Effect of work on degenerative back disease. A review

Abstract

The low-back morbidity associated with lumbar degeneration develops from a combination of hereditary and environmental causes. The evidence for the hereditary influence is mainly indirect, based on the considerable interindividual variation in morbidity. Several external factors have been found to contribute to the development of 'degenerative back disease' from early childhood to old age. In this review the occupational factors on the development of 'degenerative back disease' is obscured by the biological variation in disposition to disease, the high prevalence of degenerative changes in the general population, and the selection of workers active in different occupations. Nevertheless, several studies have shown that heavy physical work may cause radiologically detectable spinal degeneration that develops up ten years prematurely. The symptoms from the degenerative process may be many times more common in heavy occupations than in light ones. Most occupations involve exposure to several back load factors. Of the specific factors, injury and 'heavy' lifting seem to have the strongest degenerative effect. With further study the importance of whole body vibration may rise. Stooped posture causes fatigue and ache and may also contribute to the acceleration of the degenerative process. Climate affects symptoms, but does not as such hasten degeneration. The incidence of incapacity due to back disease is rising in many industrialized countries. To prevent unnecessary pain, and to avoid lost workdays, present knowledge on the cause of 'degenerative back disease' should be effectively used to improve occupational health in the workplace, and the further study of premature spinal degeneration should be pursued with increasing effort.