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Updated: May 31, 2026
Biomechanical Changes Related to Low Back Pain: An Innovative Tool for Movement Pattern Assessment and Treatment Evaluation in Rehabilitation
Published on: December 13, 2024
Systematic review: occupational physical activity and low back pain
B K Kwon1, D M Roffey, P B Bishop
1International Collaboration on Repair Discoveries, Combined Neurosurgical and Orthopaedic Spine Program, Department of Orthopaedics, University of British Columbia, Blusson Spinal Cord Center, Vancouver General Hospital, 818 West 10th Avenue, Vancouver, British Columbia, Canada V5Z 1M9. brian.kwon@vch.ca
Occupational physical activities do not show strong evidence of causing low back pain (LBP). Current literature suggests associations, not causation, complicating injury claims and prevention strategies.
Area of Science:
- Occupational Health
- Epidemiology
- Musculoskeletal Disorders
Background:
- Occupational physical activities are frequently suspected as contributors to low back pain (LBP).
- Lack of confirmed causal relationships complicates work injury adjudication, return-to-work protocols, and prevention efforts.
Purpose of the Study:
- To synthesize evidence from eight systematic reviews (SRs) on causal links between specific occupational physical activities and LBP.
- To provide clinicians with a consolidated overview of the scientific literature regarding occupational factors and LBP.
Main Methods:
- Conducted a literature search to identify eligible studies for inclusion in SRs.
- Assessed methodological quality using a modified Newcastle-Ottawa Scale (NOS).
- Evaluated levels of evidence for causation using the Bradford Hill framework.
Main Results:
- The eight SRs collectively analyzed 99 studies.
- No strong evidence supported a causal relationship between any examined occupational physical activity and LBP.
- Conflicting evidence indicated statistical association, not causation, for bending, twisting, lifting, and pushing/pulling with LBP.
- Strong evidence indicated no causal relationship between LBP and manual handling/assisting patients, awkward postures, carrying, sitting, standing, or walking.
Conclusions:
- Findings from the SRs did not support the hypothesis that occupational physical activities cause LBP.
- Insufficient or poor-quality scientific literature may hinder establishing causation.
- Population-level findings do not negate individual perceptions of occupational LBP attribution.
