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To the Editor: We believe that the Commentary on back pain in the workplace by Dr Hadler and colleagues poorly serves clinicians, patients with low back pain, and occupational health and safety professionals seeking to reduce the burden of low back pain among working people.¹ The authors argue that low back pain does not occur as a consequence of occupational physical demands (eg, lifting, twisting of the trunk, whole body vibration) but rather as a result of the "psychosocial context" of work and other phenomena. They claim that "extensive and compelling science" supports their opinions but cite only 2 published reviews and a few additional studies in support of their inference.

We consider it unfortunate that the authors did not cite any of the large international studies in which clinically and statistically significant associations were observed between occupational physical demands and low back pain after adjustment for confounders.^2-3 Also missing . . . [Full Text of this Article]

Arun Garg, PhD
Center for Ergonomics
University of Wisconsin
Milwaukee

Fred Gerr, MD
fred-gerr@uiowa.edu
Department of Occupational and Environmental Health
University of Iowa
Iowa City

Jeffrey N. Katz, MD, MSc
Division of Rheumatology, Immunology and Allergy
Brigham and Women's Hospital
Boston, Massachusetts

William S. Marras, PhD
Biodynamics Laboratory
The Ohio State University
Columbus

Barbara Silverstein, PhD, RN
Safety & Health Assessment & Research for Prevention Program
Washington State Department of Labor and Industries
Olympia

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