had had severe sciatica for 6 to 12 weeks to early surgery (microdiscectomy) or to prolonged conservative (non-surgical) treatment with surgery if needed. 

Relief of leg pain was faster for patients assigned to early surgery.  

‘In both groups, however, the probability of perceived recovery after 1 year of follow-up was 95%.’

Surgery for Disc Herniation - Naas Physio & Chiropractic

Gugliotta M, da Costa BR, Dabis E, Theiler R, Jüni P, Reichenbach S, Landolt H, Hasler P. Surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study. BMJ Open. 2016 Dec 21;6(12):e012938. doi: 10.1136/bmjopen-2016-012938. PMID: 28003290; PMCID: PMC5223716.

‘We found no evidence that surgical treatment, when compared with conservative treatment, reduced the severity of sciatica symptoms or improved the quality of life of patients with lumber disc herniation in the medium or long term.
Pain was relieved more quickly in patients who received surgical treatment (evident at the 3-week follow-up), but the difference between groups was no longer present after 3 months.’

‘Compared with conservative treatment, surgical treatment relieved back pain faster, but no relevant clinical difference was observed after 3 months.’


Kreiner et al. (2012) North American Spine Society. Evidence-Based Clinical Guidelines for Multidisciplinary Spine Care.

Question: Are there clinical circumstances in which lumbar fusion is appropriate in the treatment of lumbar disc herniation with radiculopathy?

Answer: There is insufficient evidence to make a recommendation for or against fusion for specific patient populations with lumbar disc herniation with sciatica 

Grade of Recommendation: I (Insufficient Evidence)

The best evidence available suggests that outcomes are equivalent in patients with sciatica due to lumbar disc herniation whether or not a fusion is performed.


Is Surgery Effective for Chronic (Long-Term) Back Pain?

Brox. J. et al. Lumbar instrumented fusion compared with cognitive intervention and exercises in patients with chronic back pain after previous surgery for disc herniation: a prospective randomized controlled study. Pain. 2006 May;122(1-2):145-55. doi: 10.1016/j.pain.2006.01.027. Epub 2006 Mar 20. PMID: 16545523.

This study compared the effectiveness of lumbar fusion compared with a group performing exercise & who were educated regarding the importance of movement.
This time they took a group who had low back pain lasting longer than 1 year after previous surgery for a disc herniation.

One commonly used measure of disability is called the Oswestry Disability Index. Using this as a measure of outcome, they found that it was significantly improved from 47 to 38 after fusion and from 45 to 32 after exercise and education.

 

What About Surgical Fusion After Prior Failed Surgery?

Brox JI, Nygaard ØP, Holm I, Keller A, Ingebrigtsen T, Reikerås O. Four-year follow-up of surgical versus non-surgical therapy for chronic low back pain. Ann Rheum Dis. 2010 Sep;69(9):1643-8. doi: 10.1136/ard.2009.108902. Epub 2009 Jul 26. PMID: 19635718; PMCID: PMC2938881.

This study reported that lumbar fusion surgery was not superior to exercise rehabilitation and education in a group of chronic low back pain patients with and without previous surgery for a disc herniation.

In most studies of this nature, you find a certain percentage of people do not respond to rehabilitation. They will often undergo surgery at a later date. On the surface of it, this might appear to suggest that they would have fared better if they had undergone surgery in the first place. However, in this study they found that on follow-up there was a similar number of people in the surgery group undergoing re-operations as there was in the non-surgical group. This suggests that the group who do not improve, may not have improved, even if they had undergone surgery initially. 

124 patients with disc degeneration and at least 1 year of symptoms after or without previous surgery for disc herniation. 

 

What About the Risks from Back Surgery?

Cakir, Balkan et al. “Lumbar disk herniation: what are reliable criterions indicative for surgery?.”Orthopedics 32,8 (2009): 589. doi:10.3928/01477447-20090624-19              

In this prospective study, 126 patients with disc herniations were allocated randomly to surgical (60 patients) or conservative (66 patients) treatment.

