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Back pain and driving

I was recently asked, on twitter , the question , “Is it bad for your back to be sitting and driving for long periods?”  As I recall, this question was asked by someone who commutes for about two hours each day (one hour each way).  When I started searching for information on this subject most of the research was on truck drivers, bus drivers or farmers.  The research most often was centered around sitting and whole body vibration while driving.

Here is what I learned from my research. You can read the abstracts at the end of the post.

  • Vibration produced while driving affects the spine by exciting a 4-6-Hz resonance on the lower back. The motor nerves in the lower back fire causing muscle contraction and ultimately fatigue. This leads to greater stress on the spine and intervertebral discs.
  • Sitting alone is not associated with risk of developing lower back pain
  • Sitting along with the exposure of whole body vibration and awkward sitting increased the risk of lower back pain four fold.
  • Helicopter pilots are the greatest risk for lower back pain.
  • Awkward posture is independently associated with the presence of lower back pain and/or sciatica
  • Sitting for more than half a workday, in combination with WBV and/or awkward postures, does increase the likelihood of having LBP and/or sciatica, and it is the combination of those risk factors, which leads to the greatest increase in LBP.
  • A constrained, seated posture, in combination with exposure to whole-body, jolt/vibration can impose significant stresses on the posterior intervertebral disc and can lead to back muscle fatigue.
  • Of the seven reports, one showed increased frequency of lumbar prolapse in occupational drivers, and six showed low back pain to be more frequent in whole-body vibration-exposed groups. Only two out of the four articles reporting on dose, showed a dose-response association.
  •  One study that looked are more than just driving and found the following: Lower back pain is associated with  poor mental health and belief in work as a causal factor for low-back pain, and with occupational sitting for > or =3 hours while not driving. Associations were also found for taller stature, consulting propensity, body mass index, smoking history, fear-avoidance beliefs, frequent twisting, low decision latitude, and low support at work. They found little evidence of vibration being a factor.
  • Strong evidence exists for manual materials handling, bending and twisting, and whole-body vibration as risk factors for back pain.

 Conclusion

What I learned from this research is that no matter how strong or in shape we are our spine is at risk when driving.  It is even worse off if you are sitting with poor posture and if there are long exposure to whole body vibration.  In addition, these are not the only factors. There are also psychosocial factors that also influence the likelihood of having a back pain.  So if you sit with poor posture, drive for long hours daily, have poor mental health, smoke, are over weight, and you are tall you have an increased chance of having back pain because of driving.

So how can you prevent this? A few thoughts that pop into my mind as I read the research are as follows:

  • Sit with good posture.
  • Use a back support  to aide in maintaining good posture
  • Get out frequently to stretch your back. This may not be possible in all situations
  • Eat well, exercise, manage your weight and don’t smoke
  • Drive a vehicle with functioning suspension seating

I hope you found this interesting

If you have any questions feel free and contact me

Dr Notley

Winnipeg’s only dual credentialed Chiropractor and Athletic Therapist

Abstracts

Eur Spine J. 2007 Feb;16(2):283-98. Epub 2006 May 31.
Lis AM, Black KM, Korn H, Nordin M.

Abstract

Low back pain (LBP) has been identified as one of the most costly disorders among the worldwide working population. Sitting has been associated with risk of developing LBP. The purpose of this literature review is to assemble and describe evidence of research on the association between sitting and the presence of LBP. The systematic literature review was restricted to those occupations that require sitting for more than half of working time and where workers have physical co-exposure factors such as whole body vibration (WBV) and/or awkward postures. Twenty-five studies were carefully selected and critically reviewed, and a model was developed to describe the relationships between these factors. Sitting alone was not associated with the risk of developing LBP. However, when the co-exposure factors of WBV and awkward postures were added to the analysis, the risk of LBP increased fourfold. The occupational group that showed the strongest association with LBP was Helicopter Pilots (OR=9.0, 90% CI 4.9-16.4). For all studied occupations, the odds ratio (OR) increased when WBV and/or awkward postures were analyzed as co-exposure factors. WBV while sitting was also independently associated with non-specific LBP and sciatica. Vibration dose, as well as vibration magnitude and duration of exposure, were associated with LBP in all occupations. Exposure duration was associated with LBP to a greater extent than vibration magnitude. However, for the presence of sciatica, this difference was not found. Awkward posture was also independently associated with the presence of LBP and/or sciatica. The risk effect of prolonged sitting increased significantly when the factors of WBV and awkward postures were combined. Sitting by itself does not increase the risk of LBP. However, sitting for more than half a workday, in combination with WBV and/or awkward postures, does increase the likelihood of having LBP and/or sciatica, and it is the combination of those risk factors, which leads to the greatest increase in LBP.

