Q.I would like your insights on low back pain. I have a manual labor job in which I use my back most of the time. I am not overweight and I am only 42, but I have worked for 23 years and do a lot of repetitive-motion jobs. What is the outlook for this?

G.M.

A.Low back pain is one of the most common problems among the population as a whole, and it is even more common among the manual labor work force. It is believed that about 70 percent of people will develop low back pain at some point during their life. Low back pain is the most common cause of disability in people under age 45. It is estimated that the cost for the treatment of low back pain as well as the disability it causes is in the region of $100 billion annually. About 90 percent of acute low back pain resolves within one month. When a person comes to a doctor with signs of acute lower back injury, a thorough history and physical is warranted, possibly with X-rays. An extensive workup, however, such as a magnetic resonance imaging (MRI), is not needed.

A.There has been some association between low back pain and certain risk factors, including obesity, smoking, heavy labor or heavy lifting, exposure to vibrational stress, excessive sitting and also job dissatisfaction. Degeneration of the discs can be associated with low back pain.

Performing manual labor at age 42 certainly increases the risk of persistent lower back pain. You can control some risk factors, but others are not controllable. For instance, you mention that you are not overweight, which is good. Smoking has clearly been shown to contribute to disc degeneration, and there is an association of lower back pain with smoking. Therefore, I recommend that patients with back pain stop smoking.

A.Unfortunately, in your job as a manual laborer, lifting is part of your everyday work. Some patients like to wear back supports while they work, but this has never been shown to be preventive. Since some patients feel that they get some support and like to wear them, I do not discourage their use. Certainly an exercise program that includes back and abdominal exercises would be helpful. Proper lifting techniques that use the legs can help take some of the stress off the back.

Unfortunately, there is no way to predict the outlook. Clearly, as we age, manual labor becomes more difficult. If you look at the manual labor work force, you can see that the average age is young. As people become older, they are unable to tolerate this stress to the body. Unfortunately, many manual laborers do not have other training, and it is difficult for people in their 40s or 50s to start an entirely new career.

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