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Back Pain in EMS, Part 2

Risks, prevention, and how departments can help.

Upon conclusion of this course, students will be able to:

  • Describe how lifting, posture, and body position can give rise to chronic pain syndromes;
  • Define modifiable associated risk factors for back pain; 
  • Identify specific mitigation and prevention strategies;
  • Understand the role of provider education and how departments can help.

1. Fass B. Reducing EMS Provider Lift Injuries. J Emerg Med Serv, 2017 Oct 1;

2. Vaegter HB, Thinggaard P, Madsen CH, et al. Power of Words: Influence of Preexercise Information on Hypoalgesia after Exercise-Randomized Controlled Trial. Med Sci Sports Exercise, 2020; 52(11): 2,373–9.

3. Dreischarf M, Rohlmann A, Graichen F, et al. In vivo loads on a vertebral body replacement during different lifting techniques. J Biomechanics, 2016; 49(6): 890–5.

4. Dieck GS, Kelsey JL, Goel VK, et al. An epidemiologic study of the relationship between postural asymmetry in the teen years and subsequent back and neck pain. Spine, 1985; 10(10): 872–7.

5. Pope MH, Bevins T, Wilder DG, Frymoyer JW. The relationship between anthropometric, postural, muscular, and mobility characteristics of males ages 18–55. Spine, 1985; 10(7): 644–8.

6. Nourbakhsh MR, Arab AM. Relationship between mechanical factors and incidence of low back pain. J Ortho Sports Phys Ther, 2002; 32(9): 447–60.

7. Wai EK, Roffey DM, Bishop P, et al. Causal assessment of occupational lifting and low back pain: results of a systematic review. Spine J, 2010; 10(6): 554–66.

8. Kwon BK, Roffey DM, Bishop PB, et al. Systematic review: occupational physical activity and low back pain. Occup Med (Lond), 2011; 61(8): 541–8.

9. Ribeiro DC, Aldabe D, Abbott JH, Sole G, Milosavljevic S. Dose-response relationship between work-related cumulative postural exposure and low back pain: a systematic review. Ann Occup Hygiene, 2012; 56(6): 684–96.

10. Martimo K-P, Verbeek J, Karppinen J, et al. Effect of training and lifting equipment for preventing back pain in lifting and handling: systematic review. BMJ, 2008; 336(7,641): 429–31.

11. Armstrong DP, Ferron R, Taylor C, et al. Implementing powered stretcher and load systems was a cost effective intervention to reduce the incidence rates of stretcher related injuries in a paramedic service. Applied Ergonomics, 2017; 62: 34–42.

12. Studnek JR, Crawford JM, Wilkins JR 3rd, Pennell ML. Back problems among emergency medical services professionals: the LEADS health and wellness follow-up study. Am J Industr Med, 2010; 53(1): 12–22.

13. Soteriades ES, Hauser R, Kawachi I, et al. Obesity and risk of job disability in male firefighters. Occup Med (Lond), 2008; 58(4): 245–50.

14. Jahnke SA, Poston WS, Haddock CK, Jitnarin N. Obesity and incident injury among career firefighters in the central United States. Obesity (Silver Spring), 2013; 21(8): 1,505–8.

15. Poston WS, Jitnarin N, Haddock CK, Jahnke SA, Tuley BC. Obesity and injury-related absenteeism in a population-based firefighter cohort. Obesity (Silver Spring), 2011; 19(10): 2,076–81.

16. U.S. Department of Health and Human Services. Physical Activity Guidelines for Americans,

17. Zhang TT, Liu Z, Liu YL, et al. Obesity as a Risk Factor for Low Back Pain: A Meta-Analysis. Clin Spine Surg, 2018; 31(1): 22–7.

18. Shiri R, Karppinen J, Leino-Arjas P, et al. The association between obesity and low back pain: a meta-analysis. Am J Epidem, 2010; 171(2): 135–54.

19. Shiri R, Falah-Hassani K. Does leisure time physical activity protect against low back pain? Systematic review and meta-analysis of 36 prospective cohort studies. Br J Sports Med, 2017; 51(19): 1,410–8.

20. Patterson PD, Suffoletto BP, Kupas DF, et al. Sleep quality and fatigue among prehospital providers. Prehosp Emerg Care, 2010; 14(2): 187–93.

21. Studnek JR, Ferketich A, Crawford JM. On the job illness and injury resulting in lost work time among a national cohort of emergency medical services professionals. Am J Industr Med, 2007; 50(12): 921–31.

22. Studnek JR, Crawford JM. Factors associated with back problems among emergency medical technicians. Am J Indust Med, 2007; 50(6): 464–9.

23. Steffens D, Maher CG, Pereira LSM, et al. Prevention of Low Back Pain: A Systematic Review and Meta-analysis. JAMA Intern Med, 2016; 176(2): 199–208.

24. Foster NE, Anema JR, Cherkin D, et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet, 2018; 391(10,137): 2,368–83.

25. Leffer M, Grizzell T. Implementation of a physician-organized wellness regime (POWR) enforcing the 2007 NFPA standard 1582: injury rate reduction and associated cost savings. J Occup Environ Med, 2010; 52(3): 336–9.

26. Jahnke SA, Poston WS, Haddock CK, Jitnarin N. Injury among a population based sample of career firefighters in the central USA. Inj Prev, 2013; 19(6): 393–8.

27. Brice JH, Cyr JM, Hnat AT, et al. Assessment of Key Health and Wellness Indicators Among North Carolina Emergency Medical Service Providers. Prehosp Emerg Care, 2019 Mar–Apr; 23(2): 179–86.

28. Studnek JR, Bentley M, Crawford JM, Fernandez AR. An assessment of key health indicators among emergency medical services professionals. Prehosp Emerg Care, 2010; 14(1): 14–20.

29. Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of Obesity and Severe Obesity Among Adults: United States, 2017–2018. CDC, NCHS Data Brief No. 360, 2020 Feb;

30. O’Sullivan PB, Caneiro JP, O’Sullivan K, et al. Back to basics: 10 facts every person should know about back pain. Br J Sports Med, 2020; 54(12): 698–9.

31. Law LF, Sluka KA. How does physical activity modulate pain? Pain, 2017; 158(3): 369–70.

32. Kruger J, Yore MM, Bauer DR, Kohl HW. Selected barriers and incentives for worksite health promotion services and policies. Am J Health Prom, 2007; 21(5): 439–47.

33. Sarkar S, Taylor WC, Lai D, et al. Social support for physical activity: Comparison of family, friends, and coworkers. Work, 2016; 55(4): 893–9.

34. Patterson PD. Evidence-Based Guidelines for Combatting Fatigue in EMS. J Emerg Med Serv, 2018 Feb 1;

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