Occupational low back pain

Goal of the Study?

In this Bibliometric Analysis [A bibliometric analysis of occupational low back pain studies from 2000 to 2020] the authors used two bibliometric tools; BibExcel and CiteSpace to examine 4,217 documents related to occupational low back pain (OLBP).  Bibliometric Analysis (BA) is the application of statistical methods and visualization tools to analyze books, articles and other publications.  BA attempts to put the articles into a series of clusters.  These clusters can be based on themes, country of origin, journal name, publication date, research institute, authors and something called co-citation.  Co-citation cluster analysis is the frequency of which two articles are cited together in the same document.  

 

Why are they doing this study?

Bibliometric Analysis of OLBP shows where the studies were done, who was doing the research, which industries dominated the high prevalence of OLBP and what was the research tendency over time.  Using bibliometric analysis can help researchers grasp the research structure and latest trends of OLBP.

 

What was done?

Over 4,000 articles from 2000 to 2020 were fed into the BibExcel and CiteSpace tools.  These articles were all from the subscription-based Web of Science academic database.  Terms related to OLBP were used to identify each article.  These articles were downloaded and fed through the two bibliometric tools identifying various clusters.

 

What did they find?

On a country basis, the BA analysis found that the USA, Canada and UK produced the highest number of contributions to OLBP research in the Web of Science databases.  Ontario’s Institute of Work & Heath was the most prolific institution producing over 70 articles on OLBP.  Other Canadian institutions making the top 10 were the University of Waterloo (#7), University of Toronto (#9) and University of Alberta (#10).  The top 2 contributing journals were the Journal of Occupational Rehabilitation (203 documents) and Spine (200 documents). 
Fifteen major OLBP research theme clusters were identified.  The two most popular ones were Musculoskeletal Disorder (227 documents) and Risk Factors (212 documents).  The two most recent themes were Biopsychosocial Approach and Core Outcome.

 

Why do these findings matter?

Occupational low back pain (OLBP) is regarded as one of the most common work-related musculoskeletal disorders.  OLBP not only has huge direct and indirect economic losses but is also responsible for the decline of quality of life.  Comprehensive bibliometric studies, such as this, provide general insight into aggregate performance in the OLBP field and can help identify further research directions.

Dynamic Sitting Exercise

Goal of the Study?

The objective of this study [1. An Evaluation of an Innovative Exercise to Relieve Chronic Low Back Pain in Sedentary Workers] was to examine the effectiveness of a unique supported dynamic lumbar extension with the abdominal drawing-in maneuver (ADIM) technique on stature change, deep abdominal muscle activity, trunk muscle fatigue and pain intensity during prolonged sitting in chronic low back pain (CLBP) participants.

 

Why are they doing this study?

Low back pain (LBP) is a global issue among the working population. In Thailand, where this study is based, the prevalence of LBP across various occupations is approximately 83%, and 60% of workers in call centers have reported that their LBP is aggravated by sitting during the workday. 

Previous research has demonstrated that continuous sitting results in trunk muscles’ contraction, causing muscle fatigue and reducing muscular support to the spine. This increases stress on ligaments and intervertebral discs, ultimately leading to LBP. Existing research, such as that by lead author Jerome Fryer (the CEO of Dynamic Disc Designs Corp.) et al. (2010), has demonstrated the value of the dynamic sitting exercise on restoring disc height. Moreover, the ADIM technique has been shown to be effective in reducing the spinal lumbar load in patients with chronic LBP. 

 

What was done?

This is the first study investigating the combined use of a supported lumbar extension with the ADIM technique on stature recovery in CLBP patients.

They recruited 30 patients (15 males and 15 females) between the ages of 20-39 years old. All participants included had CLBP lasting more than 3 months, had low to moderate pain levels and reported sitting for at least 2 hours at work.

The participants were randomly assigned to one of two groups: 1) control – sitting without exercise; 2) sitting with supported dynamic lumbar extension with the ADIM technique. The control group sat for a 41-minute testing period. The intervention group sat in a neutral posture for 27 seconds; at the 28th second, they straightened their lower back and drew in their lower abdomen and extend their lumbar spine with their upper limbs supported to transfer the spinal load to the upper limbs, with their chest up slightly and chin in for 5 seconds. Participants were then repositioned to a neutral position and relaxed their lower abdomen for 3 seconds. This was completed 3 times over the 41-minute sitting period.

 

What did they find?