At 1-year follow-up, patients operated on for a disc herniation showed better results compared to their conservative peers; however, this study indicates that there is no significant difference at medium- and long-term follow-up between surgical and nonsurgical treatment for disc herniation.

When comparing surgical and nonsurgical treatment options the obvious advantage of conservative treatment is the absence of complications related to surgery. Any surgical procedure, no matter how carefully performed, carries risks.

Common complications in diskectomy include wrong level surgery, missed pathology and/or retained herniation, dural leakage, epidural venous bleeding with epidural hematoma, iatrogenic instability with residual back pain, infection/diskitis, thromboembolism and postoperative epidural fibrosis.5

The reported intra- and postoperative complication rate varies between 3% and 25% for standard nucleotomy and between 2% and 11% in microsurgical diskectomy.6-10 An argument for nonoperative treatment is also the rate of reoperations after diskectomy. With regard to published data with sufficient follow-up and sound number of patients, the revision rate after diskectomy varies between 6% and 15%.9,11-13

Surgery for Lumbar Disc Herniation - Naas Physiotherapy & Chiropractor


Paul Willems (2013) Decision Making in Surgical Treatment of Chronic Low Back Pain: The performance of prognostic tests to select patients for lumbar spinal fusion, Acta Orthopaedica, 84:sup349, 1-37, DOI: 10.3109/17453674.2012.753565

Firstly, let’s highlight the fact that research suggests that non-invasive interventions, such as exercise therapy, produce similar results to spinal fusion, but ‘with considerably less complications, morbidity and costs.’ (1)

 

Fairbank, J. et al. Randomised controlled trial to compare surgical stabilisation of the lumbar spine with intensive rehabilitation. BMJ. 2005; 28;330(7502):1233.

Here, 349 patients with chronic low back pain of at least one year’s duration were selected to undergo either spinal fusion or an intensive rehabilitation programme

‘No clear evidence emerged that primary spinal fusion surgery was any more beneficial than intensive rehabilitation.’
“the potential risk and additional cost of surgery also need to be considered.”

Jacobs WC, van Tulder M, Arts M, Rubinstein SM, van Middelkoop M, Ostelo R, Verhagen A, Koes B, Peul WC. Surgery versus conservative management of sciatica due to a lumbar herniated disc: a systematic review. Eur Spine J. 2011 Apr;20(4):513-22. doi: 10.1007/s00586-010-1603-7. Epub 2010 Oct 15. PMID: 20949289; PMCID: PMC3065612.

They review the literature and state that most studies have a high risk of bias but the Wienstein study below does not. So what does the study by Weinstein & colleagues conclude?

Weinstein JN, Tosteson TD, Lurie JD, Tosteson AN, Hanscom B, Skinner JS, Abdu WA, Hilibrand AS, Boden SD, Deyo RA. Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT): a randomized trial. JAMA. 2006 Nov 22;296(20):2441-50. doi: 10.1001/jama.296.20.2441. PMID: 17119140; PMCID: PMC2553805.

The Spine Patient Outcomes Research Trial was a randomized clinical trial involving 501 surgical candidates from 13 multidisciplinary spine clinics in 11 US states.

In the group with sciatica and confirmed disc herniations it was shown that both the surgery as well as the conservative treatment group improved substantially over 2 years

Again, they suggest that early surgery in patients with sciatica may provide better short-term relief of leg pain but the evidence is low quality as only one trial investigated this properly.

After 2 years of follow-up, 45% of patients in the conservative treatment group underwent surgery and 40% in the surgery group received conservative treatment.

 

Should I Undergo Surgery for Lumbar Stenosis?

Lumbar stenosis is a narrowing of the spinal canal that can lead to compression of the nerves that supply gluteal & leg muscles.

Machado GC, Ferreira PH, Harris IA, Pinheiro MB, Koes BW, van Tulder M, Rzewuska M, Maher CG, Ferreira ML. Effectiveness of surgery for lumbar spinal stenosis: a systematic review and meta-analysis. PLoS One. 2015 Mar 30;10(3):e0122800. doi: 10.1371/journal.pone.0122800. PMID: 25822730; PMCID: PMC4378944.

