Skip to main content
Open Access Publications from the University of California


UCLA Electronic Theses and Dissertations bannerUCLA

Workplace Intervention to Reduce Back Pain Through the Control of Early Morning Flexion


The goal of this research was to test the hypothesis that a brief workplace training session on control of early morning flexion (bending – and other spine-loading activities) can significantly reduce back pain incidence, claims, disability and the associated costs. Back pain is the leading cost driver for workers’ compensation claims, globally the leading cause of days lived with disability, and one of the leading reasons people seek medical care outside of workers’ compensation. Diagnostic methods, including imaging, have not proven to result in improved outcomes. Treatments by health care professionals, regardless of specialty, have been shown to be equally effective, and comparable to education-only results. In this context, self-care approaches have garnered attention. One such approach that has shown promise for chronic low back pain sufferers is the control of early morning flexion. The current study tested this intervention in a workplace setting through a training session to control spine-loading activities within the first two hours of rising from sleep in a prospective cluster-randomized partial cross-over controlled intervention. 157 of 290 eligible university custodial services workers’ completed a baseline questionnaire and were randomly assigned (by supervisor group) into treatment and sham groups then given either treatment (bending) or sham training (lifting technique training known to have no significant impact on back pain). The questionnaire contained demographic, back pain history, workplace, activity, and exercise questions. After one year, the questionnaire was completed again and all subjects were then given the treatment training. After one more year, the questionnaire was completed again. Analysis of the baseline data revealed that when time between rising from sleep and leaving for work were less than two hours, LBP risk increased by 119%, and sciatica risk increased 152%. Bending, sitting, and lifting (objects over 10 pounds) during the first two hours after rising performed “Nearly All the Time” were associated with a 47-fold increased risk of very severe pain and 39 more days with LBP within a 6-month period. Moderate exercise after waking appeared to be somewhat protective. Mixed effects analyses with corresponding predicted values were used to assess the impact of the intervention prospectively. A pattern of greater reduction in odds and incident rate ratios for most back pain measures was observed for the treatment training as well as for the treatment. The greatest decreases for treatment training were for total days of back pain (50% reduction of incident rate ratio) and medication use for back pain (47% reduced odds). Workers should limit spine-loading activities within the first two hours after waking, although exercise may be helpful. Employers should avoid scheduling spine-loading tasks such as sitting, bending, or lifting at the beginning of work shifts. Clinicians may recommend to limit spine-loading activities within two hours after waking from sleep both at home and at work.

Main Content
For improved accessibility of PDF content, download the file to your device.
Current View