Vibration of the spine and low back pain.
Clin Orthop Relat Res. 1992 Jun;(279):49-59.
Pope MH, Hansson TH.
Abstract

There are now many studies suggesting a positive relationship between both low back pain and spinal degeneration and exposure to whole body vibration. Such relationships appear to be particularly marked in drivers of tractors, earth-moving equipment, and trucks. There is a tendency toward a greater incidence of complaints as exposure increases. Vibration affects the spine by exciting a 4-6-Hz resonance that is related to the biologic “soft spring” between S-1 and the seat. The muscle nerves fire sequentially under vibration and fatigue. In animals, vibration exposure leads to pronounced creep, increased disk pressure, and changes in the levels of neuropeptides in the dorsal root ganglia.

Semin Perinatol. 1996 Feb;20(1):54-60.Wilder DG, Pope MH, Magnusson M.
Abstract

The risk of experiencing low back pain is associated with mechanical factors. Anatomic factors, such as advancing pregnancy, can also place extra mechanical stress on the lower back. Mechanical factors, such as those related to the workplace, can be minimized by ergonomic interventions. A constrained, seated posture, in combination with exposure to whole-body, jolt/vibration can impose significant stresses on the posterior intervertebral disc and can lead to back muscle fatigue. Interventions that reduce the jolt/vibration magnitude and duration of exposure will decrease the mechanical work performed on the intervertebral disc. Such interventions range from jolt/vibration isolating seats and vehicle cabs, to decreasing exposure time and maintaining simple supported postures during ingress and egress. Improvements in seat configuration can reduce the intervertebral disc pressure and the strain on the posterior disc.

Palmer KT, Harris CE, Griffin MJ, Bennett J, Reading I, Sampson M, Coggon D.Scan J Work Environ Health 2008 Oct;34(5):364-73. Epub 2008 Oct 14.
Scand J Work Environ Health. 2009 Jan;35(1):80. Harris, E Claire [corrected to Harris, E Clare].

Abstract

RESULTS:
Strong associations were found with poor mental health and belief in work as a causal factor for low-back pain, and with occupational sitting for > or =3 hours while not driving. Associations were also found for taller stature, consulting propensity, body mass index, smoking history, fear-avoidance beliefs, frequent twisting, low decision latitude, and low support at work. However, the associations with the six metrics of whole-body vibration were weak and not statistically significant, and no exposure-response relationships were found.
CONCLUSIONS:
Little evidence of a risk from professional driving or whole-body vibration was found. Drivers were substantially less heavily exposed to whole-body vibration than in some earlier surveys. Nonetheless, it seems that, at the population level, whole-body vibration is not an important cause of low-back pain among those referred for MRI.

Lings S, Leboeuf-Yde C. Int Arch Occup Environ Health. 2000 Jul;73(5):290-7.

Abstract

RESULTS:
Twenty-four original articles concerning the association between whole-body vibrations and the lower back were retained for use. The quality of the papers was mostly low, but improved with time. Only seven articles passed our predetermined quality criteria. Of the seven reports, one showed increased frequency of lumbar prolapse in occupational drivers, and six showed low back pain to be more frequent in whole-body vibration-exposed groups. Only two out of the four articles reporting on dose, showed a dose-response association.
CONCLUSIONS:
Despite the lack of definite evidence, we found sufficient reasons for the reduction of whole-body vibration-exposure to the lowest possible level. If new knowledge is to be produced, good prospective studies with repeated measurements of exposure, analyses of work postures, and clear definitions and subgroupings of low back pain are needed. Other research in this field should be given up, and the resources used for more important issues, as the size of the problem of whole body vibration is probably on the decrease because of the technical prophylactic developments that are already in progress.