Nineteen published reports (17 trials) were included in this systematic review.

The authors concluded that ‘The results of this Cochrane review show a paucity of evidence on the efficacy of surgery for lumbar spinal stenosis, as to date no trials have compared surgery with no treatment, placebo or sham surgery.’

 

Is Spinal Manipulation Effective for Treatment of a Lumbar Disc Herniation?

Santilli V, Beghi E, Finucci S. Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations. Spine J. Mar-Apr 2006;6(2):131-137.

Santilli performed a randomized double-blind controlled trial assessing the short-and long-term effects of spinal manipulation on acute back pain and sciatica with disc protrusion.

Of 102 patients, 53 received manipulations and 49 received simulated manipulations. Manipulations appeared more effective on the basis of the percentage of pain-free cases:

local pain 28 vs. 6%; p<.005;

radiating pain 55 vs. 20%; p<.0001

Patients receiving manipulations had lower mean VAS1 (p<.0001) and VAS2 scores (p<.001).

This study provides Level I therapeutic evidence that spinal manipulation is significantly more effective than sham treatment for the relief of back and leg pain due to acute (less than 10 days) lumbar disc herniation with radiculopathy.’

There were no adverse events.

 

Should I Have Spinal Manipulation or Surgery for Sciatica?

McMorland G, Suter E, Casha S, du Plessis SJ, Hurlbert RJ. Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study. J Manipulative Physiol er. 2010 Oct;33(8):576-584.

Patients referred by primary care physicians to neurosurgical spine surgeons were consecutively screened for symptoms of unilateral lumbar radiculopathy 

Forty consecutive patients who met inclusion criteria (patients must have failed at least 3 months of nonoperative management including treatment with analgesics, lifestyle modification, physiotherapy, massage therapy, and/or acupuncture) were randomized to either surgical microdiskectomy or chiropractic spinal manipulation.

Sixty percent of patients with sciatica who had failed other medical management benefited from spinal manipulation to the same degree as if they underwent surgical intervention.

They recommended that ‘patients with symptomatic lumbar disc herniation failing medical management should consider spinal manipulation followed by surgery if warranted.’

The manipulation group received an average of 21 treatment sessions & an additional 6 supervised rehabilitation sessions over the 52-week duration of the study. Patients in the surgical arm underwent a single microdiscectomy procedure followed by 6 supervised rehabilitation sessions over the 52-week duration of the study. No new neurological deficits arose from either of the treatment protocols nor were there any significant adverse events reported


Some orthopaedic guys have said that manipulation should be avoided. Is this accurate?

Well, in both the Sintilli & McMorland studies above there was not a single significant adverse effect reported.


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What is the Best Medication for Back Pain?

 

What is the Best Medication to Take for my Back Pain?

I am frequently asked by patients: ‘what drug should I take to ease my back pain?’ My normal response is to avoid taking them if possible, unless you are really finding it a struggle to sleep at night.

One of the most commonly available pain-killers is paracetamol, and, because most people already have some at home, it is often taken in an attempt to ease back pain.

One study reviewed all the published evidence in relation to using paracetamol to treat low back pain (1)

Based on the available evidence they concluded that: ‘paracetamol is ineffective in the treatment of low back pain and provides minimal short-term benefit for people with osteoarthritis.’

The UK National Institute for Health & Care Excellence (NICE) guidelines corroborated this and they no longer recommend paracetamol for back pain treatment.

 

Anti-inflammatories for Back Pain. Naas Physio & Chiropractic Clinic


What Anti-Inflammatory Drug Should I Take for My Back Pain?

The drugs that are most frequently used for treating back pain are the anti-inflammatory group of drugs. For decades, they formed the standard practice in treating back pain.

Because of the opioid crisis, the pharmaceutical industry are looking for alternative treatments for pain. One alternative is the use of non-steroidal anti-inflammatory drugs (NSAIDs). (5)

In the U.S. for example, around 60% of patients with osteoarthritis or chronic low back pain are prescribed NSAIDs.

