Occupational Medicine Advance Access originally published online on June 16, 2006
Occupational Medicine 2006 56(7):494-496; doi:10.1093/occmed/kql045
© The Author 2006. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Effects of driving on low back pain
Toshihiko Sakakibara,
Yuichi Kasai and
Atsumasa Uchida
Mie University Faculty of Medicine, Department of Orthopaedic Surgery, 174 2-chome Edobashi, Tsu-shi, Mie, 514-8507, Japan
Correspondence to: Toshihiko Sakakibara, Murase Hospital–Orthopaedic Surgery, 12-10, 3 Kanbe Suzuka Mie 513-0801. Tel: +81-593-82-0330; fax: +81-593-82-8562; e-mail: sakakitoshi{at}mac.com
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Abstract
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Background Many previous studies have demonstrated that driving
a car is a risk factor for low back pain (LBP). We have frequent
contact with medical representatives who often drive cars for
business, and have noticed that many of them suffer from LBP.
Aims To investigate how driving affected the occurrence of LBP in medical representatives.
Methods Questionnaire survey of all medical representatives working in Mie Prefecture (Japan).
Results A total of 551 medical representatives replied (92%). We divided the subjects into Group A (with LBP) and Group B (without LBP). There was no significant difference in mean age, height, weight or duration of continuous employment between the two groups. Mean total mileage was 342 539 km in Group A and 251 945 km in Group B (P < 0.05). There was no significant difference in estimated daily mileage or estimated daily driving time between the two groups. As for backrest inclination, most of the respondents in Group A chose 105° and the majority in Group B chose 120° (P < 0.001).
Conclusion The total mileage was significantly higher in Group A than in Group B. We considered that the risk for LBP increased as the lumbar spine load accumulated day by day while driving a car almost every day without a holiday.
Keywords Driving; low back pain; occupational; seating
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Introduction
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We have frequent contact with medical representatives who often
drive cars for business, and have noticed that many of them
suffer from low back pain (LBP). The purpose of this study was
to investigate how driving affected the occurrence of LBP in
medical representatives by means of a questionnaire survey.
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Methods
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We sent a questionnaire to all medical representatives working
in Mie Prefecture (Japan).
Table 1 shows the contents of the
questionnaire. We divided the subjects into two groups. Group
A (with LBP) consisted of subjects who had LBP at the time of
the survey, and who replied that the LBP was exacerbated by
driving. Those who had LBP before joining the company were not
included in this group. Group B (without LBP) consisted of subjects
who had no LBP at the time of the survey; those who had had
LBP in the past were excluded.
We compared answers to questions (6)–(17) between Groups
A and B. In Group A, we also reviewed the relationship between
driving exposure data and the severity of pain. For statistical
analysis, we used Student's
t-test, chi-square test and the
Mann–Whitney test. A
P value of <0.05 was considered
to indicate statistical significance.
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Results
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A total of 551 medical representatives replied giving a response
rate of 92%. The mean age of the respondents was 35.7 years
(range 22–58 years). There were 530 men and 21 women.
Of the 551 respondents, 290 (53%) had LBP and 261 (47%) did
not at the time of the survey. Of the 290 respondents with LBP,
219 (76%) had mild, 70 (24%) had moderate and 1 (0.3%) had severe
pain. Eighty-four (29%) had LBP before joining the company.
A total of 225 (78%) including 68 respondents who had LBP before
joining the company replied that the pain was exacerbated by
driving. Among the 261 respondents who had no LBP at the time
of the survey, 27 (10%) had had LBP in the past. Thus, in the
end, Group A consisted of 157 subjects (125: mild pain, 31:
moderate pain, 1: severe pain) and Group B of 234. There was
no significant difference in mean age, height, weight or duration
of continuous employment between the two groups. Mean total
mileage was 342 539 km in Group A and 251 945 km in Group B
(
P < 0.05). There was no significant difference in estimated
daily mileage or estimated daily driving time between the two
groups. As for backrest inclination, most of the respondents
in Group A chose 105° and the majority in Group B chose
120° (
P < 0.001). There were no significant differences
between the two groups in the type of road most frequently used,
sitting position, angle of knee flexion or transmission type
(
Table 2). There was no significant relationship between driving
data and the severity of LBP.
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Discussion
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In this study, we found that the total driving distance was
significantly higher in representatives with LBP than in those
without LBP. However, there was no significant difference in
estimated daily driving distance, estimated daily driving time
or duration of continuous employment between the two groups.
One explanation therefore is that respondents with LBP drove
a car for business almost every day without a holiday and thus
accumulated a greater lumbar spine load than respondents without
LBP who were not driving every day.
We also found a significant difference between the two groups in terms of their backrest inclination: 105° in respondents with LBP against 120° in respondents without LBP. We were unable to clarify whether LBP occurred because the backrest inclination was 105° or that the most comfortable angle was 105° when the respondents with LBP drove a car.
Although it was suggested that the type of road most frequently used, sitting position, angle of knee flexion or transmission type influenced the occurrence of LBP, we found no significant relationship between LBP and these factors in the present study. We found there was no significant relationship between driving data and the severity of LBP, probably because the number of subjects was too small to detect that relationship.
Many previous studies have demonstrated that driving is a risk factor for LBP [1–6]. Walsh et al. [7] reported that driving for >4 h/day was associated with LBP. Porter et al. [8] reported that the number of days absent due to LBP for high annual mileage drivers was greater than that for low annual mileage drivers.
There were some limitations in our study. Because it was cross-sectional, we would need to perform a prospective and longitudinal study to clarify the hypothesis drawn from it. We also used figures showing backrest inclination, angle of knee flexion and sitting position, but this form of assessment has not been validated. Furthermore, besides driving a car, smoking, sports, job satisfaction and psychological state have also been mentioned as risk factors for LBP [9,10]. We plan to perform a study considering these factors in the near future.
In conclusion, our study suggests that the taking of rest days from driving may be important in vocational drivers to prevent accumulation of lumbar spine load and the development of LBP. The relevance of seat angle in the development of LBP requires further investigation.
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Conflicts of interest
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None declared.
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References
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Abstract
Introduction