This study found that a dynamic lumbar extension with the ADIM technique protected from the detrimental effects on stature change and deep trunk muscle fatigue that can result from prolonged sitting. They found the intervention significantly reduced stature loss compared to the control group. Additionally, they found that this combined approach prevented an increase in pain intensity during prolonged sitting in people with CLBP. 

 

Limitations?

This study has several limitations, including the use of young participants, setting the study in a laboratory rather than the workplace, self-reported data, lack of consensus on body positioning, and limiting the findings to immediate effects rather than long-term outcomes.

 

Why do these findings matter?

Clinicians can implement this intervention for patients who sit for long periods of time as a way to prevent LBP problems. 

Ergonomic Seating

Lower back pain is a global problem. Its rate has increased steadily over the last several decades, with now more than 637 million individuals suffering around the world. 1

What has also been steadily increasing is the act of sitting. People are working from home more than ever, especially with the recent coronavirus outbreak, forcing people to self-isolate to reduce the spread of the disease. Even before COVID-19, businesses and individuals have increasingly adopted computer-based platforms that increase screen time. Engaging with screens are a large part of life for many and presents a new reality of work life.

What do we know about the origins of lower back pain?

Lower back pain is considered multifaceted with intervertebral disc degeneration (IDD) being the most probable leading cause. IDD is a precursor to many commonly known conditions, with only some of them being disc herniation, spondylosis and lumbar spinal stenosis. 2 A common radiological finding within IDD and the other related spinal conditions are the reduction of spacing between the vertebra. Or, in other words, disc height loss. So how does disc height loss occur?

 

Disc height loss is normal through the day/night cycle. As humans, we lose approximately 20% of the fluid from our discs over the day to regain it at night, when we lie down to sleep. 3 The regaining or recovery of the fluid and respective height is imperative for the health of the disc. If we do not recover the height, this leads to a state of compression and resulting pain. On the flip side, if discs regain too much fluid, this also results in over expansion as we see with astronauts. Problems also incur if one lies in bed for too long.

 

So we need a balance—a balance of compression and decompression to our spines. If there is an excess in either direction, problems can arise. To minimize over-compression, we have to look at our postural behaviours. And one act that we just do too much of is sitting. We know that sitting causes disc compression and height loss as the spine undergoes the movement of flexion. 4. And why does the spine round into that posture? Well, the main reason is because of traditional seat pans 5 which cause the lumbar spine to round and causing increased pressure on the disc. 6

So what is it about sitting that is so different?

If you look carefully at a single motion segment (vertebra-disc-vertebra complex), each vertebra is separated by three joints. The largest and most important anatomical structure in the fight to resist compression is the intervertebral disc, which supports about 80 percent of the load in the standing posture. The remaining 20% load is distributed through the facet joints. Lumbar Model - Intervertebral Disc and FacetsProfessional LxH Dynamic Disc Model

I often describe this using a tricycle as a metaphor. The big tire on the front is like the disc, and the two facet joints are similarly like the two little tires. Sitting will place all the pressure over the big tire on the front of the tricycle, which increases the pressure on it. And over time, because the disc is a hydraulic structure, water will squeeze water out of it, reducing its height.

Neutral Loading

Office Chairs and Lumbar Alignment

To optimize sitting alignment during sitting, researchers have looked at lumbar supports to balance the motion segments of the spine. 7 These groups of researchers asked one question: Which office chair feature is better at improving spine posture in sitting? What they did was evaluate 28 participants, measuring by x-ray postures in four different chair conditions: control, lumbar support, seat pan tilt and backrest with scapular relief. They concluded that not one of the four stood out with regards to improving lumbar flexion, but the angled seat pan did improve pelvic posture significantly. They also discussed how the tilting seat pan did reduce flexion in the lumbar spine and suggesting that this may still be of practical significance. 8

 

Ergonomic Seating from Dynamic Disc Designs Corp.

At Dynamic Disc Designs, we are introducing ergonomic seating. Some may know the CEO, Jerome Fryer BSc DC, who has, from an early start in his career, observed the increasing trend of global sitting. In 1998, he made a simple observation during his training years as a chiropractor. And this simple observation of self-decompression led to two publications in The Journal of Bodywork and Movement Therapies and also The Spine Journal.

With the knowledge gained, he thought it was time to bring it to others.

With an adjustable seat pan and a saddle orientation to keep your hips in a more neutral position, the Ergonomic Saddle – Task Chair will optimize lumbopelvic posture. A 12-degree seat pan tilt is adjustable to each user’s unique lower back.

Seat Pan Angle Adjustability

Adjustable Tilt