In the UK, the National (NICE) guidelines recommend anti-inflammatories (NSAIDs) as the first choice for treating back pain & sciatica.

Anti-inflammatory drugs (NSAIDs) are commonly used for pain management. Common examples of include:

  • Ibuprofen
  • Diclofenac
  • Celecoxib

The logic behind the use of anti-inflammatories is that decreasing inflammation will lead to a decrease in pain and speed up recovery. A common misconception amongst patients is that their back pain is caused by local inflammation. In the vast majority of back pain that I treat there is  no evidence of inflammation in the site of back pain.

Even in cases where inflammation is present, the question is:

Is inflammation harmful?
Does blocking inflammation improve healing?
How much inflammation is too much?
How long should I take anti-inflammatories for, if at all?

 

Should I take anti-inflammatories if I have a fracture?

It has been recognised for a long time that taking NSAIDs decreases bone healing and increase the rates of non-union of bones. Because of this, they are generally avoided after orthopaedic surgery.

Previous research in animals also suggests that anti-inflammatory drugs (NSAIDs) may delay wound healing (4,6).

The anti-inflammatories block prostaglandins which have been shown to play an important role in bone repair, which includes differentiation of osteoblast and osteoclast precursor cells (6)

If they block wound and bone healing, is this an indication that they may have a similar impact when it comes to spinal pain?

What is the Evidence for Anti-Inflammatories in Helping Back Pain?

Mancado & colleagues reviewed the available data on anti-inflammatory drugs for treating spinal pain. They included 35 high quality studies (known as randomised controlled trials). (3)

From analysing all the available research, they concluded that anti-inflammatories (NSAIDs) are effective in treating spinal pain; however, they are no more effective than using a placebo

They reported that 6 participants needed to be treated with NSAIDs, for one additional participant to achieve clinically important pain reduction.

Can Blocking Inflammation Lead to Long-Term Back Pain?

A recent study attempted to answer some of these questions by testing for inflammatory markers in blood samples from 98 patients with recent onset low back pain (2)

At follow-up 3 months later, when testing blood samples for inflammation, they found that participants whose pain had gone at 3 months demonstrated more inflammation on initial testing. Inflammation was indicated by the presence of a higher number of immune cells known as neutrophils.
In the group with persistent pain, there was no increase in inflammatory cells measured on initial testing.

Neutrophils are a type of immune cell that helps to fight infection and dominate in the the early stages of injury.

Here, the researchers found that blocking neutrophils in mice prolonged the pain up to ten times the normal duration. In mice, treating the pain with steroid or nonsteroidal anti-inflammatory drugs (NSAID) like diclofenac led to prolonged pain, despite helping to decrease pain in the short term. The mice were less sensitive to touch in the initial phase.

If the scientists administered neutrophils, then this prolonging of pain was reversed, showing that these immune cells are vital for recovery from back pain.

So, the presumption that decreasing swelling aids recovery needs to be re-evaluated in light of these findings.

As part of the study, they examined data of 500,000 people from the United Kingdom Biobank, a database of medical information. They found those taking anti-inflammatory drugs to treat their pain were much more likely to have pain two to ten years later.

They also found that taking painkillers, such as Tylenol were less likely to experience chronic pain compared to those who took anti-inflammatory medication.

Medication for Back Pain

Benefit & Risk From Taking Anti-Inflammatories

At present, there are no pain-killers that provide clinically important effects for spinal pain over placebo (3)

Even after all this is considered, ‘NSAIDs increased the risk of gastrointestinal reactions by 2.5 times’, contributing to 18,000 gastric bleeds each year in the UK, & contributing to over 2,000 deaths.

