Skip to main content
Occupational and Environmental Medicine logoLink to Occupational and Environmental Medicine
. 1999 May;56(5):343–353. doi: 10.1136/oem.56.5.343

Interactions between physical and psychosocial risk factors at work increase the risk of back disorders: an epidemiological approach

J J Devereux, P W Buckle, I G Vlachonikolis
PMCID: PMC1757735  PMID: 10472310

Abstract

OBJECTIVES: To investigate the possible interactions between physical and psychosocial risk factors at work that may be associated with self reported back disorders. METHODS: 891 of 1514 manual workers, delivery drivers, technicians, customer services computer operators, and general office staff reported risk factors at work and back disorders with a self administered questionnaire (59% return rate). Of the 869 respondents with a valid questionnaire, 638 workers were classified in to one of four exposure groups: high physical and high psychosocial; high physical and low psychosocial; low physical and high psychosocial; and low physical and low psychosocial. Low physical and low psychosocial was used as an internal reference group. The exposure criteria were derived from existing epidemiological publications and models for physical and psychosocial work factors. The frequency and amplitude of lifting and the duration spent sitting while experiencing vibration were used as physical exposure criteria. Ordinal values of mental demands, job control, and social support from managers and coworkers were used as psychosocial exposure criteria. RESULTS: The highest increase in risk was found in the high physical and high psychosocial exposure group for symptoms of back disorders. In the crude and multivariate analyses, a departure from an additive risk model was found for the 7 day prevalence of symptoms of a low back disorder and also for a recurrent back disorder not present before the current job but also experienced in the past 7 days. CONCLUSION: This study suggests that an interaction between physical and psychosocial risk factors at work may exist to increase the risk of self reported back disorders. Ergonomic prevention strategies that aim to minimise the risks of symptoms of work related back disorders should not only focus on physical but also on psychosocial risk factors at work. The greatest benefits are likely to be realised when both physical and psychosocial factors are put right.

 

