Saskia Baltrusch

8 Chapter 1 General Introduction “[…] what I notice is that there is an increase of people with low-back pain despite the technological developments that are happening. It seems to only get worse instead of better.” (Physiotherapist at Rehabilitation Centre Heliomare in the Netherlands) Low-back pain is the number one cause of disability in the world [1]. With a lifetime prevalence between 75-84% [2], it represents a high socioeconomic burden. The Netherlands spends more than 3 billion euros on low-back pain each year, with a ratio of 12% to 88% between direct costs, such as medical care, and indirect costs, such as production loss and disability costs [3]. Thus, low-back pain causes a considerable burden on industry, involving negative consequences for companies and the individual employee [4,5]. A variety of factors is believed to contribute to the onset of low-back pain [6], including biomechanical, psychosocial and personal factors [7,8]. Researchers have, for many years, tried to understand the underlying mechanisms of this multifaceted disorder. With no clear pathological cause established in almost 90 % of the cases [9], current treatment is not very successful. Therefore, the prevalence of low-back pain has not decreased despite the increased awareness of its burden on society and the individual. The challenge of reducing occupational risk factors in practice A systematic review has found that high level occupational physical activity has an 18% increased risk of early mortality for men [10]. This already indicates the detrimental health consequences associated with physical labor. Physically demanding jobs that require heavy lifting, trunk rotations or working in awkward postures for a longer period of time have been shown to lead to high back loading. This might sooner or later result in low-back injury and pain [7, 11- 13]. Being aware of the occupational risk factors and the increased need to prevent work-related low-back pain, companies strive to introduce preventive strategies in their work environment. Research has focused on different ways of adapting work environments to reduce mechanical risk factors. For example,