 

References:

  • Machado GC, Maher CG, Ferreira PH, Pinheiro MB, Lin CW, Day RO, McLachlan AJ, Ferreira ML. Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials. BMJ. 2015 Mar 31;350:h1225. doi: 10.1136/bmj.h1225. PMID: 25828856; PMCID: PMC4381278.
  • Parisien M, Lima LV, Dagostino C, El-Hachem N, Drury GL, Grant AV, Huising J, Verma V, Meloto CB, Silva JR, Dutra GGS, Markova T, Dang H, Tessier PA, Slade GD, Nackley AG, Ghasemlou N, Mogil JS, Allegri M, Diatchenko L. Acute inflammatory response via neutrophil activation protects against the development of chronic pain. Sci Transl Med. 2022 May 11;14(644):eabj9954. doi: 10.1126/scitranslmed.abj9954. Epub 2022 May 11. PMID: 35544595.
  • MachadoGC, Maher CG, Ferreira PH, et al. Non-steroidal anti-inflammatory drugs for spinal pain: a systematic review and meta-analysis. Annals of the Rheumatic Diseases 2017;76:1269-1278.
  • Nagano A, Arioka M, Takahashi-Yanaga F, Matsuzaki E, Sasaguri T. Celecoxib inhibits osteoblast maturation by suppressing the expression of Wnt target genes. J Pharmacol Sci. 2017;133(1):18–24.
  • Zhao-Fleming, H., Hand, A., Zhang, K. et al.Effect of non-steroidal anti-inflammatory drugs on post-surgical complications against the backdrop of the opioid crisis. Burn Trauma 6, 25 (2018). https://doi.org/10.1186/s41038-018-0128-x
  • Jeffcoach DR, Sams VG, Lawson CM, Enderson BL, Smith ST, Kline H, et al. Nonsteroidal anti-inflammatory drugs’ impact on nonunion and infection rates in long-bone fractures. J Traum Acute Care Surg. 2014;76(3):779–83.

Myth Busters: What’s the Best Way to Lift to Avoid Back Pain?

Is bending dangerous if you have back pain?

Lifting with back pain: The approach of lifting with the legs and avoiding bending from the back is “common knowledge” as a key method for protecting the back from injury. However, the question is: does research back this approach up?

How many times have you heard someone being advised to “keep the back straight” and “bend from the knees”. Is this actually effective or should it be largely ignored? Questioning such firmly entrenched beliefs is part of the scientific process.

 

Naas Physiotherapy & Chiropractor. Best way to lift to avoid back pain

What Happens in My Back When I Squat versus Bending while Lifting?

Spinal compression and the pressure present within the spinal discs does not appear significantly different whether squatting or bending from the spine when lifting. Research suggests that the forces were equal or slightly higher in squatting when compared to bending from the back when lifting. 

In fact, a recent review of the science actually found that flexing from the lower back improved lifting capacity and muscle coordination when compared to a straight spine lift. This research brings into question the traditional advice to lift with a flat or slight backward arch of the back (Mawston et al. 2021). 

 

Should I Squat or Bend My Back When Lifting?

 Saraceni N, Kent P, Ng L, Campbell A, Straker L, O’Sullivan P. To Flex or Not to Flex? Is There a Relationship Between Lumbar Spine Flexion During Lifting and Low Back Pain? A Systematic Review With Meta-analysis. J Orthop Sports Phys Ther. 2020;50(3):121-130. doi:10.2519/jospt.2020.9218

Here, the authors reviewed all the literature on spinal flexion when lifting.

They found that there was low-quality evidence that greater spinal flexion during lifting was not a risk factor for LBP onset or persistence.  

 

Does Ergonomic/Lifting Technique Training in the Workplace Prevent Back Pain? 

Wai EK, Roffey DM, Bishop P, Kwon BK, Dagenais S. Causal assessment of occupational lifting and low back pain: results of a systematic review. Spine J. 2010;10(6):554-566. doi:10.1016/j.spinee.2010.03.033

This research included 35 studies. They found moderate evidence of an association for specific types of lifting and LBP.

The authors reported that ‘based on these results, it is unlikely that occupational lifting is independently causative of LBP in the populations of workers studied.’

 

Luger T, Maher CG, Rieger MA, Steinhilber B. Work-break schedules for preventing musculoskeletal symptoms and disorders in healthy workers. Cochrane Database Syst Rev. 2019 Jul 23;7(7):CD012886. doi: 10.1002/14651858.CD012886.pub2. PMID: 31334564; PMCID: PMC6646952.