Full Text

The Full Text of this article is available as a PDF (176.3 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Armstrong T. J., Buckle P., Fine L. J., Hagberg M., Jonsson B., Kilbom A., Kuorinka I. A., Silverstein B. A., Sjogaard G., Viikari-Juntura E. R. A conceptual model for work-related neck and upper-limb musculoskeletal disorders. Scand J Work Environ Health. 1993 Apr;19(2):73–84. doi: 10.5271/sjweh.1494. [DOI] [PubMed] [Google Scholar]
  2. Bongers P. M., de Winter C. R., Kompier M. A., Hildebrandt V. H. Psychosocial factors at work and musculoskeletal disease. Scand J Work Environ Health. 1993 Oct;19(5):297–312. doi: 10.5271/sjweh.1470. [DOI] [PubMed] [Google Scholar]
  3. Bovenzi M., Zadini A. Self-reported low back symptoms in urban bus drivers exposed to whole-body vibration. Spine (Phila Pa 1976) 1992 Sep;17(9):1048–1059. doi: 10.1097/00007632-199209000-00007. [DOI] [PubMed] [Google Scholar]
  4. Burdorf A., Sorock G. Positive and negative evidence of risk factors for back disorders. Scand J Work Environ Health. 1997 Aug;23(4):243–256. doi: 10.5271/sjweh.217. [DOI] [PubMed] [Google Scholar]
  5. Burton A. K., Tillotson K. M., Symonds T. L., Burke C., Mathewson T. Occupational risk factors for the first-onset and subsequent course of low back trouble. A study of serving police officers. Spine (Phila Pa 1976) 1996 Nov 15;21(22):2612–2620. doi: 10.1097/00007632-199611150-00011. [DOI] [PubMed] [Google Scholar]
  6. Ferguson S. A., Marras W. S. A literature review of low back disorder surveillance measures and risk factors. Clin Biomech (Bristol, Avon) 1997 Jun;12(4):211–226. doi: 10.1016/s0268-0033(96)00073-3. [DOI] [PubMed] [Google Scholar]
  7. Gail M. H. A bibliography and comments on the use of statistical models in epidemiology in the 1980s. Stat Med. 1991 Dec;10(12):1819–1885. doi: 10.1002/sim.4780101204. [DOI] [PubMed] [Google Scholar]
  8. Garg A., Moore J. S. Epidemiology of low-back pain in industry. Occup Med. 1992 Oct-Dec;7(4):593–608. [PubMed] [Google Scholar]
  9. Greenland S. Limitations of the logistic analysis of epidemiologic data. Am J Epidemiol. 1979 Dec;110(6):693–698. doi: 10.1093/oxfordjournals.aje.a112849. [DOI] [PubMed] [Google Scholar]
  10. Guo H. R., Tanaka S., Cameron L. L., Seligman P. J., Behrens V. J., Ger J., Wild D. K., Putz-Anderson V. Back pain among workers in the United States: national estimates and workers at high risk. Am J Ind Med. 1995 Nov;28(5):591–602. doi: 10.1002/ajim.4700280504. [DOI] [PubMed] [Google Scholar]
  11. Hales T. R., Sauter S. L., Peterson M. R., Fine L. J., Putz-Anderson V., Schleifer L. R., Ochs T. T., Bernard B. P. Musculoskeletal disorders among visual display terminal users in a telecommunications company. Ergonomics. 1994 Oct;37(10):1603–1621. doi: 10.1080/00140139408964940. [DOI] [PubMed] [Google Scholar]
  12. Haslegrave C. M. What do we mean by a 'working posture'? Ergonomics. 1994 Apr;37(4):781–799. doi: 10.1080/00140139408963688. [DOI] [PubMed] [Google Scholar]
  13. Heliövaara M., Mäkelä M., Knekt P., Impivaara O., Aromaa A. Determinants of sciatica and low-back pain. Spine (Phila Pa 1976) 1991 Jun;16(6):608–614. doi: 10.1097/00007632-199106000-00002. [DOI] [PubMed] [Google Scholar]
  14. Hildebrandt V. H. Back pain in the working population: prevalence rates in Dutch trades and professions. Ergonomics. 1995 Jun;38(6):1283–1298. doi: 10.1080/00140139508925188. [DOI] [PubMed] [Google Scholar]
  15. Holmström E. B., Lindell J., Moritz U. Low back and neck/shoulder pain in construction workers: occupational workload and psychosocial risk factors. Part 1: Relationship to low back pain. Spine (Phila Pa 1976) 1992 Jun;17(6):663–671. doi: 10.1097/00007632-199206000-00005. [DOI] [PubMed] [Google Scholar]
  16. Houtman I. L., Bongers P. M., Smulders P. G., Kompier M. A. Psychosocial stressors at work and musculoskeletal problems. Scand J Work Environ Health. 1994 Apr;20(2):139–145. doi: 10.5271/sjweh.1419. [DOI] [PubMed] [Google Scholar]
  17. Hughes R. E., Silverstein B. A., Evanoff B. A. Risk factors for work-related musculoskeletal disorders in an aluminum smelter. Am J Ind Med. 1997 Jul;32(1):66–75. doi: 10.1002/(sici)1097-0274(199707)32:1<66::aid-ajim8>3.0.co;2-p. [DOI] [PubMed] [Google Scholar]