Med Pr. 2011;62(2):187-202.
[Article in Polish] Solecki L.

Abstract
A literature review was performed for the years 1990-2007. It covered reports addressing the problems associated with the prevalence of low back pain and musculoskeletal disorders among farmers. In addition, the anticipated relationship between low back pain and whole body vibration in farmers was evaluated based on 12 reports for the years 1987-2009. The review confirmed that the prevalence of back pain is significantly higher in farmers exposed to whole body vibration than in the control group (not exposed to vibration). The frequency of back pain is related with whole body vibration, as well as with prolonged sitting position, wrong body posture and physical work load (especially lifting and carrying loads). The prevalence of these symptoms increases with the increased vibration dose and duration of exposure. Disorders in the lower section of the spine were associated with age, accidents (concerning the back), cumulative dose of whole body vibration, and overload due to wrong body posture. Long-term exposure affecting the whole body is harmful to the skeletal system (degeneration of the spine). The results of the study suggest that the repeated or constant exposure to mechanical shocks may increase the risk of low back pain. The investigations confirmed that there is a dose-response type of relationship between exposure to whole body vibration and pain in the lumbar section of the spine.

Semin Perinatol. 1996 Feb;20(1):38-53. Bovenzi M.

Abstract
Occupational exposure to whole-body vibration (WBV) and postural stress in a driving environment may contribute to an increased risk for low back pain (LBP) disorders. In two epidemiological studies of bus drivers and tractor drivers, LBP disorders were found to be associated with age, back accidents, cumulative WBV dose, and postural overload. A review of the literature showed that the exposure-response relationship for WBV and injuries to the lower back is not fully clarified. There is a shortage of information on the health risk from WBV in female workers. Because it is estimated that several thousand women are exposed to intense WBV in the workplace, the health effects of WBV on female reproductive organs and vertebral column should be carefully investigated.

Ugeskr Laeger. 1998 Jul 13;160(29):4298-301. [Article in Danish] Lings S, Leboeuf-Yde C.

Abstract
Whether exposure to whole body vibration (WBV) in transport vehicles and moving machinery constitutes a health risk is unclear. The literature on this subject is vast, but most is of limited scientific value. A recent review covering the literature up to 1992 has been used as a basis for a further search concerning the period 1992-1996. Fifty-three articles were found: 14 epidemiological studies, 15 human laboratory experiments, four animal experiments, seven field studies and 13 reviews. Almost all epidemiological studies yielded insufficient information and had methodological shortcomings. Of the reviews, only three were critical. Experimental data support the hypothesis that WBV can have a negative effect on the spine. Epidemiological studies have shown drivers to have an increased prevalence of low back pain, probably in a dose-related fashion. Hence, it is likely that long-term exposure to WBV can contribute to back disorders. Present studies do not allow for a quantitative specification of the association between exposure and effect.

Scand J Work Environ Health. 1999 Oct;25(5):387-403.
Hoogendoorn WE, van Poppel MN, Bongers PM, Koes BW, Bouter LM.

Abstract
This systematic review assessed aspects of physical load during work and leisure time as risk factors for back pain. Several reviews on this topic are available, but this one is based on a strict systematic approach to identify and summarize the evidence, comparable with that applied in the clinical literature on the efficacy of intervention for back pain. A computerized bibliographical search was made of several data bases for studies with a cohort or case-referent design. Cross-sectional studies were excluded. A rating system was used to assess the strength of the evidence, based on the methodological quality of 28 cohort and 3 case-referent studies and the consistency of the findings. Strong evidence exists for manual materials handling, bending and twisting, and whole-body vibration as risk factors for back pain. The evidence was moderate for patient handling and heavy physical work, and no evidence was found for standing or walking, sitting, sports, and total leisure-time physical activity.

Originally posted 2011-10-24 16:00:00.