The evidence collected indicates that manual handling training is largely ineffective in reducing back pain and back injury.

Naas Physio Clinic: What's the Best Way to Lift to Avoid Back Pain?

Clemes SA, Haslam CO, Haslam RA. What constitutes effective manual handling training? A systematic review. Occup Med (Lond). 2010 Mar;60(2):101-7. doi: 10.1093/occmed/kqp127. Epub 2009 Sep 4. PMID: 19734238.

In this review that included 53 papers the authors found that ‘the evidence collected indicates that manual handling training is largely ineffective in reducing back pain and back injury.’ 

 

Sundstrup E, Seeberg KGV, Bengtsen E, Andersen LL. A Systematic Review of Workplace Interventions to Rehabilitate Musculoskeletal Disorders Among Employees with Physical Demanding Work. J Occup Rehabil. 2020 Dec;30(4):588-612. doi: 10.1007/s10926-020-09879-x. PMID: 32219688; PMCID: PMC7716934.

The evidence synthesis recommends that implementing strength training at the workplace can reduce injury among workers with physically demanding work.

Based on the scientific literature, participatory ergonomics and multifaceted workplace interventions seem to have no beneficial effect on reducing musculoskeletal disorders among this group of workers. 

 

Does Lifting Technique Training Help to Decrease Back Pain?

Unfortunately, education on lifting technique has not been shown to reduce the incidence of low back pain. Despite this, proper lifting technique is taught in workplaces across the globe, and also frequently, in clinics.

As mentioned, bending the back more when lifting has not been shown to be linked to back injury!

 

Do Ergonomic Work Supports Help for Shoulder & Arm Pain?

Van Eerd D, Munhall C, Irvin E, Rempel D, Brewer S, van der Beek AJ, Dennerlein JT, Tullar J, Skivington K, Pinion C, Amick B. Effectiveness of workplace interventions in the prevention of upper extremity musculoskeletal disorders and symptoms: an update of the evidence. Occup Environ Med. 2016 Jan;73(1):62-70. doi: 10.1136/oemed-2015-102992. Epub 2015 Nov 8. PMID: 26552695; PMCID: PMC4717459.


This literature review showed moderate evidence for amending mouse setup, use of forearm support, & stretching programmes in preventing shoulder & arm pain.

Interestingly, they did find that a resistance training programme had strong evidence in preventing upper limb disorders.

 

What About Work Breaks?

Luger T, Maher CG, Rieger MA, Steinhilber B. Work-break schedules for preventing musculoskeletal symptoms and disorders in healthy workers. Cochrane Database Syst Rev. 2019 Jul 23;7(7):CD012886. doi: 10.1002/14651858.CD012886.pub2. PMID: 31334564; PMCID: PMC6646952.

We found low-quality evidence that different work-break frequencies may have no effect on participant-reported musculoskeletal pain, discomfort and fatigue.

For productivity and work performance, evidence was of very low-quality that different work-break frequencies may have a positive effect. 

 

Do People with Back Pain Lift Differently to Those Without Back Pain?

Saraceni N, Campbell A, Kent P, Ng L, Straker L, O’Sullivan P. Exploring lumbar and lower limb kinematics and kinetics for evidence that lifting technique is associated with LBP. PLoS One. 2021 Jul 21;16(7):e0254241. doi: 10.1371/journal.pone.0254241. PMID: 34288926; PMCID: PMC8294511.

21 LBP and 20 noLBP participants completed a 100-lift task, where lumbar and lower limb kinematics and kinetics were measured during lifting, with a simultaneous report of LBP intensity every 10 lifts.

 

Workers with a history of LBP, lift with a style that is slower and more squat-like than workers without any history of LBP.

 

Common assumptions that LBP is associated with lumbar kinematics or kinetics such as greater lumbar flexion or greater forces were not observed in this study, raising questions about the current paradigm around ‘safe lifting’.

 

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