  18. Hurrell J. J., Jr, McLaney M. A. Exposure to job stress--a new psychometric instrument. Scand J Work Environ Health. 1988;14 (Suppl 1):27–28. [PubMed] [Google Scholar]
  19. Johanning E. Back disorders and health problems among subway train operators exposed to whole-body vibration. Scand J Work Environ Health. 1991 Dec;17(6):414–419. doi: 10.5271/sjweh.1681. [DOI] [PubMed] [Google Scholar]
  20. Johansson J. A., Rubenowitz S. Risk indicators in the psychosocial and physical work environment for work-related neck, shoulder and low back symptoms: a study among blue- and white-collar workers in eight companies. Scand J Rehabil Med. 1994 Sep;26(3):131–142. [PubMed] [Google Scholar]
  21. Kelsey J. L. An epidemiological study of the relationship between occupations and acute herniated lumbar intervertebral discs. Int J Epidemiol. 1975 Sep;4(3):197–205. doi: 10.1093/ije/4.3.197. [DOI] [PubMed] [Google Scholar]
  22. Kelsey J. L., Githens P. B., White A. A., 3rd, Holford T. R., Walter S. D., O'Connor T., Ostfeld A. M., Weil U., Southwick W. O., Calogero J. A. An epidemiologic study of lifting and twisting on the job and risk for acute prolapsed lumbar intervertebral disc. J Orthop Res. 1984;2(1):61–66. doi: 10.1002/jor.1100020110. [DOI] [PubMed] [Google Scholar]
  23. Kelsey J. L., Hardy R. J. Driving of motor vehicles as a risk factor for acute herniated lumbar intervertebral disc. Am J Epidemiol. 1975 Jul;102(1):63–73. doi: 10.1093/oxfordjournals.aje.a112135. [DOI] [PubMed] [Google Scholar]
  24. Koopman J. S. Interaction between discrete causes. Am J Epidemiol. 1981 Jun;113(6):716–724. doi: 10.1093/oxfordjournals.aje.a113153. [DOI] [PubMed] [Google Scholar]
  25. Krause N., Ragland D. R., Greiner B. A., Fisher J. M., Holman B. L., Selvin S. Physical workload and ergonomic factors associated with prevalence of back and neck pain in urban transit operators. Spine (Phila Pa 1976) 1997 Sep 15;22(18):2117–2127. doi: 10.1097/00007632-199709150-00010. [DOI] [PubMed] [Google Scholar]
  26. Krause N., Ragland D. R., Greiner B. A., Syme S. L., Fisher J. M. Psychosocial job factors associated with back and neck pain in public transit operators. Scand J Work Environ Health. 1997 Jun;23(3):179–186. doi: 10.5271/sjweh.196. [DOI] [PubMed] [Google Scholar]
  27. Leboeuf-Yde C., Lauritsen J. M., Lauritzen T. Why has the search for causes of low back pain largely been nonconclusive? Spine (Phila Pa 1976) 1997 Apr 15;22(8):877–881. doi: 10.1097/00007632-199704150-00010. [DOI] [PubMed] [Google Scholar]
  28. Leino P. I., Berg M. A., Puska P. Is back pain increasing? Results from national surveys in Finland during 1978/9-1992. Scand J Rheumatol. 1994;23(5):269–276. doi: 10.3109/03009749409103728. [DOI] [PubMed] [Google Scholar]
  29. Liira J. P., Shannon H. S., Chambers L. W., Haines T. A. Long-term back problems and physical work exposures in the 1990 Ontario Health Survey. Am J Public Health. 1996 Mar;86(3):382–387. doi: 10.2105/ajph.86.3.382. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Linton S. J., Kamwendo K. Risk factors in the psychosocial work environment for neck and shoulder pain in secretaries. J Occup Med. 1989 Jul;31(7):609–613. doi: 10.1097/00043764-198907000-00012. [DOI] [PubMed] [Google Scholar]
  31. Magnusson M. L., Pope M. H., Wilder D. G., Areskoug B. Are occupational drivers at an increased risk for developing musculoskeletal disorders? Spine (Phila Pa 1976) 1996 Mar 15;21(6):710–717. doi: 10.1097/00007632-199603150-00010. [DOI] [PubMed] [Google Scholar]
  32. Nuwayhid I. A., Stewart W., Johnson J. V. Work activities and the onset of first-time low back pain among New York City fire fighters. Am J Epidemiol. 1993 Mar 1;137(5):539–548. doi: 10.1093/oxfordjournals.aje.a116707. [DOI] [PubMed] [Google Scholar]
  33. Pietri F., Leclerc A., Boitel L., Chastang J. F., Morcet J. F., Blondet M. Low-back pain in commercial travelers. Scand J Work Environ Health. 1992 Feb;18(1):52–58. doi: 10.5271/sjweh.1614. [DOI] [PubMed] [Google Scholar]
