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  • Writer's picturePaul Monaro

Lumbar - Epidemiology General & Construction

I am currently involved in research into low back pain (LBP) in construction workers. This is for the purpose of designing education and training aimed at helping to prevent injury in trainees entering the workplace. I have written an extensive review on the subject. The following excerpt from this review details interesting facts regarding the prevalence of LBP both in the general population, and in construction. I have highlighted some of the more concerning statistics. From this you will see just how extensive the problem is.


LBP in the General Population.

The lifetime prevalence of LBP is consistently reported as being 80% 5,17,19. It affects around 10% of the worlds’ population at any point in time 18. LBP is the most common reason for activity limitation in those under 45 years of age 5,6,13. It is the primary health problem affecting quality of life 6 . 13% of all sick days in the UK, and 19% in Sweden, were due to LBP 8 The incidence of LBP continues to rise 5,15 . Over the past 10 years in the US, while the percentage of disability has decreased for circulatory disorders (11.8% to 9.6%) and respiratory conditions (3.6% to 3.1%) it has increased for MSK injuries (20.6% to 25.4%), particularly LBP 20. Currently, LBP is the third most frequent cause of disability behind arthritis and heart disease 5 . In the US 20%, and in Europe 40% of the population will suffer from LBP over the course of a year 5 . Of all MSK injuries, 20% were to the low back 4 . Also, 20% 10 to 25% 12 of all workrelated, and 33% 10 to 40% 12 of all compensable injuries were to the low back. It was the second most common reason to visit a doctor, the fifth most frequent reason for hospital admission, and the third most common reason to require surgery 17. In Australia in 1994, LBP cost the economy an estimated $400 million, with a workers compensation bill of $300 million 5 . In the US the corresponding cost was $15 to $30 billion 5 . Two per cent of the US workforce is compensated each year due to LBI 8 .


LBP in Construction

While the lifetime incidence of LBP is reported at 80% for the general population, it was reported as 90% in construction 16 . In US construction in 1999, the incidence of LBI was said to be 50% higher than for all other industries 1 . In US manual handling jobs, 80% of work injuries were to the low back 5,11. In injury surveys, 70% of workers reported LBP 1 , 60% to 66% had suffered from LBP in the previous 12 months 6,7, and over 30% had experienced LBP during the previous week 7 . LBI accounted for 29% of all injuries in highway construction 3 and 25% across all industries 6 . In apprentice workers, 54.4% reported injuries to the lower back, for which 16.8% had consulted a physician, and 7.3% had missed work days during the previous year14. 23% of older workers required a physician visit for their LBP 1 . In the US in the 1980’s, 25% of all compensatory injuries were to the low back 2 . It was the main reason for work absenteeism 6 and the most common reason for early retirement 7,8 . For general construction related injuries, 82% of those surveyed had suffered at least one MSK injury, and the incidence of lost workdays from non-fatal injuries was highest for construction 7 . Construction accounted for 10 of the top 25 sectors requiring interventions for MSK injuries. 1 In Sweden, 72% of sick leave of over 4 weeks duration was due to MSK injury, with 54% due to LBI. MSK injuries in construction were 41.5 per 1000 workers, compared to 35.4 for other industries 9 . In apprentice construction workers, 76.8% reported MSK symptoms 14 .


References:

1. Albers, T & Estill, C (2007). Simple Solution – ergonomics for construction workers. NIOSH, Department of Health and Human Servises, Centre for Disease Control & Prevention. http://www.cdc.gov/niosh/docs/2007-122/pdfs/2007-122.pdf 2. Carlton, R (1987). The effects of body mechanics instruction on work performance. American Journal of Occupational Medicine, 41, 16-20. 3. Choi, S (2012). A study of trade-specific occupational ergonomics considerations in the U.S. construction industry. Work, 42, 215-222. 4. Clemes, S et al (2010). What constitutes effective manual handling training? A systematic review. Occupational Medicine, 60, 101-107. 5. Cole, M & Grimshaw, P (2003). Low back pain and lifting- a review of epidemiology and aetiology. Work, 21, 2, 173-184. 6. Ergonomics Manual for Mason Tenders, (2000). N.Y. State Laborers Health & Safety Trust Fund. The Occupational & Industrial Orthopaedic Centre,

Journal of Occupational Therapy, 44, 5, 402-407. 14. Merlino, L et al (2003). Symptoms of musculoskeletal disorders among apprentice construction workers. Applied Occupational and Environmental Hygiene, 18, 1, 57-54. 15. Oude Hengel, K et al (2011). Intervention mapping as a framework for developing an intervention at the worksite for older construction workers. American Journal of Health Promotion, 26, 1, e1-e10. 16. Perich, D et al (2011). Low back pain in female adolescent rowers: a multi-dimensional intervention study. Knee Surgery, Sports Traumatology & Arthroscopy, 19, 1, 20-29. 17. Roffey, D et al (2010). Causal assessment of workplace manual handling or assisting patients and low back pain: results of a systematic review. The Spine Journal, 10, 629-651. 18. Steffens, D et al (2015). What triggers an episode of acute low back pain? A case-crossover study. Arthritis Care and Research, 67, 3, 403-410. 19. Vakos, J et al (1994). Electromyographic activity of selected trunk and hip muscles during a squat lift: effect of varying the lumbar posture. Spine, 19, 6, 687-695. 20. Deyo, R et al (2009). Overtreating chronic back pain: time to back off? Journal of the American Borad of Family Medicine, 22, 1, 62-68.


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