Preventing Low Back Pain

Disorders of the spine producing low back pain (LBP) are endemic in industrialized societies. The symptoms stem from many different diseases, and although many associate the complaint with herniation of a lumbar or lumbosacral disk, identifiable disorders of the disk account for a minority of cases. Table 23.1 lists some of the diagnoses associated with low back pain. The annual incidence is 5% in the United States, and the lifetime reported prevalence ranges from 60% to 90%.1–8 It is the most frequent cause of morbidity that limits activity in persons less than 45 years old,9–11 the second most frequent complaint recorded by physicians for ambulatory visits, and for men 25 to 64 and women 35 to 64, the most frequent complaint.12 Rates are higher in men, and this correlates with the differences in the physical demands of jobs performed by men compared with women. The decline of work-related pain with age for both sexes can be explained by the “healthy worker” effect, wherein those at greatest risk steadily drop out of the work force. Also, as workers gain seniority, they move into jobs that are less physically demanding.