  34. Punnett L., Fine L. J., Keyserling W. M., Herrin G. D., Chaffin D. B. Back disorders and nonneutral trunk postures of automobile assembly workers. Scand J Work Environ Health. 1991 Oct;17(5):337–346. doi: 10.5271/sjweh.1700. [DOI] [PubMed] [Google Scholar]
  35. Riihimäki H. Low-back pain, its origin and risk indicators. Scand J Work Environ Health. 1991 Apr;17(2):81–90. [PubMed] [Google Scholar]
  36. Riihimäki H., Viikari-Juntura E., Moneta G., Kuha J., Videman T., Tola S. Incidence of sciatic pain among men in machine operating, dynamic physical work, and sedentary work. A three-year follow-up. Spine (Phila Pa 1976) 1994 Jan 15;19(2):138–142. doi: 10.1097/00007632-199401001-00003. [DOI] [PubMed] [Google Scholar]
  37. Smedley J., Egger P., Cooper C., Coggon D. Prospective cohort study of predictors of incident low back pain in nurses. BMJ. 1997 Apr 26;314(7089):1225–1228. doi: 10.1136/bmj.314.7089.1225. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Sorock G. S., Courtney T. K. Epidemiologic concerns for ergonomists: illustrations from the musculoskeletal disorder literature. Ergonomics. 1996 Apr;39(4):562–578. doi: 10.1080/00140139608964481. [DOI] [PubMed] [Google Scholar]
  39. Stewart P. A., Herrick R. F., Blair A., Checkoway H., Droz P., Fine L., Fischer L., Harris R., Kauppinen T., Saracci R. Highlights of the 1990 Leesburg, Virginia, International Workshop on Retrospective Exposure Assessment for Occupational Epidemiology Studies. Scand J Work Environ Health. 1991 Aug;17(4):281–285. doi: 10.5271/sjweh.1701. [DOI] [PubMed] [Google Scholar]
  40. Stürmer T., Luessenhoop S., Neth A., Soyka M., Karmaus W., Toussaint R., Liebs T. R., Rehder U. Construction work and low back disorder. Preliminary findings of the Hamburg Construction Worker Study. Spine (Phila Pa 1976) 1997 Nov 1;22(21):2558–2563. doi: 10.1097/00007632-199711010-00018. [DOI] [PubMed] [Google Scholar]
  41. Vasseljen O., Jr, Westgaard R. H. Can stress-related shoulder and neck pain develop independently of muscle activity? Pain. 1996 Feb;64(2):221–230. doi: 10.1016/0304-3959(95)00103-4. [DOI] [PubMed] [Google Scholar]
  42. Vasseljen O., Jr, Westgaard R. H., Larsen S. A case-control study of psychological and psychosocial risk factors for shoulder and neck pain at the workplace. Int Arch Occup Environ Health. 1995;66(6):375–382. doi: 10.1007/BF00383143. [DOI] [PubMed] [Google Scholar]
  43. Videman T., Nurminen M., Troup J. D. 1990 Volvo Award in clinical sciences. Lumbar spinal pathology in cadaveric material in relation to history of back pain, occupation, and physical loading. Spine (Phila Pa 1976) 1990 Aug;15(8):728–740. [PubMed] [Google Scholar]
  44. Viikari-Juntura E., Rauas S., Martikainen R., Kuosma E., Riihimäki H., Takala E. P., Saarenmaa K. Validity of self-reported physical work load in epidemiologic studies on musculoskeletal disorders. Scand J Work Environ Health. 1996 Aug;22(4):251–259. doi: 10.5271/sjweh.139. [DOI] [PubMed] [Google Scholar]
  45. Walker A. M. Proportion of disease attributable to the combined effect of two factors. Int J Epidemiol. 1981 Mar;10(1):81–85. doi: 10.1093/ije/10.1.81. [DOI] [PubMed] [Google Scholar]
  46. Walsh K., Varnes N., Osmond C., Styles R., Coggon D. Occupational causes of low-back pain. Scand J Work Environ Health. 1989 Feb;15(1):54–59. doi: 10.5271/sjweh.1891. [DOI] [PubMed] [Google Scholar]
  47. Wiktorin C., Hjelm E. W., Winkel J., Köster M. Reproducibility of a questionnaire for assessment of physical load during work and leisure time. Stockholm MUSIC I Study Group. MUSculoskeletal Intervention Center. J Occup Environ Med. 1996 Feb;38(2):190–201. doi: 10.1097/00043764-199602000-00017. [DOI] [PubMed] [Google Scholar]
  48. Wiktorin C., Karlqvist L., Winkel J. Validity of self-reported exposures to work postures and manual materials handling. Stockholm MUSIC I Study Group. Scand J Work Environ Health. 1993 Jun;19(3):208–214. doi: 10.5271/sjweh.1481. [DOI] [PubMed] [Google Scholar]
  49. Wilder D. G. The biomechanics of vibration and low back pain. Am J Ind Med. 1993 Apr;23(4):577–588. doi: 10.1002/ajim.4700230406. [DOI] [PubMed] [Google Scholar]

Articles from Occupational and Environmental Medicine are provided here courtesy of BMJ Publishing Group

RESOURCES