• Darren M Roffey, Eugene K Wai, Paul Bishop, Brian K Kwon, and Simon Dagenais.
• Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
• Spine J. 2010 Jun 1; 10 (6): 544-53.

Background ContextLow back pain (LBP) is a prevalent and expensive musculoskeletal condition that predominantly occurs in working-age individuals of industrialized nations. Although numerous occupational physical activities have been implicated in its etiology, determining the causation of occupational LBP still remains a challenge.PurposeTo conduct a systematic review evaluating the causal relationship between occupational pushing or pulling and LBP.Study DesignSystematic review of the literature.SampleStudies reporting an association between occupational pushing or pulling and LBP.Outcome MeasuresNumerical association between exposure to pushing or pulling and the presence of LBP.MethodsA systematic review was performed to identify, evaluate, and summarize the literature related to establishing a causal relationship, according to Bradford-Hill criteria for causation for occupational pushing or pulling and LBP. A search was conducted using Medline, EMBASE, CINAHL, Cochrane Library, and OSH-ROM, gray literature, hand-searching occupational health journals, reference lists of included studies, and expert knowledge. Methodological quality was assessed using a modified Newcastle-Ottawa Scale.ResultsThis search yielded 2,766 citations. Thirteen studies met the inclusion criteria. Eight were high-quality studies and five were low-quality studies. There was conflicting evidence with one high-quality study demonstrating a positive association between occupational pushing or pulling and LBP and five studies showing no relationship. One study reported a nonstatistically significant dose-response trend, four studies discussed temporality of which one indicated a positive finding, two studies discussed the biological plausibility of a causal link between occupational pushing or pulling and LBP, and no evidence was uncovered to assess the experiment criterion.ConclusionsA qualitative summary of existing studies was not able to find any high-quality studies that fully satisfied any of the Bradford-Hill causation criteria for occupational pushing or pulling and LBP. Based on the evidence reviewed, it is unlikely that occupational pushing or pulling is independently causative of LBP in the populations of workers studied.Copyright 2010 Elsevier Inc. All rights reserved.

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